The History of Menthol

– [Lisa] Well good morning. And welcome everyone to our webinar sponsored by the Michigan Department of Human Health Services, Tobacco Section. My name is Lisa Knight,
I am the Director of Health, Youth, Education
and Community Engagement at the Urban League of West Michigan. – [Tom] And I am Tom Moore, Tobacco Program Coordinator
at Wellness Services in Flint. – [Lisa] And we’re here
today to just really kind of discuss the history
of menthol and tobacco, as it has impacted communities of color and those who are in
disproportionate communities and just really kind of give you some of our information
from our perspective. I work primarily in the black and brown communities in my city. – [Tom] And I work
predominantly with individuals living with HIV from my location. – [Lisa] So we’ll go ahead
and get started here. I’m gonna do the first
half of this presentation and then Tom is gonna take it home. So we wanna start talking
about the history of menthol and looking at how tobacco companies capitalized on cultures. So we know tobacco companies have always marketed their products to appeal to racial and ethnic communities and the most striking example, of course, is the menthol cigarettes. Creating menthol cigarettes allowed for people to smoke with more ease. So there was a sense of freedom, a sense of connectivity, a sense of community, a sense of belonging. This was all created through
the use of marketing. So menthol cigarettes actually
made it easier to smoke more. And it was primarily targeted at the African American community. So about 85% of most black
smokers used menthol cigarettes and that’s nearly three times
higher than white smokers. Big tobacco companies
were the first to utilize African Americans as executives
in their organization to really feed them
information on the culture, on what they liked, and
where they liked to be. And so they used musicians and they used actors and actresses, they used people in sports to make them think that
this was the thing to do, this was okay to do
and it made you popular and it made you feel like
you a were part of the crowd doing some of these things. And so what happened is when you begin to think about the culture, minorities never really fit
into those particular areas. There were very few minority
actors at that time. There were very few minorities in sports. But they utilized that
because they knew that with any culture, with any people, they’re always gonna look up to somebody, they’re always gonna focus on someone that seems to have been
able to make it out. And so being able to utilize that, to draw a people in, has been one of their stronger
strategies over centuries. The marketing is strong,
it’s pervasive, it’s heavy. And a 2013 studies found
that black children were three times more likely to recognize advertisement for Newports. They were the most popular
brand of menthol cigarettes that were being used in communities. I remember even myself as a young person, that if you smoked Newports, you were in, you were part of the crowd. And a lot of times, we were always looking for connections with people and
ways to feel like we belong. So we also think about
how tobacco companies have sponsored a number
of cultural traditions. Some of the list of
that are Mexican rodeos, powwows, Cinco de Mayo
festivals, Black History Month, even events that go on at colleges. African American Arts and music festivals across the country. Music is a powerful tool,
especially in our culture. And so being able to be a part of that, saying that they wanna sponsor the event, but we realize that behind all of that it’s really an opportunity for them to begin to capture new
people into that market. So we have some visual
items for you here today just to show some of the
marketing and how it was done. Smokes, you know, that’s where it’s at. Telling people if you’re a smoker, that’s the right place to be, that’s where we need you to be. Boxing was really heavy in the past and that’s something that we focused on. So the figures that were very
popular in the sports arena. With music, music is something that draws our culture together, so what better way, using music artists to
put their advertising out into the community and draw people in. Tobacco companies market
disadvantaged communities. So where our organization is located, within a five mile radius, there are over 50 stores
and/or gas stations that sell tobacco
products that are marketed towards the minority community. So you see ad placement right
in eye level of our children. There are stores that take EBT, they sell alcohol, they sell fast snacks
and things like that. So nothing healthy about it but they make sure to draw people in. Who are these communities? People that are lower income. People that don’t own their homes. People that have low
social economic status. People that are poor. Older generations. So you have a continuing
cycle that happens in these communities
that have food deserts. And so there are people that
can’t necessarily make it to the larger grocery store
chains to get their food, and especially if they’re
receiving services or any type of state aid. Then, you know, they’ll send
the kids around to the store. That’s what used to
