Perceptions of a Menthol Cigarette and Flavored Cigar Ban in Black and White Adults in the United States who Smoke Menthol Cigarettes and Factors Associated with Ban Opposition or Ambivalence

ObjectivesMenthol flavoring is a critical public health issue, but prior work has largely represented the voices of White adults who smoke (AWS) menthol cigarettes who comprise a small subset of AWS menthol cigarettes in the US. This study compared perceptions of a hypothetical MC/FC ban among Black and White AWS menthol cigarettes. MethodsParticipants were a convenience sample of 2,113 Black and 1,087 White AWS menthol cigarettes collected through Amazon Mechanical Turk between July 2023 and January 2024. Participants reported opinions about a MC/FC ban, likely public health outcomes, and hypothetical impact of the ban on their smoking behavior. Stepwise logistic regression modeled factors associated with ban opposition/ambivalence. ResultsOver one-third of menthol cigarette users supported a MC/FC ban (Black, 37.2% vs White, 34.5%, p=.13], but Black AWS were more likely to endorse public health benefits of a ban assessed via agreement with 5 statements of FDA rationale [3.0 (SD=1.7) versus 2.4 (SD=1.8), p<.001]. Smoking more cigarettes per day, belief that menthol cigarettes are more addictive/harder to quit, and intent to continue using nicotine under a ban increased odd of opposition/ambivalence. ConclusionsCompared to White AWS, Black AWS were more likely to believe that a MC/FC ban would benefit public health and showed no statistical difference in overall support for a ban. Targeted outreach to those who consume more menthol products and those who do not intend to quit nicotine could increase ban support among menthol users. Summary Box1) What is the current understanding of this subject?Knowledge of the publics perception of a MC/FC ban is largely informed by White menthol cigarette users. Given that Blacks represent the majority of AWS menthol cigarettes in the US, the paucity of data from Black voices engenders a critical gap in research used to inform health policy. 2) What does this report add to the literature?Compared to White AWS, Black AWS were more likely to believe that a MC/FC ban would benefit public health and showed no statistical difference in overall support for a ban. To our knowledge, this study comprises the largest convenience sample of perceptions and perceived impact of a federal MC/FC product standard among Black AWS menthol cigarettes in the US and provides valuable evidence to inform policy action in these areas. 3) What are the implications for public health practice?Findings support ongoing efforts to advance a MC/FC product standard and suggest that targeted outreach to those who consume more menthol products and those who do not intend to quit nicotine could increase ban support among menthol users.