Menthol flavoring — which smooths the harshness of cigarettes — is a key ingredient sought by African-American smokers. It's also the only flavoring not banned in historic tobacco-regulation bills moving through Congress.

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Joey Ivansco/AJC/Staff (ENLARGE)

Roy Patterson, 51, waits to purchase a pack of Salems at Hardy's Market in Atlanta. While a bill's proponents deny black smokers were sacrificed for politics, others aren't so sure.

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The legislation would ban chocolate, strawberry and other candy flavorings that experts say appeal to youths but are not widely used. For now, it exempts menthol, which accounts for more than one-quarter of cigarette sales.

Not including menthol in the ban, some anti-smoking advocates say, is based on sound public health policy. But the menthol exception has other prominent health officials tempering and even withdrawing their support for the bills. Among black smokers, about 75 percent use menthol cigarettes.

"This gives the appearance that the lives of black youngsters are valued less than white youngsters," said Dr. Louis Sullivan, a former secretary of health and human services and president emeritus of Morehouse School of Medicine in Atlanta. "I feel very strongly there should be an absolute ban on all flavorings."

The bills' supporters emphasize that they specifically give the Food and Drug Administration the authority to reduce or ban menthol in the future — if the agency determines that it is dangerous.

"My major concern, after all these years of struggle, is that the FDA be given authority to regulate tobacco as a drug," said Dr. David Satcher, a former U.S. surgeon general and director of the Center of Excellence on Health Disparities at Morehouse School of Medicine. "Nicotine is one of the most addicting drugs known to man."

The menthol controversy is growing as a key vote approaches in Congress on whether to give the FDA wide-ranging authority to regulate tobacco products.

The African American Tobacco Prevention Network will this week announce it is officially withdrawing support for the legislation because of the menthol loophole, said William Robinson, the group's executive director.

While critics of the loophole worry it could take years for the FDA to make rules addressing menthol, other anti-smoking advocates say gaining FDA regulation of tobacco products is the most important step to reducing harm to everyone.

The legislation, as currently written, appears to have a chance, advocates say.

Menthol is a minor part of the bill, which would create a new arm of the FDA and for the first time give the agency authority to regulate tobacco products, restrict advertising, prevent industry misrepresentations, and address addiction and toxicity issues. Advocates said they expect the bill to go to the floor of the House of Representatives for a vote within the next three weeks.

"This is not the first piece of legislation in Washington that's the result of some compromise," Satcher said. "I'm just so concerned we don't miss this opportunity."

Menthol products made up about 27 percent of the 376 billion cigarettes consumed in the U.S. in 2005, according to the most recent data available from the Federal Trade Commission.

Experts don't know why menthol cigarettes are overwhelmingly preferred by African-American smokers.

Additives such as menthol are put into cigarettes "specifically to reduce the smoke harshness and enable the smoker to take in more dependence-causing and toxic substances," according to a report issued by a World Health Organization scientific study group last year.

Health officials have been concerned about menthol for years. It's one theory being investigated to explain why African-American men have higher rates of lung cancer.

Carefully controlled studies have not found a consistent pattern that shows smoking menthol cigarettes — compared with nonmenthols — increases risks for cancer, heart disease or lung disease, said Terry Pechacek, associate director for science at the Office on Smoking and Health at the Centers for Disease Control and Prevention in Atlanta.

"Menthol is an issue of scientific concern," Pechacek said. "We don't have the proof exactly of how and why on a lot of these ... but they're all pointing to this being an issue we need to pay close attention to."

Concerns remain that menthol may contribute to smokers taking in more toxins, help hook new smokers by getting them past the harshness of their first cigarettes, and make it more difficult for smokers to quit. Cigarette manufacturers say they've found no proof that menthol is harmful.

Dr. Gregory Connolly, a professor at the Harvard School of Public Health, notes menthol is the only additive advertised to consumers.

