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Evaluating the effect of switching to non-menthol cigarettes among current menthol smokers: an empirical study of a potential ban of characterising menthol flavour in cigarettes
  1. Krysten W Bold1,
  2. Peter Jatlow1,2,
  3. Lisa M Fucito1,
  4. Tore Eid2,
  5. Suchitra Krishnan-Sarin1,
  6. Stephanie O'Malley1
  1. 1 Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2 Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Krysten W Bold, Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA; krysten.bold{at}


Introduction Menthol cigarette use remains a serious public health problem, prompting the consideration of tobacco regulatory efforts to ban menthol cigarettes. The current study uses a novel empirical design to model the potential effects of a ban of menthol cigarettes on smoking behaviour among current menthol smokers.

Methods 29 non-treatment-seeking adults who smoked menthol cigarettes were recruited in Connecticut in 2017–2018 (n=15 female; n=17 Black, n=10 White, n=5 Hispanic). Repeated-measures analyses examined within-person changes in smoking behaviour when participants were switched from smoking their usual brand menthol cigarettes to a matched-brand non-menthol cigarette for 2 weeks to model a potential ban of menthol cigarettes.

Results Participants smoked significantly fewer non-menthol (vs menthol) cigarettes per day (mean decrease=2.2 cigarettes, SD=3.2, p<0.001), confirmed by significant reductions in urine cotinine levels (p=0.013). After switching to non-menthol cigarettes, participants had significantly lower nicotine dependence scores (reduced by >18%, p<0.001) and greater increases in quitting motivation and confidence (rated 1–10) (motivation: mean increase=2.1, SD=2.8, p<0.001; confidence: mean increase=1.3, SD=3.3, p=0.04). Exploratory analyses indicated significant interactions by race (p=0.004); Black smokers had greater reductions in cigarettes per day (mean decrease=3.5 cigarettes, SD=2.8) versus non-Black smokers (mean decrease=0.2, SD=2.6).

Conclusions Banning menthol as a characterising flavour in cigarettes may decrease smoking and reduce the addictive potential of cigarettes among current smokers. Results provide additional support for tobacco regulatory policies banning menthol flavour in an effort to improve public health.

Trial registration NCT03075839.

  • addiction
  • public policy
  • priority/special populations
  • disparities

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  • Contributors KWB led the study design, data collection, analysis and manuscript preparation. SO’M, SK-S and LMF contributed to the study design, analysis and interpretation. PJ and TE contributed to the study design, laboratory analysis and interpretation. All authors have read and approved the manuscript for submission.

  • Funding Research reported in this publication was supported by grant numbers P50DA036151 and U54DA036151 from the NIDA and FDA Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

  • Competing interests SO’M reported having been a consultant or an advisory board member for Alkermes, Amygdala, Arkeo, Cerecor, Mitsubishi Tanabe, Opiant, Pfizer; honoraria from the American Society of Clinical Psychopharmacology Alcohol Clinical Trials Initiative supported by Abbott, Amygdala, Ethylpharm, Lilly, Lundbeck, Otsuka, Pfizer, Arbor Pharmaceuticals, and Indivior and from the Emmes Corporation as a DSMB member for the NIDA Clinical Trials Network; a coinvestigator on studies receiving donated medications from Astra Zeneca, Norvatis; a contract from Lilly; and a scientific panel member for Hazelden Foundation. No other authors have conflicts to report.

  • Patient consent for publication Not required.

  • Ethics approval All procedures were approved by the University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.