happen when we were kids. Food stamps used to be little booklets and so they would give us
the little dollar booklets to go around to the candy store and get, you know, a snack or get some candy or some gum or something like that. And these products were
marketed all over the store. All over the windows. I mean some of the stores that
you see in these communities, you can’t even see in the windows because there’s tobacco
marketing all over the building. And then as soon as you walk in the store, right where all the candy is, right where all the sweet stuff is, all things that kids are attracted to, all of the colorful packaging, is right there on the counter for them to be able to see and for them to be able to access. The tobacco industry spends
millions and millions of dollars on marketing to these communities. I mean there is so much money
spent just on advertising. We took a group of young
people around our community to do tobacco scans on some of
these stores and gas stations and we had the opportunity
to talk to some of the owners or the people that were
managing the store, and just asked them if you had the ability to remove some of the advertising and move where you have
this product placement, could you do it? And the comments that we got back from them was basically no. Because the people that
are out in the community that do the marketing
for the tobacco companies that actually work for them pay them large sums of money to do this. Now why would somebody do that if there was not a very
strong purpose behind that? If they weren’t really dedicated in selling this product, right? They wouldn’t be giving money, they wouldn’t be advertising. And that’s like any product. Any product that you may deal with. I worked at a store before doing retail and certain organizations come in at certain times to bring their product. And they stock their particular area. And we were told very explicitly, if they were to offer us
any money, do not take that. So it’s not something that doesn’t go on across commerce, across business. This is a tactic that is used a lot when people are really trying
to market their product. The thing about in this area, they give them a lot of money. And so it’s really hard for a lot of stores to turn that down because they survive off of those price points that they
have in their stores. And if this is a high price point, if they’re selling a lot of this product, they’re receiving a lot more
kickback for doing this. And there’s laws and things against that but that doesn’t seem to stop people. So it’s a systematic targeting at disadvantaged
communities that become more of the public health
problem in our communities. And we really wanna focus on that and help people understand that this is not just something that started, this is nothing new, it’s something that has been going on for generations and generations and will continue to go on until we begin to address
some of those things. Again, you see some
more of the advertising. “I did come with a
warning, yet you chose me. “So now you suffer!” It just speaks to the
addictive nature of nicotine in these products that cause people to continue to smoke over and over again. But we also have to look
at the systemic issues that are attached to this and
why people begin to smoke. So we know that some of
the statistics out there show that menthol makes
cigarettes easier to smoke and harder to quit. The flavoring allows the
lungs to expand further, allowing more of the toxic
chemicals into the body. It can also lead to
addiction, disease and death. And this is part of the
reason why African Americans are more likely to die from
smoking related disease than any other group even though they usually smoke fewer cigarettes and start smoking at an older age. Here’s more advertising around tobacco and how they use this
advertising to draw people in. There are families. They’re utilizing families
to really draw people in and make them think that this is okay. And we know that typically in marketing, when someone sees something three times, it is embedded in their unconscious mind. And so they see those things. And knowing that the
unconscious mind processes million bits of information at one time, and the conscious mind, 40, anything that’s embedded
in your unconscious mind is generally the thing that you operate off the quickest, right? That’s what’s moving. That’s what has the power. That’s what takes control. And so when we constantly
see this information being embedded in our unconscious mind, when something happens or triggers us, we react off of that thing. If I’m constantly seeing
advertising marketed at me saying this is cool, this
is gonna make me look good, this is something that I should do, eh, as a young person, I’m gonna try it. That’s just the kind of
creatures that we are. There we have a little more marketing from some people that were very popular in advertising, in the arts, in acting. Some of the other information
we wanna talk about is black leadership in
the tobacco industry. And so when we talked about how tobacco
companies tried to support events and different
cultural opportunities, we look at how R.J. Reynolds sponsored a number of black leaders
to hold meetings at churches to give warnings against menthol. Why would you sponsor an event if you weren’t trying to
