Greater Appeal and Greater Harm? Young Adults’ Preference for Menthol Versus Nonmenthol Very-Low-Nicotine Cigarettes in a Cross-Over Trial

Abstract

Introduction

The U.S. Food and Drug Administration proposed rulemaking to reduce cigarette nicotine content and ban menthol in cigarettes. Menthol is popular among young adults who smoke, although it is unclear how this group would respond if both policies were implemented.

Methods

A total of 112 young adults who smoke menthol cigarettes completed 3 visits that varied by cigarette smoked (2021–2024): usual brand menthol, menthol very-low-nicotine cigarette (0.3 mg nicotine/g tobacco), and nonmenthol very-low-nicotine cigarette. Very-low-nicotine cigarette flavor order was counterbalanced. Subjective response and smoking topography were assessed at each session as well as pre–post smoking measurements of expired carbon monoxide, cigarette weight, cardiovascular effects, nicotine withdrawal, and craving. Repeated-measures ANOVAs were used to examine differences in the outcomes across cigarette type.

Results

Total smoking duration, interpuff interval, and puff count were higher for usual brand than for both very-low-nicotine cigarette smoking. Interpuff interval was higher in menthol very-low-nicotine cigarette smoking than nonmenthol. Usual brand was more appealing than both very-low-nicotine cigarettes and led to greater increases in carbon monoxide and cardiovascular effects and decreased postsmoking cigarette weight and craving compared with both very-low-nicotine cigarettes. Menthol very-low-nicotine cigarettes produced more positive subjective responses, higher carbon monoxide, and lower postsmoking cigarette weight and craving than nonmenthol.

Conclusions

Participants preferred menthol over nonmenthol very-low-nicotine cigarettes, although very-low-nicotine cigarettes were less appealing than usual brand, overall. Despite similar topography across very-low-nicotine cigarette flavors, toxicant exposure and craving were greater and lower, respectively, after menthol than after nonmenthol very-low-nicotine cigarette smoking. Findings support the U.S. Food and Drug Administration’s proposals to ban menthol cigarettes and institute market-wide reductions in cigarette nicotine content.