Black or African American populations experience significant health disparities related to tobacco use, especially menthol cigarettes that are highly marketed to these communities. Among all tobacco users, 33.8% of cigarette smokers use menthol cigarettes and 76.8% of black individuals prefer menthol-flavored cigarettes. The menthol cooling effects reduce the harshness of cigarette smoke enabling deeper inhalations and incrincreaseotine absorption. This leads to high rates of smoking initiation and difficulty in quitting resulting in a significant public health crisis and was estimated to 10.1 million additional smokers and 378,000 premature deaths with menthol cigarettes. Hence, menthol cigarettes are banned in most countries including the U.S., tobacco companies introduced menthol-mimicking products by raising concerns about the potential impact of a nationwide menthol ban.
The Cannabis, Alcohol, Nicotine, Discrimination, and Lived Experience survey (conducted by YouGov online panel) collected responses from U.S. residents aged 21 and older. The sample size was specifically expanded for tobacco users and racial/ethnic minorities. With a response rate of 73.5% and a total sample size of 3,200, YouGov’s sample matched the strategy ensured by national representativeness. This survey adhered to many of the American Association for Public Opinion Research (AAPOR) Best Practices for Survey Research in both its design and data analysis.
Each participant was shown the images of menthol and non-menthol cigarettes and subsequently asked questions regarding their awareness and usage. The self-reported susceptibility is to try a synthetic cooling agent cigarette which is designed to mimic the flavor of menthol that was assessed through a series of questions. Participants were also inquired about the likelihood of switching to these synthetic cigarettes if the use of menthol was banned. Statistical analyses were conducted using Statistical Analysis System (SAS) software with a significance threshold set at P = 0.05.
The sample included 3,200 adults (47.4% men) from diverse racial/ethnic backgrounds with 34.8% holding a college degree and 36.7% reporting an annual household income of $75,000 or more. Notably, 29.1% (95% Confidence Interval [CI], 27.0%-31.1%) of participants viewed the synthetic cooling agent cigarettes as like menthol cigarettes.
In multivariable logistic regression the awareness was significantly higher among American Indian or Alaska Native individuals (adjusted odds ratio [AOR], 1.86; 95% CI, 1.35-2.58), Black or African American individuals (AOR, 1.94; 95% CI, 1.50-2.51), men (AOR, 1.40; 95% CI, 1.14-1.72), and those aged 60 years or younger (AOR, 1.40; 95% CI, 1.03-1.90 to 2.72; 95% CI, 1.96-3.78). Additionally, participants residing in states with menthol bans were more likely to be aware (AOR, 1.51; 95% CI, 1.11-2.04). Multivariable models indicated that younger adults (AOR, 4.49; 95% CI, 1.23-16.35 to 7.10; 95% CI, 2.06-24.46) and current smokers were more likely to use synthetic cooling agent cigarettes. Furthermore, 50.8% (95% CI, 42.8%-58.7%) of menthol smokers indicate that they would switch to synthetic cooling agent cigarettes if menthol were effectively restricted. Participants with prior exposure to these cigarettes were more inclined to make the switch.
The research highlights the widespread national availability of products that cocontainS-3, a cooling agent that mimics the sensation of menthol. This similarity encourages smoking, particularly among individuals who typically use menthol cigarettes potentially undermining the public health benefits of menthol restrictions. Additionally, smokers who do not usually use menthol cigarettes may also be susceptible and possibly seek to reduce the harshness of their smoking experience.
Notably, half of the current menthol smokers aware of these synthetic alternatives indicated they would switch to them if menthol cigarettes were banned. To prevent industry evasion, the study recommends implementing more comprehensive flavor-ban regulations and enhancing public education about the potential risks.
References: Choi K, Hamilton-Moseley KR, Phan L, et al. Knowledge and use of menthol-mimicking cigarettes among adults in the US. JAMA Netw Open. 2025;8(1):e2454608. doi:10.1001/jamanetworkopen.2024.54608.