market towards that event? It’s the subliminal things that
we don’t really think about. So they support
fraternities, the sororities. And the NAACP actually in 2016 adopted a menthol resolution with the support of the tobacco company. So it’s really kind of playing these organizations against themselves. They don’t really realize the work that’s being done on the
back side to draw people in. So one of the things we like to talk about is the African American youth
who have become addicted. So 3.9% of African American
high school students smoke, compared to 9.9% of white students. We begin to look at the
marketing that’s done in these disenfranchised communities and you see the number of young people that are beginning to smoke and they’ll begin to get
addicted at younger ages. More than 64% of African
American youths, 12 to 17, prefer Newport, why? They’re easier to smoke. The menthol allows your lungs to expand, it allows them to take in more. And a lot of our kids are
exposed to other drugs. They’re exposed to alcohol, they’re exposed to illegal
substances very early in life. But again in these communities, you have a lot of stress, from lack of employment, not being able to pay your bills, not being able to take
care of your family. Just opportunities that
are not presented for them that may be presented for other
populations that cause them to use these particular
items as stress relief. So the problem of menthol, it masks the harshness
of the tobacco smoke. I remember my mother being a smoker of Pall Mall Golds when I was a kid, and those things were, ouf, rough. And so, of course, as a young person, you know, we’re gonna try stuff. Because we see it all the time. I saw her doing it and we
snuck out and tried it. And I literally thought I was gonna burn my lungs out of my body. And then at another younger age, I tried a menthol cigarette. And I could tell the difference. But I really didn’t know the impact that it would have on me. And I’m so glad that that was not something that I continued to do. Menthol smokers have decreased
success in quitting smoking. And so we really wanna begin to look at some of the impact of menthol in the health concerns
for African Americans. The problem of menthol. “Black people smoke at a similar rate “compared to white people “with 16.7% smoking
every day or some days, “but they are more likely to die “from a tobacco-related
disease than white people.” And so you think about all
the other health disparities that are going on in black
and brown communities and then you add this on top of that and it just lessens their ability to live a longer lifespan. I had a young man sitting in
my office not too long ago in a program that I was working with and I started talking to
him about his smoking, because he was doing a lot of it. And he literally said to me, Ms Lisa I know I shouldn’t do it and I should stop, he said, but I can’t. He said it really helps me because all of the issues that I’m dealing with and I’m so stressed out from day-to-day, I don’t have anything else to do. And so when they weigh the odds between smoking an illegal substance as opposed to smoking
this particular substance, they’ll take this substance to at least keep them
out of the legal system. But that doesn’t help their life outcomes. Menthol flavoring allows lungs to expand. We talked about that earlier. It’s part of the reason
why African Americans die from smoking-related disease more than any other group. And the four leading causes of
death among African Americans are heart disease, cancer,
stroke and diabetes. Tobacco use is a major
major major risk factor for all of them. And so we really want to
begin to focus on that and hopefully get some
movement in our community and around legislature, especially
around some of the things that are going on in the news now. And actually get menthol out of there too. Because I believe some of the
things that I saw recently, menthol was kind of
left out of that group. So then how does that impact
this particular culture? We’re talking about taking the flavors out of vape liquids for youth but how does menthol impact the community? Because it’s still there and it still has an
impact on their lifespan. So what do we do, right,
affects all of the people around us in more ways
than we realize, right? Smoking affects the brain, much in the way like other drugs do. It causes people to take
multiple breaks on their job which could affect their employment. And then if you lose your employment, then you’re back in the cycle
of not having an employment, trying to find another job, possibly not having transportation, being able to pay your bills. So it’s a continual cycle, right? People are harder to insure when they have pre-existing conditions. It alters your blood chemistry, and second-hand smoke causes
pre-mature death in children. And we know that in the
African American community, that infant mortality is a
very very very high rate. And so we’re gonna turn
this over now to Tom Moore. And he’s gonna talk a little bit more about the cultural relevance of tobacco. – [Tom] Thank you, Lisa. – [Lisa] You’re welcome. – [Tom] So one of the
things I like to start off, right off the bat, when working with folks
