Dr. Amy Cohn and The Dangers of Flavor

“Why are flavored products so exciting to young people? What sort of psychological and cognitive factors, make young people want to use these flavored tobacco products more than regular tobacco flavored products?”

This is how Dr. Amy Cohn, associate professor of pediatrics at the OU College of Medicine and faculty member at the Oklahoma Tobacco Research Center, describes her area of study.

Her goal is to understand the strategies that Big Tobacco uses to hook young people onto their products, creating lifetime customers and casualties. She has discerned that having sweet, fruity and minty flavors make the products feel more familiar to young people and provide a kid-friendly stepping stone toward tobacco use.

The use of flavors has been an effective tactic by Big Tobacco for decades. Previous regulations have been put in place to protect youth from tobacco by restricting flavors, first in the Family Smoking Prevention and Tobacco Control Act, passed by Congress in 2009, which banned the sale of flavored cigarette products — except for menthol. More recently, in January 2020, the FDA announced a ban of flavored vaping cartridges in an effort to curb the youth vaping epidemic. The new regulation comes with loopholes already being exploited by the tobacco industry, including – once again – the ban’s exception of menthol.

Research shows that youth and young adult smokers have an easier time smoking menthol than regular tobacco products because it masks the harsh flavor. “That minty cooling sensation, quote unquote, makes the medicine go down easier,” Cohn said.

According to a 2019 study published in the American Journal of Preventative Medicine, more than 2 out of 5 — 43.2% — said the first cigarette they smoked was menthol. And 42% of respondents named a menthol brand as their regular brand. It’s not as if only five or 10 percent of young people who started smoking start with a menthol cigarette, it’s almost half of them stresses Cohn.

Kids are unaware of how serious addiction can be, she says, and she would make sure they know that vapes and other flavored tobacco products still contain nicotine.

“I think young people don’t realize, because they’re young, that it will make it harder for them to quit when they get older. So what we’ve found in a lot of research is that young people will say, ‘Oh, I’ll quit later, I’ll quit later, I’m just experimenting now,’ but by the time they want to quit, they’re older, they have more deeply entrenched habits and they’re addicted to nicotine. So nicotine is an important piece of awareness that young people should know about.”

Cohn cautions that while research on e-cigarettes has revealed that they may be less harmful than cigarettes, that doesn’t make them harmless. Contrary to what many young people believe, the vapor produced from e-cigarettes is not water droplets – it is an aerosol composed of poisonous and addictive chemicals. But the products are engineered to make the habit hard to break.

“Tobacco companies want to get you hooked on their products. So, whenever you use their product, they want to make you a repeat customer,” Cohn said. “They do that by putting nicotine in their products and making their packaging colorful and bright. So, your destiny is out of your hands once you start.”

Dr. Cohn’s research shows that, in addition to youth and young adults, tobacco companies have historically targeted African American, Hispanic and female demographics. Cohn describes a diversity of tactics: advertising in community-specific magazines, marketing flavored tobacco products at much higher rates in African American neighborhoods and lobbying to reduce tobacco control policies.

Dr. Cohn goes on to share that research shows that 80% of African American smokers prefer menthol cigarettes and menthol makes up about 30% of the market share of cigarettes. This health disparity and large market share are reasons why public health advocates are calling that menthol no longer be exempt from these flavored tobacco bans.

But the idea of menthol ban is not unanimous among community advocates. Cohn says some view a menthol ban as racist community control that limits the choices of African Americans. But others insist that continuing to allow menthol tobacco products adversely impacts the health of African Americans.

As Dr. Phil Gardiner of the African American Tobacco Control Leadership Council puts it, “Menthol makes the poison go down easier.”

Dr. Cohn would agree, saying, “I believe that a menthol ban will have a positive impact on those groups who disproportionately use menthol cigarettes.”

Cohn encourages tobacco control advocates not to lose sight of other insidious Big Tobacco strategies while tackling the e-cigarette epidemic.

“As we continue to kind of look over at e-cigarettes, I don’t want us to forget that menthol cigarettes are looming in the corner, and we should not give up the fight on focusing on those products,” she said. “I think personally the tobacco companies are benefiting from the fact that we aren’t focusing on menthol.”

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Published by Tobacco Stops With Me on February 25, 2020