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Brief report o
<br /> n
<br /> rates between the African American and general populations(0.66) (over 1980-2018) of the corresponding population referred to n
<br /> reported in ref 15.Then,using the menthol cessation multiplier for on each row, relative to the entire US population. For example, o
<br /> African Americans estimated by Mills et a116 (0.47, 95% Cl 0.24 the table shows that, among African Americans, menthol was =*
<br /> to 0.91) and the proportion of menthol smokers among current responsible for 1.5 million extra smokers, 157 000 smoking-
<br /> African American smokers, we applied the same process used in related premature deaths and 1.5 million excess life-years lost �
<br /> ref 10 to compute the cessation rates for African American non- during 1980-2018, representing 15%, 41% and 50% of the 6
<br /> menthol and menthol smokers.The specific formulation and cessa- total menthol toll, respectively. However, during the sameCD
<br /> tion values for 1980 are shown in the Supplement to ref 10 and period,African Americans constituted only around 12% of the Q
<br /> v
<br /> online supplemental tables A2 and A3. overall US population. v'
<br /> The annual adult smoking initiation rates for African Amer- The last row of the table shows a hypothetical African Amer-
<br /> icans were computed by taking the average NHIS smoking ican population that exhibits the same menthol smoking-related
<br /> w
<br /> prevalence among 18-24 year-olds, consistent with ref 10. The parameters as the general population.We simulated this scenario
<br /> switching rates between menthol and non-menthol smokers were by setting the values of menthol-affected parameters for the 6
<br /> calculated as in the 2011 menthol report17 (2.29%switching to African American population to those of the general popula-
<br /> menthol and 1.08% to non-menthol cigarettes). An extensive tion. In this hypothetical group,the estimated menthol smoking o
<br /> sensitivity analysis (see online supplemental table A4) showed excess initiation, premature deaths and life-years lost would 0
<br /> that these parameters exert little influence on the results. The have represented 13%, 16% and 21% of the overall menthol o
<br /> ratio of yields from experimenter to smoker is 19 and menthol harm, respectively; much more in agreement with the propor- CD
<br /> ry
<br /> mortality multiplier for the African American population remains tional(relative to the entire US)size of this population(12%).It r2
<br /> as in the Le-Mendez work,10 following their same arguments. is worth noting,though,that the menthol death toll in the low- o
<br /> As in ref 10, we first used NHIS smoking prevalence data over menthol population is still above its proportional share. This is M
<br /> 1980-2018 (when the NHIS survey was conducted) to calibrate due to the mortality rates among African American smokers, �
<br /> the model.Then,we used the calibrated model to replicate African g g population. 00
<br /> P which are hi her than in the general o
<br /> Americans' smoking prevalence trajectory during 1980-2018. n
<br /> Finally,to quantify the harmful effect of menthol use on the African 8
<br /> American population,we repeated the previous step to generate an DISCUSSION m
<br /> alternative smoking trajectory for African Americans duringthesame Since the 1960s, the tobacco industry has targeted the African m
<br /> period,eliminating the effect of menthol since 1980. We achieved American community for the consumption of menthol cigarettes 3
<br /> this by adjusting the smoking initiation and cessation rates to elimi- through aggressive marketing, including intense advertising m
<br /> nate the effect of menthol on those parameters(see the Appendices and price discounts. Simultaneously, the industry supported No
<br /> to the 2011 TPSAC Menthol Report17 and the Le-Mendez paper10). numerous African American organisations to gain the trust of the o
<br /> Finally, we compared our results from both scenarios (with and African American community. Several publications 9 describe -,O< p
<br /> without menthol cigarettes)to calculate the impact of menthol on the marketing efforts by the tobacco industry to establish a o
<br /> smoking prevalence, life-years lost and smoking-related premature special connection between menthol cigarettes and the African o
<br /> deaths. Additionally, we compared our results with those for the American community. In a fascinating article entitled `The a
<br /> general population reported in Le-Mendez's work10 and calculated African Americanization of menthol cigarette use in the United a
<br /> the disproportionate harm inflicted on the African American popu- States',3 Gardiner recounts the long history of, and explains the o
<br /> lation due to menthol. facts behind, the relationship between African Americans and 3
<br /> menthol cigarettes, and how those products became an inte-
<br /> RESULTS gral part of the African American culture. In essence, the iden-
<br /> The simulated smoking prevalence for African Americans closely tification of African American smokers with menthol has been
<br /> 07
<br /> captures the NHIS reported smoking prevalence over 1980-2018 purposely orchestrated by the tobacco industry following their
<br /> with pseudo-W=0.95 (pseudo-W=1—[Errors Sum of Squares]+ goal of maximising their profits. o
<br /> Total Sum of Squares])(see online supplemental figure Al and A2). Unfortunately, this marketing strategy turned out to be a o
<br /> Table 1 shows the harm attributable to menthol cigarettes for the huge success for the tobacco industry, but deadly for the black o
<br /> general population (from Le-Mendez's work10),the African Amer- community. Besides creating a brand with which African Ameri- s
<br /> ican population and the hypothetical low-menthol African Amer- cans could identify and call their own,the industry exposed this 3.
<br /> ican population. A complete sensitivity analysis on the values in population to a substance that amplifies the damaging effects of o
<br /> table 1 is presented in online supplemental table A4. cigarette smoking. Menthol intensifies this harm by increasing 3
<br /> The values in the first three columns of the table are self- the chances that individuals transition from experimentation
<br /> explanatory;the numbers within parentheses show the percent- to regular smoking,is 19 and b increasing dependency, which m
<br /> P' P g g� Y g
<br /> ages that those values represent,relative to those for the general leads to delayed cessation.16 These effects increase the number of
<br /> CD
<br /> population. The last column shows the average proportion smokers and the amount of time they remain smoking.
<br /> m
<br /> N
<br /> Table 1 Excess smoking initiation,smoking-related deaths and life-years lost due to menthol cigarettes over 1980-2018 for the adult general, o
<br /> African American and hypothetical low-menthol African American population N
<br /> Cumulative excess smoking Cumulative excess life-years Average percentage of v
<br /> initiators(%) Cumulative excess deaths(%) lost(%) population(%) C
<br /> General population 10137808(100) 377528(100) 2 951 533(100) 100 n
<br /> W
<br /> African American population 1 508913(15) 156471 (41) 1476198(50) 12
<br /> Hypothetical low-menthol 1 286848(13) 61 132(16) 606840(21) 12 p
<br /> African American population m
<br /> m
<br /> 2 Mendez D,Le TTT Tob Control2021;0:1-3.doi:10.1136/tobaccocontrol-2021-056748 °-
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