in tobacco cessation, is being conscious of your identity. I’m a gay, white, queerish man. And I need to own that
coming in to the community that I am working with and I’m serving. And I want the folks we’re seeing to be aware of that as well, because folks that we’re trying to help and folks who are tobacco users are more often than not, navigating many life stresses and traumas. And over the years working
in tobacco programs, I’ve noticed that many times
folks are single-minded when we talk about tobacco cessation, of just getting people to quit. Just quit. But there’s a larger web of things going on in this individual’s life that need to be kind of brought into these services and conversations too, for tobacco cessation programs. Especially for white folks working within black and brown communities. We need to be mindful of those
life stresses and traumas, both historical and individual, these persons are navigating
when coming to us. That’s why I started looking more into minority stress models, which are often used by social
workers and sociologists to kind of discuss how
individuals and communities navigate experience, traumas or stressors. I noticed that this is very
helpful when talking to other, not only tobacco providers but tobacco networks and other agencies that might be working with
tobacco cessation programs, to kind of understand like, folks come in the door, we
don’t know who they are. We don’t know what they’re
bringing with them, and we need to be as mindful as possible. So with this model, we really break it down
to five basic steps to kind of keep in your
mind when working with folks to build that greater
network to kind of get them as much help for their
quit needs as possible. So on the left, I start with what’s called the external stigma related stressors. And what this really says is,
for those who are listening, what have we learned about race,
gender, sexual orientation, the sex we’re assigned at birth, class, through the media around us? Through our family dynamics. Through church communities,
through schools. Like how do we learn
about those identities while we’re creating our own? And this happens at a
very very very young age. We as individuals start
picking up on, you know, how people are positively rewarded for certain behaviors
and not other behaviors. And moving forward, we start to understand what we think the world is around us, and has an identity is forming, we might kind of feel like, well, I don’t match that. And we become very fearful. For those who are listening,
kind of keep in mind, what we learn about being
a woman in television. Take a minute to think about what we learn about race through books and music and magazines. And then how we put that inside of us and we carry that around. And at times in social services, we bring that into those offices with us. From those external stigmas, we can then develop individuals’ general psychological processes. Which are usually brought
down into two different parts. Interpersonal functioning
or emotional functioning. And basically what that means is how a person learns to cope
with daily repeated exposure to those external
stigmas that I mentioned. So if you are seeing a lot of racist material on the television, you’re watching the news,
that’s a whole lot right there. You’re starting to learn what it means to be a black or a brown
person in our community. You learn how to cope with those images and those words and those actions. And then you learn how to internalize those images and those words, in your identity, moving forward. Which groups are safe to navigate around, which groups are not safe. And that’s where we get
things like coat switching, as a means to survive in
different communities. And that can be traumatic, and that can be stressful, wearing all this wherever you go. Lisa made a really great point earlier about how the tobacco
industry is really good at understanding how,
when you market an image or a message at least three times, we subconsciously internalize that. Well imagine that for stigmas. Homophobia, transphobia, racism, classism, and it goes on and on and on. So when young folks and communities are developing this moving forward, internal stigma can
really start to develop within an individual. And their internal stigma can look like believing
that the external stigmas that you’re learning about is true. Feminine men are bad. If I act feminine, I’m a bad person too. Certain genders, stereotypes, are okay. And I have to act that way too, and if I don’t, I’m
going against the grain, and that can be problematic. If I don’t act this way, I’m gonna be rejected. Not just by my family, but by
possibly my community as well. And if I go outside that
community where I might be safe, it’s dangerous even
more out there possibly. And through those internalized stigmas of rejection and possible self-hate, you can increase your risk of
particular health problems. And a lot of times, I tell folks this really leads greatly
to health disparities. Depression, social
anxiety, paranoia, PTSD, thoughts of suicide, self-harm. You’re trying to survive. Like you said earlier, Lisa,
that stress outside your life, so you’re gonna find ways
to kind of cope with it. And over the generations, tobacco has been marketed
