III. Being a Black Smoker
The marketing, advertising and promotional blitz has had its effect. A greater percentage of African-American adults are smokers. This is particularly true for men. In 1987, 30.7% of white men twenty years and older were smokers, while 40.3% of African-American men were smokers. The smoking rate between black women and white women was essentially the same, with 27.3% of white American women twenty years and older being smokers and 27.9% of African-American women. However, African-American smokers smoke approximately 35% fewer cigarettes per day than do white smokers. Nevertheless, African-Americans have higher rates of most smoking-related diseases. This may be a result of the fact that *687 African-Americans smoke disproportionately more mentholated cigarettes. Eighty percent of African-American smokers smoke mentholated cigarettes while only 25% of white smokers smoke mentholated cigarettes. This use of menthol is associated with increased health risks and has resulted in significantly poorer health status for African-Americans.
A. The African-American Smoker
African-Americans start smoking later than white Americans. Since 1970 the prevalence of smoking among African-American adolescents (especially teenage girls) has declined. However, even though African-Americans are strongly motivated to quit smoking, fewer African-Americans than white Americans are able to do so. Furthermore, African-Americans are less likely to abstain for over a year. Consequently, African-Americans are more likely to be long-term smokers.
*688 In addition, African-American smokers are not heavy smokers. In fact, the average adult, African-American smoker smokes significantly fewer cigarettes than the average white adult smoker. However, despite the fact that African-Americans start later in life and smoke fewer cigarettes, they show high levels of nicotine dependence. It is puzzling that African-Americans have more illness even though they start smoking later in life and smoke fewer cigarettes. Part of the reason for this lies in the African-American preference for mentholated brands which are high in tar and nicotine. Although menthol is a naturally occurring alcohol, most of the menthol currently used is synthetic. Menthol is used in a number of commercial products such as toothpaste, mouthwash, and foods. It is considered not directly carcinogenic and is rated generally regarded as safe by the Food and Drug Administration. About 75% to 90% of African-Americans report a preference for menthol compared to only 23% to 25% of white Americans. This menthol brand preference is not related to educational level, occupational class, or age. Not only do menthol *689 cigarettes tend to be higher than nonmenthol cigarettes in tar and nicotine, but they may also have their own independent effect on addiction and dependency, which has not been adequately studied.
Only two studies to date have directly addressed the relationship between smoking mentholated cigarettes and the increased cancer risk in African-Americans. The studies made opposite conclusions, leaving unanswered the question of whether menthol explains the black-white lung cancer difference. Furthermore, no study has been made into the addictive and dependency power of menthol combined with nicotine. Simple logic says that African-Americans who smoke mostly mentholated cigarette may be trying to kick two habits--nicotine and menthol. While simple logic may be wrong, no settlement should be made until the answer to the question is proven through biomedical research.
This lethal preference for menthol brands by African-American smokers is shaped by targeted advertising campaigns by the tobacco industry, which advertises these brands in culturally specific magazines and on billboards in predominantly African-American neighborhoods. In fact, the success of menthol brands are almost entirely tied to the African-American market. Menthol cigarettes were introduced in the 1930s, but did not exceed 3% of the total market until 1949. In the 1960s, advertising for menthol cigarettes began appearing in Ebony, an African-American-oriented magazine. By 1963 the market share was 16%, and by 1976 it was 28%. Sales to African-Americans accounted for the vast majority of this increase. It is clear that the tobacco company targeted the African-American community, but they pushed on them a drugged, enhanced version (menthol) which is more addicting and more deadly.
B. African-American Health Status
The fact that African-Americans are sicker and are dying at a higher rate than European-Americans is not news. African-Americans have more illnesses, have lower survival rates, and die at greater rates than white Americans. The excess death rates for African-Americans have exceeded those for white Americans for every major chronic condition except chronic obstructive pulmonary disease. That is, for every 100,000 persons, 511 white persons die from major chronic illnesses while 779 *690 black persons die. Thus, there were 268 black persons who would not have died from major chronic illness if they had been white. In fact, before the age of sixty-five, African-American smokers lose twice as many years of potential life as white smokers. Quite literally, being a black smoker is more dangerous to your health than being a white smoker.
Table 1
TABULAR OR GRAPHIC MATERIAL SET FORTH AT THIS POINT IS NOT DISPLAYABLE
One of three cancer deaths in America is related to tobacco use, and African-American communities are disproportionately its victims. Tobacco-related cancers account for approximately 45% of the incidence of cancer in African-American men and 25% of the incidence in African-American women. The incidence of oral cavity and pharynx cancer in black men exceeds white men by 49.1%. The incidence of lung and bronchus cancer in black men exceeds white men by 40.7%. And to a somewhat lesser degree, the same pattern is true for women. *691 Furthermore, African-American smokers (women in particular) have significantly higher lung cancer rates for any given level of smoking.
After having developed cancer, European-Americans are more likely to survive it than African-Americans. For instance, the five-year survival rate for European American men for oral cavity and pharynx cancer exceeds that of African-American men by 12.9%. Similarly, the five-year survival rate for white American men for lung and bronchus cancer exceeds that for black men by 1.3%. And to a lesser degree, a similar pattern is true for women. In addition to mortality, African-Americans suffer greater morbidity than do white Americans. For instance, even though African-American women smoke fewer cigarettes than white American women, African-Americans have lost greater permanent lung capacity. Furthermore, tobacco smoking does not affect only the health of the smoker, but also that of the infant if a woman smokes during pregnancy. In 1987, for every 100,000 infant deaths, 8.6 white infants died compared to 17.9 black infants.
C. Summary
At this point it is unclear what the tobacco industry knew about the addicting power of mentholated nicotine. Given the significant difference in dependence and the health status of smokers of mentholated cigarettes, it would be another injury to the African-American community not to have its specific harm addressed in any tobacco settlement. African-Americans find smoking socially unacceptable, tend to start smoking later in life, smoke fewer cigarettes per day, are strongly motivated to quit and have a high nicotine dependence, making abstinence difficult even for lighter smokers. It is the higher nicotine dependence that makes it harder for black smokers to quit. It is the preference for mentholated brands that may explain why African-Americans smoke fewer cigarettes but have higher cancer rates.
The tobacco industry has used targeted advertizing to effectively drive up their sales and profits. In doing so, it drove up the death rate of African-Americans. *692 Consequently, Congress should not pass any legislation that does not specifically address the needs of African-Americans.
