Menthol cigarette alternative products: Awareness, use, and substitution intentions among adults who smoke menthol...

Menthol cigarette alternative products (e.g., menthol accessories, non-menthol cooling cigarettes) have entered the market and may bypass menthol cigarette restrictions. Understanding awareness, use, and substitution intentions if menthol cigarette sales are prohibited is important for assessing their potential to undermine the public health benefit of such policies.

We conducted a cross-sectional survey in 2023 of N = 116 Connecticut adults who smoked menthol cigarettes (mean age = 33.4, 50.9 % female, 50.9 % Black, 13.8 % Hispanic). We assessed awareness and ever use of menthol cigarette alternative products including menthol accessories (i.e., menthol filter capsules, sprays, cards, filter tips) and non-menthol cooling cigarettes with synthetic coolants. We measured substitution intentions to use each product if menthol cigarettes were restricted. Logistic regression models examined associations between sociodemographic and smoking characteristics and outcomes of awareness, ever use, and substitution intentions.

Overall, 66.4% were aware of at least one type of menthol accessory, 41.4% had used one, and 80.2% reported substitution intentions if menthol cigarettes were restricted. Moreover, 39.6% were aware of non-menthol cooling cigarettes, 25.9% had used them, and 56.0% reported substitution intentions. Younger age was associated with awareness of menthol accessories and non-menthol cooling cigarettes. Higher nicotine dependence was associated with awareness, ever use, and substitution intentions across all products.

We found considerable awareness, ever use, and substitution intentions of menthol cigarette alternative products among adults who smoke menthol cigarettes. Findings underscore the importance of comprehensive menthol cigarette restrictions that cover accessories and non-menthol cooling cigarettes to maximize public health.