as a coping mechanism. I’m really stressed out. That cigarette’s gonna help me out. I’m really anxious. The cigarette’s gonna bring me down. In reality, that’s not the truth. But you become more and more dependent through that pattern you create. And through those health problems, physical health problems start happening more and more within those
marginalized communities that you mentioned earlier, especially black and
brown communities, Lisa. You see a lot more risky behavior, more substance use, a lot more risky, quote
unquote, risky sexual behavior. Put you more at risk of STIs and HIV. That substance use risk puts you at risk of
more health disparities in addition to risky health sex behavior. And that’s what we gotta
keep in mind moving forward. That when we’re working with
individuals, for tobacco, a lot of times it’s not just
tobacco that’s going on there. And kind of being open
minded to talk about, all right, how does
things like homophobia, bi-phobia, transphobia,
racism, sexism, ageism, limited education, hostile
medical environments and more plays into that tobacco use? And how as an agency do I help
individuals navigate that? If an individual comes in talking about a lot of anxiety and
we don’t address that, how is that gonna help with tobacco quit? If we, especially white folks, aren’t aware of how the history of menthol has historically impacted
black and brown populations, how are we gonna address
that particular quit? That is much more difficult to navigate than other brands of
cigarettes that are out there. If we’re not aware of, not just individual traumas, but 400 years worth of historical traumas, environmental as well, that can be problematic. So again, individuals come to us with a lot more kind of in the background that we need to be prepared. And have networks to build off of so we can have the best kind
of success outcomes we can. That’s why it’s really
important for us as agencies to develop culturally appropriate tobacco cessation programs. And so one of the things I always ask the folks that I work with is, you know, we’re always big
on talking about equality. Equality, equality. But we should really
be striving for equity. And I always ask folks, what’s the difference between equality and what’s the difference between equity? And I usually tell people, ’cause you know there
will be times they forget, and I let them know that you know equality is when we want to
treat everybody the same. Like in the photo here, everyone gets a box to
try to see over the fence. But equity understands that sometimes folks might need a little bit extra or a little bit more to help them get to that level to see over it. And that health equity
has a goal of liberation. So eventually that fence won’t be there and we can all see the other side. And as tobacco cessation programs, we need to keep that in mind that we need spaces that are safe and accessible to anyone coming in. We need to be mindful
of intersectionality, that, going back to the previous slide, of how racism, homophobia,
transphobia, sexism, all intersect in
individuals and communities and how that impacts their tobacco use. If we don’t include trans women of color in these conversations as well, that’s a disservice to a community that may have, that does
have, a large tobacco use. We need to be focused
on trauma informed care to understand the impact, as I was saying, of mental health, physical
and emotional health that our individuals are navigating, and then treat the whole person and not just a single symptom or behavior. They are more than just their trauma. Shifting away from just trauma informed, being more healing centered is important. Because again, we are
more than our traumas and we need agencies that
build that empowerment so people feel good about themselves and they can move forward to walk away from their tobacco use. Motivational interviewing
is another great way to work with individuals to
open up the question more so they, the person we’re working with, guides the conversation
and we are the ones pushing them through the conversation. Be mindful again of the
communities we work with. If I’m a white person working with predominantly black and brown folks, I need to be mindful of that
working within the communities and their particular needs. And the possible mistrust
they have of me walking in because of the identity I carry with me. Be mindful of tobacco cessation
policies that are biased. As Lisa mentioned before,
menthol policy law changes are kind of wishy washy right now. We’re focusing on vaping flavors. But here menthol, which impacts greatly
a particular community and is well known it hits
this particular community, that’s kind of just put on the back burner time and time and time again. And that’s problematic. Be mindful of how mental health is key in a lot of health disparities
in tobacco cessation. If an individual reports that they’re navigating a lot of anxiety, talk to them how that anxiety will impact their tobacco reduction or quit. If you don’t do that, we
see more and more folks returning to their tobacco use and kind of walking away from any ideas of quitting in the future. It’s key to have welcoming
spaces like I said, and trusting spaces. If you do not have images in your clinic, in your tobacco cessation office, that matches the community
