Abstract Title Black and White Menthol Smokers’ Perceptions of the FDA’s Proposed Ban on Menthol Cigarettes

Background Menthol as a characterizing flavor in cigarettes is a critical public health issue due, in large part, to targeted tobacco industry marketing that has led to Black adults disproportionately using a product that is more addictive and harder to quit. Recent estimates indicate that 81% of Black adults who smoke and 34%-51% of adults who smoke in other racial/ethnic minority groups use menthol cigarettes. In April 2022, FDA announced its commitment to advance a product standard banning menthol in cigarettes and prohibiting characterizing flavors other than tobacco in cigars. To-date, no federal menthol cigarette or flavored cigar (MC/FC) product standards (commonly called ‘bans’) have been enacted, despite evidence that these actions could potentially improve public health and promote smoking cessation.

Methods Study participants were registered workers on Amazon’s Mechanical Turk (MTurk) who opted into the study between July 2023 and January 2024. Eligible participants (n=3,200) completed a survey assessing perceptions and perceived impacts of the FDA’s proposed product standard limiting characterizing flavors in MC/FC. Eligible participants were African American/Black or White adults (> 21 years of age) who had been menthol cigarette smokers for at least one year and were using a computer with a United States IP address.

Results There was no difference in favor/opposition to the proposed MC/FC ban with 37.2% of Black and 34.5% of White adults who smoke menthol cigarettes stating that they were in favor of the ban (p=0.13). Notably, while overall endorsement of beliefs that menthol cigarettes are more addictive, harmful, and harder to quit than non-menthol cigarettes was low overall, Black participants in this study were more likely than White participants to endorse these beliefs. A greater proportion of Black adults also demonstrated support for the FDA's proposed rationale for the product standard. Both groups were concerned that a MC/FC ban would lead to increased policing and victimization in their community (95.3% overall) and other vulnerable communities (90.9% overall).

Conclusion Our research has produced several key findings, including identification of factors associated with support of or opposition to the ban, racial differences in perceptions of the proposed ban, determination of specific concerns related to the impact of the ban, and participant intentions for future tobacco use or cessation following the ban. This data will serve to inform the FDA’s policies on menthol flavoring and assist public health researchers in planning for best smoking cessation practices in anticipation of the proposed policy shift.