Lung Cancer Awareness Month ended in November reminding us how many people are still affected by the disease as it continues to impact marginalized populations, most notably African Americans. According to the US Department of Health and Human Services Office of Minority Health, the death rate of lung cancer for African American men was 55.4 per 100,000 compared to 49.4 per 100,000 for white men from 2014 to 2018. One of the reasons the Black community experiences lung cancer from smoking is that, historically, tobacco companies have been heavily advertising their products toward them throughout time.
One of the reasons the Black community experiences lung cancer from smoking is that, historically, tobacco companies have been heavily advertising their products toward them throughout time.
To get to the heart of the issue, we should discuss the impact of smoking cigarettes, a major cause of lung cancer. Numerous community organizations address this issue, including the Northeast Ohio Black Health Coalition. They have conducted a billboard campaign and awareness programs to end smoking, particularly menthol cigarettes which disproportionately impact the Black community. Early in November, they invited Dr. Valerie Yerger, professor of health policy at the University of California San Francisco, to their monthly Fighting for Our Lives: Menthol Free Communities meeting to discuss her studies about nicotine, menthol, and melanin.
Nicotine stores in melanin as a health problem
Dr. Yerger presented her research on the relationship between melanin and nicotine. Literature published by Dr. Yerger and her colleague, Dr. Ruth E. Malone sought to understand the relationship between melanin and nicotine. This scholarly article examined documents from PubMed and internal industry tobacco documents. This investigation showed that many studies involving animals with excessive amounts of melanin contained more nicotine than those with lower amounts of melanin. They also noted that nicotine becomes entrapped during melanin synthesis and it is a precursor to the creation of new melanin. Some of the research they have read pointed out that carcinogens— N-nitrosamines N’-nitroso nornicotine (NNN) and 4-(methylnitrosamino)-l-(3 pyridyl)-l-butanone (NNK)— from tobacco smoke accumulate in melanin-containing tissues. Hence, Dr. Yerger and Dr. Malone concluded that nicotine, NNN, NNK and benzo(a)pyrene can gather in human melanin-containing tissues. This can harm Black individuals because they have more melanin than other individuals of different races.
Dr. Yerger’s research also discussed “the degree of association of tobacco use, dependence, and nicotine exposure with skin pigmentation among African American smokers.” Dr. Yerger and her colleagues hypothesized that melanin concentration is positively correlated to nicotine dependence, exposure to nicotine, and the number of cigarettes smoked per day (CPD). They compared two types of melanin: constitutive and facultative.
This can harm Black individuals because they have more melanin than other individuals of different races.
Constitutive melanin is made from genes that are not affected by the sun whereas facultative melanin includes both the constitutive component and melanin that produces from ultraviolent radiation on the skin (e.g. tanning). In this case, they used a reflector to measure melanin content on the foreheads (facultative) and armpits (constitutive) from Black smokers. They gathered other information such as cotinine (a biomarker for nicotine exposure) levels and results from the Fagerström Test of Nicotine Dependence (FTND). After their analysis, they concluded that facultative melanin, but not constitutive melanin, was significantly and positively related to CPD, cotinine and FTND scores. Due to the positive association between facultative melanin and nicotine dependence, a darker pigmented person might store more nicotine in their body than a lighter pigmented individual. This also means it could take a while for nicotine to leave the body for darker pigmented people.
The relationship between menthol and nicotine
Dr. Yerger also highlighted how menthol and nicotine are related. In her previous research that examined this relationship, Phillip Morris, a tobacco company, conducted a study analyzing impact scores (how well a product will be liked by a smoker) of cigarettes with high levels of menthol but low levels of nicotine. Her research investigated how these types of cigarettes affected smokers. Her research found that smokers like menthol cigarettes due to the taste and how they respond to the body, particularly the trigeminal nerve. Menthol cigarettes harm the Black population. In fact, 1.5 million life- years were lost among African Americans from 1980 to 2018, even though they make up 12 percent of the US population.
If the FDA bans menthol cigarettes and flavored cigars, then 923,000 smokers who will quit using them.
Plans to end the sale of menthol and flavored cigarettes
Dr. Yerger’s research proves that there is a link between menthol cigarette and flavored cigar use. There are efforts in placed to address this issue, such as a potential ban from the US Food and Drug Administration (FDA). She explained that if the FDA bans menthol cigarettes and flavored cigars, then 923,000 smokers who will quit using them. Significantly out of the 923,000 smokers, 230,000 will be Black individuals. As we are waiting to hear on the outcome from the FDA, menthol/flavored bans as community interventions should combat this public health issue in the meantime. NEOBHC is working on an ordinance to ban menthol/flavored cigarettes across Cleveland. Other Black led organization such as the National Association for the Advancement of Colored People (NAACP), Delta Sigma Theta and the National Medical Association have spoken out to support the regulation and prohibition of selling menthol and flavored tobacco products. If you are interested in learning how you can help end the sale of menthol and tobacco flavored products, please contact Dr. Lashale Pugh, Research and Evaluation Director of NEOBHC, at firstname.lastname@example.org.