you work in, work with, that’s gonna turn people away, right away. (coughing) Sorry. Okay. If you’re working in a community that’s predominantly black or brown, and your entire staff is super white, that’s a problem right there. Folks walking in that front door will notice that real quick. And they may walk right away. If your front staff is not educated on the communities they’re working with, that is the first line of defense that can push people away. If they have no idea of
the LGBTQ plus community, especially trans women and misidentifying, and intentionally put that harm out there, folks aren’t gonna come back. Creating inclusive intake
materials is important too. So the papers you ask questions of folks, you let them answer the
questions right away. What pronoun do you identify with, you know, how often do you smoke, what is smoking look like to you, what is tobacco use look like to you? That way, they kind of
guide that tobacco plan, and again, you’re not pushing them into something that won’t fit them. I often think that a lot of
tobacco cessation programs try to be as monolithic as
possible and that doesn’t work with the particular
communities we work with. Not just Michigan but
across the United States. Again, train your staff
continuously on education. Not just around LGBTQ plus folks but black and brown folks. Folks with disabilities,
age, youth, poverty. It’s really important to
really get at those layers of why certain populations are using more tobacco than others. Call patients by their pronouns
and names they tell you. You ask the individual first. That way you’re again creating that space where they kind of come
in and feel comfortable. And creating bathroom spaces
that are essentially important. They’re especially
important for individuals. Many trans women will walk into spaces and bathrooms can be
very dangerous for them. And they’ll pick up on that many times. Again creating these culturally
appropriate environments is important for a person. Not only for their wellbeing but for their tobacco quit means. Time and time again when
I work with individuals for their tobacco use,
they’re in pre-contemplation. But then they talk about housing issues, transportation issues,
mental health issues. And to be fair, those are a lot of things. If you don’t have a house to live in, you’re not gonna focus
on your tobacco use. And if you’re trying to access an agency that doesn’t know about you or the community you’re coming from, they’re not gonna successfully
quit moving forward, and you’re just kind of
sitting there going like, well why isn’t anybody
coming to my programs? So I really really encourage
the folks listening to kind of keep this in mind and sit back and reflect on, is my space an open space
for anyone coming in? Does my space reflect the
communities I’m working with? If I felt some sort of weight today, because a lot of times white
folks get very icky feeling when we talk about especially
race or transgender issues, sit with that for a while
and ask yourself why. Why am I feeling this way? And maybe I need someone to
come in to do a training, to educate myself and the staff more because this is something that
we need to continuously do and after that 5:00 o’clock
we don’t just things down. We need to learn more and
more about communities that we don’t belong, we grew up in, but we navigate. – [Lisa] So thank you all
for tuning in with us today and listening to the conversation. We hope that you may have learned a little bit of information. You may have some questions or some thoughts about
what you may have heard, or even about what may be
going on in your community and some ways that you can advocate for culturally appropriate responses towards tobacco advocacy
prevention for our communities. Communities of color,
the LGBTQ communities, for our black and brown communities, for anybody out there who’s really dealing with this tobacco addiction issue and how we use some of the approaches to relate with the client guests that come through our doors. You can contact me. My name again is Lisa Knight. You can catch me at L Knight, with a K, – [Tom] And if you have any
questions for myself, Tom Moore, you can get ahold of me at
[email protected] – [Lisa] We hope again
that you enjoyed this time. Tom, you did great, thank you
for sharing that information. We know that this did not start yesterday. It is something that
we’ve all been working on for a number of years and
so we really appreciate all of the partners in the
communities across the state who are doing this work. And again, it’s gonna take
all of us to work together to come up with new ideas and thoughts. Tobacco companies come up with new ways to market and advertise every day, and so we can’t rely on
the old processes any more. We have to move forward and
think of new and engaging ways to connect with our communities and try to save the population, right? From the addiction that
comes from tobacco use. So thank you again, have a great day. We hope to connect with you all again. And again, if you need to connect with us, you have our contact information. We look forward to speaking with you and thank you again. – [Tom] Thank you.

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