MINNEAPOLIS -- The Food and Drug Administration is exploring a ban on menthol-flavored cigarettes, a move tobacco-control advocates say is long overdue. They argued it shouldn't stop similar efforts in states such as Minnesota.

Supporters of the recently announced federal action acknowledged rules could take years to develop while facing expected lawsuits from the tobacco industry, which is why they want approval of a statewide bill to ban all flavored tobacco sales. Many municipalities in Minnesota have adopted their own bans.

LaTrisha Vetaw, health policy and advocacy manager at NorthPoint Health and Wellness Center, said the crackdown on menthol products in Minneapolis has helped, but the industry has tried to work around it.

"A corner store can no longer sell menthol or flavored tobacco products," Vetaw explained. "But now, they've put in four clear walls inside of these stores and are calling it a tobacco shop within a corner store."

Vetaw and others calling for higher-level bans contended they would help end heavy marketing of menthol products in Black communities. Opponents, including retailers, countered a ban could have unintended consequences, including the creation of more underground markets.

The proposed state ban has seen activity in recent legislative sessions, but hasn't been able to clear all the necessary hurdles.

Republican lawmakers who are skeptical of a statewide ban said it sends mixed messages amid a push for marijuana legalization. But tobacco prevention groups, not part of the legalization effort, pointed out there are a range of health effects from smoking that need to be addressed.

Laura Smith, spokesperson for ClearWay Minnesota and Minnesotans for a Smoke Free Generation, emphasized the need to press forward.

"That's why we're continuing to work statewide and on the local level to get these life-saving policies passed, because we know they can a make a big difference towards reducing these tobacco addictions and easing disparities that many people face, especially Black Americans."

The Centers for Disease Control and Prevention reports 93% of Black adults who smoke started by using menthol cigarettes.

Aside from bans, the groups say the state needs to stay committed to funding prevention efforts. Various budget proposals this spring included higher totals, with money for health equity in prevention work, but advocates stressed it still needs to be part of the final spending plan.

Virginia groups are using different methods to warn young people about the dangers of smoking.

Along with tobacco-free parks, the state has taken things to a legislative level to prevent youth from using tobacco. In 2022, House Bill 685 aimed to prevent the sale of tobacco products to Virginians under age 21.

The bill failed in committee. But the group "Henrico Too Smart 2 Start" has taken a collaborative approach through its social media "Influence the Influencers" contest.

Terrell Pollard, board chair of the Henrico Too Smart 2 Start, described the contest's goals.

"The contest is to see what youth can earn the most 'likes' through a youth-created video about not using substances," said Pollard. "And it does two things: One, incentivizes youth to be a part of youth substance use prevention strategies, as well as flood social media with healthy, positive messages."

He said the idea stems from the increased substance-use issues that arose during the pandemic.

A 2022 study by the Centers for Disease Control and Prevention and the Food and Drug Administration found more than three million kids across the U.S. use tobacco products.

Going forward, Pollard said he hopes to make this an annual contest to bolster the group's mission of youth tobacco-use prevention. However, he said there will be changes made to this contest in years to come.

"Because of the collaborative nature that the videos were created, we want to move to a format where we're offering prizes to a group of students," said Pollard. "So, it could be a school club, a school itself. We wanted to encourage that collaboration."

The "Influence the Influencers" winners will be decided during the second week in June.

The American Lung Association has released its 2022 State of Lung Cancer report, which shows Indiana has some work to do.

The leading cause of lung cancer is smoking, and the state ranks high in the Lung Association report with 19% of Hoosiers doing so. Indiana also ranks high with the second leading cause of lung cancer, as 40% of home radon tests are at or above the Environmental Protection Agency action level. With early detection, the five-year lung cancer survival rate is 61%.

Tiffany Nichols, Indiana director of advocacy for the American Lung Association, said many people don't realize treatments are possible.

"Many Hoosiers don't understand that there are lifesaving treatments out there," Nichols observed. "I think we need to do a better job at letting people that are at risk of getting lung cancer know there are things out there. They don't necessarily have to die from lung cancer."

She encouraged people to ask their doctors to find out if they are eligible for a lung-cancer screening.

Indiana ranks 20th in the nation in early screenings, but it still represents only 7% of high-risk patients, and nationally only 5% are screened. The Lung Association maintains states should mandate coverage of lung-cancer screenings "in all fee-for-service and managed-care plans without any financial or administrative barriers in their Medicaid programs."

Nichols added health professionals need to advocate for screenings.

"I think health professionals need to make it known that there are screening things that are out there that can help to diagnose and to check for lung cancer early," Nichols urged.

In March of last year, the U.S. Preventive Services Task Force updated the recommendations around lung cancer screenings to include a larger age range and more current and former people who smoke.

A new report from Stanford University finds tobacco companies continue to directly target African Americans, women, and young people with their advertising, creating a larger market for a product which has been linked for years to cardiovascular disease and cancer.

It comes as efforts are underway at the state and federal levels to remove menthol cigarettes from the market.

Dr. Robert K. Jackler, professor at the Stanford University School of Medicine and the report's lead author, said the preference among the targeted groups for menthol cigarettes is the product of a concerted campaign.

"Urban heavily Black-populated areas got carpeted by billboards and signs in store windows, discount coupons," Jackler explained. "The companies would have vans that would give out free samples of cigarettes in poor neighborhoods."

In 2020, the California Legislature prohibited most flavored tobacco products, but the law was put on hold when the industry gathered signatures to force a referendum. In November, voters will consider Proposition 31, which upholds the restrictions. And the industry is funding the "No on 31" campaign, arguing blocking adults from buying menthol products would lead to a drop in sales-tax revenue and create an illegal market, increasing crime.

Jackler predicted voters will pass the ballot initiative, reaffirming the California Legislature's intention to remove most forms of flavored tobacco from the market.

"The tobacco industry is very cynical," Jackler asserted. "They used the initiative petition to buy a couple of more years of profit off of California. They knew they were going to lose this, I think, in the election."

The report finds tobacco companies market menthol to youth because it makes it easier to smoke, masking the taste and numbing the throat. It also noted menthol encourages deeper inhalation and thus, greater exposure to nicotine.

Dr. Jessica Sims, medical director of managed care at UCLA Health and an American Heart Association volunteer expert, thinks removing menthol cigarettes and flavored vaping products from the market will improve public health.

"Nicotine itself has been demonstrated to cause permanent harm to the teenage brain that's still developing," emphasized. "It causes difficulties with attention and memory, and can impact someone's trajectory in life."

In April, the FDA proposed to remove menthol cigarettes and flavored cigars from the market but no final rule has been issued. In 2009, Congress passed the Family Smoking Prevention and Tobacco Control Act, which prohibited all flavors other than tobacco and menthol in cigarettes.