Increase in Youth Smoking: The Surgeon General's Pink Panther Public Health Policy

In the recent report, Preventing Tobacco Use Among Youth and Young Adults, the Surgeon General sounds more like Inspector Jacques Clouseau in The Pink Panther than the nation's top health officer. After demonstrating beyond a reasonable doubt that menthol flavoring is the key culprit in getting children and young adults to smoke cigarettes, she fails to urge the Food and Drug Administration to exercise its power to ban use of this flavoring by tobacco companies. It's like Inspector Clouseau finding someone holding a smoking gun over the dead victim riddled with bullets and not making the connection that he might be the killer.

Here are some of the findings in the Surgeon General's report:
--Mentholated flavoring increases the addictive potential of smoking among youth.
--A higher percentage of adolescent and young adult smokers smoke mentholated cigarettes than in any other age group.
--Up to 58 percent of middle school smokers and 49 percent of high school smokers smoke menthol cigarettes.
--In recent years, adolescent and young adult smoking of menthol cigarettes has increased significantly, while smoking non-mentholated cigarettes has gone down significantly.
--Menthol flavoring is a masking agent that enhances smoking initiation by softening the harshness of smoke to allow inhalation (key to nicotine addiction).
--By the mid-1970s tobacco industry marketing research found that menthol cigarettes "were popular among young smokers because they were perceived as less harsh and easier to smoke."
--National surveys "confirm that menthol cigarette use is disproportionately common among younger and newer teen smokers."
--Menthol cigarettes are more likely to be marketed in stores near schools with higher proportion of African American students.
--Among black smokers, mentholated Newport cigarettes are preferred by 59 percent of adolescents and 70 percent of young adults (thanks to targeting by the tobacco companies).
--Tobacco companies use menthol to increase the appeal of smokeless tobacco products to young people.
--Evidence indicates that highly addictive, smooth tasting tobacco products like menthol cigarettes increase the likelihood that tobacco will be consumed by young people.

The Surgeon General expresses alarming concern that smoking among 12 to 17 year olds and young adults age 18 to 25 has increased. Then after she presents overwhelming evidence that menthol cigarettes are largely to blame for that rise, what does the Surgeon General do? In an Inspector Clouseau imitation, she simply finds that "mentholated cigarettes deserve special note" and "continued surveillance of menthol cigarettes is warranted"--all of this in an appendix to the report!

The Surgeon General does express awareness that menthol cigarettes "are the focus of a report by the U.S. Food and Drug Administration's Tobacco Product Scientific Advisory Committee," set up by Congress to advise the FDA. She notes that this Committee has concluded that "the availability of menthol cigarettes have [sic] an adverse impact on public health in the United States by increasing the number of smokers with resulting premature death and avoidable mortality," and that "removal of menthol cigarettes from the marketplace would benefit public health in the United States."

Again in Inspector Clouseau mode, the Surgeon General concludes that this was not a recommendation to remove menthol cigarettes from the marketplace and writes that "tobacco companies submitted their industry the FDA...and argued that menthol cigarettes had no disproportionate impact on the public health."

Nowhere in the report, or in any other statement, does the Surgeon General urge the Food and Drug Administration to ban menthol flavoring of cigarettes by the tobacco industry; rather, she stands by, ignoring the smoking gun, waiting for the FDA to act.

With such clear and convincing evidence that menthol is the heavy artillery in the tobacco industry campaign to get kids to start smoking and get hooked, the Surgeon General's report is Pink Panther public health policy that lets the Food and Drug Administration continue to drag its feet on banning menthol flavoring in cigarettes.

We need a Surgeon General like C. Everett Koop who pulled no punches in dealing with the tobacco industry, found that cigarettes were addictive and killed and crippled hundreds of thousands of people each year, and added new energy to my calls as Secretary of Health, Education, and Welfare in 1978--more than 30 years ago--that smoking is Public Health Enemy Number One.