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Menthol versus non-menthol flavouring and switching to e-cigarettes in black and Latinx adult menthol combustible cigarette smokers: secondary analyses from a randomised clinical trial
  1. Nicole L Nollen1,
  2. Eleanor L S Leavens1,
  3. Jasjit S Ahluwalia2,
  4. Myra Rice3,
  5. Matthew S Mayo4,
  6. Kim Pulvers5
  1. 1 Department of Population Health, University of Kansas School of Medicine and the University of Kansas Cancer Center, Kansas City, Kansas, USA
  2. 2 Behavioral and Social Sciences, Brown University School of Public Health, Alpert Medical School, and Legorreta Cancer Center, Providence, Rhode Island, USA
  3. 3 Neuroscience Interdepartmental Graduate Program, University of California Los Angeles, Los Angeles, California, USA
  4. 4 Department of Biostatistics & Data Science, University of Kansas School of Medicine and the University of Kansas Cancer Center, Kansas City, Kansas, USA
  5. 5 Psychology, California State University San Marcos, San Marcos, California, USA
  1. Correspondence to Dr Nicole L Nollen, Department of Population Health, University of Kansas School of Medicine, Kansas City, KS 66160, USA; nnollen{at}


Background As the US Food and Drug Administration takes regulatory action on menthol cigarettes, debate continues about how restricting menthol e-liquids might impact adult menthol smokers in switching to e-cigarettes.

Methods Switching patterns and e-cigarette acceptability were assessed at week 6 among 64 black and Latinx menthol cigarette smokers who used JUUL menthol (n=39) or non-menthol e-cigarettes ((n=25), primarily mint or mango) as part of a randomised switching trial.

Results No clear evidence of effects was found between menthol versus non-menthol e-cigarettes on use or subjective effects/acceptability, effect sizes for all comparisons were small (effect size=0.0–0.2), and Bayes factor ranged from 0.10 to 0.15. Specifically, 82.1% of participants who used menthol-flavoured e-cigarettes fully or partially switched to e-cigarettes compared with 88.0% of participants who used a non-menthol (p=0.75). Further, both groups demonstrated substantial reductions in cigarettes per day (menthol e-cigarettes: −8.5±10.4 vs non-menthol e-cigarettes: −8.8±5.8, p=0.87), comparable grams of e-liquid consumed (menthol e-cigarettes: 9.2±9.8 g vs non-menthol e-cigarettes: 11.0±11.0 g, p=0.47), and positive subjective effects, including ‘just right’ throat hit (menthol e-cigarettes: 70.7% vs non-menthol e-cigarettes: 66.7%, p=0.93) and flavour liking (menthol e-cigarettes: 75.6% vs non-menthol e-cigarettes: 66.7%, p=0.32).

Conclusions Both menthol and non-menthol e-cigarettes were associated with high rates of use and acceptability among menthol smokers. Findings require confirmation in a fully powered non-inferiority or equivalence study but provide preliminary evidence to inform regulatory action on menthol e-cigarettes that could slow youth initiation without impacting black and Latinx menthol cigarette smokers interested in switching to e-cigarettes.

Trial registration number NCT03511001.

  • Electronic nicotine delivery devices
  • Disparities
  • Harm Reduction
  • Public policy

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  • Contributors NLN, MR, KP and JA contributed to the conception and design of the study, supervised data collection and critically revised the manuscript for important intellectual content. MSM performed the initial analyses and contributed to interpretation of the data. ELSL contributed to interpretation of the data and critically revised the manuscript for important intellectual content. The manuscript was written by NLN with input from all coauthors who read and approved the final version.

  • Funding This work was supported in full or part by SC3GM122628 (KP and MR), K01DA054995 (ELSL), the National Cancer Institute Cancer Center Support Grant P30CA168524, and used the Biostatistics & Informatics and Clinical Pharmacology Shared Resources (NLN, ELSL and MSM), and P20GM130414 (JA), an NIH-funded Center of Biomedical Research Excellence (COBRE).

  • Competing interests JA received sponsored funds for travel expenses as a speaker for the 2021 annual GTNF conference. He also serves as a consultant, and has equity, in a start-up company Respira Technologies.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.