"It does have unique sensory properties that probably contribute to nicotine dependence," Connolly said. Menthol, he said, anesthetizes, cools and masks the harsh properties of burning tobacco. "It tricks the smoker into thinking they're not smoking as intensely," he said.

Connolly said he believes the tobacco legislation is important, even without a menthol ban.

The legislation has gained rare industry support from Philip Morris USA. As for menthol, the company has taken the position that it's unreasonable to prohibit the use of an ingredient just because it gives a unique taste that may be preferred by some adult smokers, company spokesman Brendan McCormick said.

Advocates of the bill say the menthol exception is not an industry-driven compromise.

"No one in the public health community is aware the treatment of menthol was for any other reason than a concern for public health," said Matthew Myers, president of the Campaign for Tobacco-Free Kids, a major anti-smoking group supporting the legislation. The bill bans candy flavorings because they are new to the market and have potential for widespread appeal among children, he said.

"Unlike the candy flavors, there's more than 10 million people in the United States who smoke menthol cigarettes," Myers said.

"If you immediately withdrew a product so many people use and are addicted to, you can't say for certain what the reaction would be," Myers said. It might cause people to quit smoking, he said, but it might also lead to illegal trafficking in menthol cigarettes or other behavioral changes.

"Would these smokers look to get their fix from other nonmentholated cigarettes or would they start to use another substance?" asks an issue paper circulated by the Campaign for Tobacco-Free Kids. The document states the organization's position that menthol should not be immediately banned because it "would negatively impact the public's health."

That's "poppycock," said Sullivan, whose outspoken criticism in 1990 contributed to R.J. Reynolds scrapping a plan for a new cigarette called Uptown specifically targeted at black consumers. At the time he was serving as health secretary for then-President George H.W. Bush.

"That's the kind of statement I would expect to be issued by a tobacco company, not a health-advocacy group working to ban flavorings from cigarettes," Sullivan said.

Sullivan and some other African-American health leaders worry the controversy over menthol could derail what they otherwise believe is landmark public health legislation.

But they said they are speaking out because the lax approach to menthol fails to fairly protect the health of black Americans.

"I'd much rather have a bill that's the right bill than a flawed bill," Sullivan said.

Robinson's group, the National African American Tobacco Prevention Network, complained about the menthol provision when it signed on as a supporter in 2006, he said, yet saw the greater good in gaining regulation over tobacco. In the wake of a menthol article earlier this month in The New York Times, Robinson said too many of his group's constituents have expressed outrage over the loophole.

"We don't want to be the institution that pushes it and kills the bill," Robinson said. "But we also don't want a bill that's bad."

U.S. Rep. Henry Waxman, the bill's House sponsor, said he's continuing to review the menthol issue to make sure the bill deals with it in the most effective way.

"I'm determined to see tobacco legislation pass Congress that protects all our children," Waxman said. "Leading public health experts have told us that giving FDA the authority to ban menthol is the best way to balance both public health considerations with the reality that many adults only smoke menthol cigarettes."

In Atlanta, Vincent Van-diegriff is on the front lines of the war against tobacco as chairman of the HEART Coalition in Fulton County. Over the years, the health education group has surveyed tobacco advertising at stores in predominantly black and white neighborhoods.

Unlike mostly white neighborhoods, Vandiegriff said, Atlanta's mostly black neighborhoods are bombarded with tobacco marketing.

"The pictures on these little corner stores either talk about Kool cigarettes, Newports, that's menthol. They glorify the stuff," he said.

"Ninety-nine percent of those advertisements are for menthol cigarettes," said Vandiegriff, who supports banning the flavoring. "Menthol and flavored cigarettes are generally targeted to the African-American community."

At Hardy's Market, just down the street from the Morehouse School of Medicine, signs promote Kool, Marlboro Menthol and Newport.

Roy Patterson, 51, came in to buy a pack of Salem, which is menthol. Like most menthol smokers, he's never liked nonmenthol cigarettes.

"It's just a rougher smoke to me," Patterson said of nonmenthol cigarettes.

"It's like smoking bushes."