Testimony of American Cancer Society Cancer Action Network to the New York City Council Health Committee

January 30, 2019 • New York, NY

Chair Levine and members of the Health Committee, thank you for the opportunity to testify today.  My name is Bill Sherman and I am Managing Director for Government Relations at the American Cancer Society Cancer Action Network (ACS CAN), the nonprofit, nonpartisan, advocacy affiliate of the American Cancer Society.  I am pleased to be able to speak in support of Int 1345-2019 and Int 1362-2019.

Every year in New York City over 40,000 people are diagnosed with cancer. Even though US cancer death rates have decreased by 26 percent from 1991 to 2015, not all Americans have benefited equally from the advances in prevention early detection, and treatments that have helped achieve these lower rates. Significant differences persist in cancer incidence, survival, morbidity, and mortality among specific populations in the US.

Lung and bronchus cancer is the single largest cause of cancer death in New York City.  While the lung and bronchus cancer death rate has declined by 45 percent since 1990 in men and by 19 percent in women since 2002 nationwide due to reductions in smoking, we continue to see disparities by gender, race/ethnicity, and socio-economic status.

Smoking remains the leading cause of preventable death in the United States, New York State and New York City.[1] Each year more than 12,000 people in New York City die from illnesses related to tobacco use.[2] 

Smoking not only causes cancer, it can damage nearly every organ in the body, including the lungs, heart, blood vessels, reproductive organs, mouth, skin, eyes, and bones. Smoking accounts for about 30 percent of all cancer deaths in the United States,[3] including about 80 percent of all lung and bronchus cancer deaths.[4] The impact of tobacco use goes beyond health. The annual health care costs in New York State directly caused by smoking are $10.39 billion.[5]

Last year marked a landmark in New York City’s efforts to continue reducing smoking rates with new laws taking effect that raised the minimum prices for cigarettes and all other tobacco products, capped the number of tobacco and e-cigarette retailers citywide, created a retail license for e-cigarettes, increased the fee for a cigarette retail dealer license, required all residential buildings to create and disclose a smoking policy, prohibited smoking, including the use of e-cigarettes in common areas in multiple unit dwellings, and prohibited the sale of tobacco products at pharmacies. But more needs to be done.

Flavored Tobacco Products

The 2009 Family Smoking Prevention and Tobacco Control Act implemented a federal prohibition of characterizing flavors other than tobacco or menthol in cigarettes. The prohibition included candy-and fruit-flavors. Additionally, in 2009 a New York City law was adopted that restricted the sale of most forms of flavored tobacco products to certain adult-only venues. The legislation covers most flavors like the products I am showing you today. However, the federal and city laws exempt “tobacco, menthol, mint or wintergreen flavors” and flavored electronic cigarettes.

While cigarette smoking rates have declined significantly in recent years, the use of electronic cigarettes has been skyrocketing, especially among youth. During the one-year period between 2017 and 2018, among high school students who currently used e-cigarettes, use of flavored e-cigarettes increased as well. [6] Use of any flavored e-cigarette went up among current users from 60.9 percent to 67.8 percent, and menthol use increased from 42.3 percent to 51.2 percent among all current e-cigarettes users – including those using multiple products – and from 21.4 percent to 38.1 percent among exclusive e-cigarette users.[7] Flavors in tobacco products are frequently listed as on the top three reasons youth use e-cigarettes.[8] Additionally, kids whose first tobacco product was flavored are more likely to become current tobacco uses than those whose first product was tobacco flavored. 

ACS CAN strongly recommends implementing evidence-based policies to prevent the initiation and use of all tobacco products.  The use of products containing nicotine in any form among youth is unsafe and can harm brain development. Furthermore, evidence indicates that many young people who use e-cigarettes also smoke cigarettes.[9] There is some evidence that young people who use e-cigarettes may be more likely to smoke cigarettes in the future. Using nicotine in adolescence may also increase risk for future addiction to other drugs.  

Recent spikes in the use of e-cigarettes makes clear that more must be done to regulate tobacco products and the industry's deceptive marketing practices.

The exemption for mint, wintergreen and menthol is so troubling because menthol makes cigarettes easier to smoke and harder to quit. [10] The chemical compound creates a cooling effect, reduces the harshness of cigarette smoke and suppresses coughing. Those effects may make menthol cigarettes more appealing to young, inexperienced smokers. Research shows that they are more likely to addict youth and more difficult to quit than regular cigarettes.[11] Many people who smoke think menthol cigarettes are less harmful. In fact, there is no evidence that cigarettes, cigars, or smokeless tobacco products that have menthol are safer than other cigarettes. This myth has been perpetuated via a decades long campaign by the tobacco industry. [12]

There are huge disparities in menthol cigarette use in New York City by borough and income level. While 74.1 percent of people who smoke in the Bronx use menthol cigarettes, only 36.6 percent of people who smoke in Manhattan use menthol cigarettes. Some 58.5 percent of New Yorkers at the lowest income level smoke menthol cigarettes while only 29.4 percent of New Yorkers at the highest level of income smoke menthol cigarettes. [13]

At the same time there is a huge racial and ethnic disparity in menthol cigarette use in New York City. While 84.8 percent of Black adults who smoke and 63.8 percent of Latino adults who smoke use menthol cigarettes, only 22.6 percent of White adults who smoke use menthol cigarettes in New York City. [14]  This disparity among race and ethnicity is not accidental.

Tobacco companies have specifically targeted minority communities, particularly African-Americans, with intense advertising and promotional efforts. A wealth of research indicates that African-American neighborhoods have a disproportionate number of tobacco retailers, pervasive tobacco marketing, and more marketing of menthol products.[15]

The disparities in menthol cigarette use in New York City are contributing to the negative health disparities that exists in New York City and must be addressed.

ACS CAN Recommends

It is time for New York City to fully restrict the sale of all flavored tobacco products, including electronic cigarettes, and including menthol, mint and wintergreen. By passing both Int 1345-2019 and Int 1362-2019 we can reduce the use of tobacco products, reduce the death and disease associated with its use and make progress toward achieving health equity.