Menthol flavour enhancer use and willingness to buy under a menthol cigarette ban

BACKGROUND: In response to bans on menthol cigarettes, new products allow individuals to add menthol flavours to non-menthol cigarettes. Our study examined the past use of such products and willingness to use them in the future. METHODS: We conducted an online survey in 2024 with a nationally representative sample of 1236 US adults (age 21+) who currently smoked menthol cigarettes. Participants reported ever using menthol flavour enhancers for cigarettes (filter tips, liquid, capsules or cards) and willingness to buy them if menthol cigarettes were banned. RESULTS: Overall, 28% of participants had ever used menthol flavour enhancers. Past use was more common among those who used other tobacco products versus those who smoked only cigarettes (37% vs 11%, OR: 3.31, 95% CI 1.81 to 6.03). Past use was also higher among transgender adults, Western US residents, men, and participants in the combined racial category (Hispanic, multiracial or other) compared with non-Hispanic White participants (all p<0.05), while non-Hispanic Black participants did not differ (p>0.05). Overall, 55% of participants were willing to buy menthol flavour enhancers if menthol cigarettes were banned. The highest interest (29%) was in a menthol filter tip placed on cigarettes. Willingness was higher among participants who used other tobacco products and were transgender (both p<0.05). CONCLUSIONS: Interest in menthol enhancers was high among people who smoke menthol cigarettes, which could undermine the intended public health benefits of menthol cigarette bans. Policies to address menthol flavour enhancers, combined with surveillance and cessation support, may be important to the success of menthol bans.