Association of Use of Menthol- Versus Tobacco-Flavored ENDS with Switching Completely Away from Cigarettes and Differences by Menthol Cigarette Smoking

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Introduction Menthol cigarettes and menthol-flavored electronic nicotine delivery systems (ENDS) are a current focus of US regulatory policy considerations. Informed policy requires understanding how ENDS flavor may influence smoking behavior, and whether this association varies by preferred cigarette flavor. Materials and methods The analytic sample included 8,428 US adults who smoked cigarettes (AWS) in the Adult JUUL Switching and Smoking Trajectories Study and used tobacco- or menthol-flavored JUUL products. Repeated-measures logistic regressions assessed the time-varying association between primary JUUL flavor (menthol vs. tobacco) and switching (no past-30-day smoking) across four follow-ups in year 2 of the study, adjusting for sociodemographics and baseline smoking history. Analyses also examined interactions with cigarette flavor preference (menthol vs. non-menthol). Results AWS smoking menthol cigarettes predominantly used menthol-flavored JUUL (∼70% of follow-ups) and had significantly higher switch rates (aOR[95%CI] = 1.30[1.09–1.55]). AWS primarily using menthol-flavored (vs. tobacco-flavored) JUUL had higher odds of switching (aOR = 1.24[1.08–1.43]). The association varied by preferred cigarette flavor: AWS who smoked non-menthol cigarettes had higher odds of switching when using menthol- (vs. tobacco-flavored) JUUL aOR = 1.21[1.05–1.40]). Among AWS who smoked menthol cigarettes, the difference in switching was not significant, but trended in the opposite direction (aOR = 0.94[0.79–1.11] for menthol- vs. tobacco-flavored JUUL). More generally, AWS who used cigarette-incongruent JUUL flavors (especially non-menthol cigarettes and Menthol-flavored JUUL) had higher odds of switching (aOR = 1.16[1.04–1.29]). Discussion Some menthol-flavored ENDS may promote complete switching beyond that facilitated by tobacco-flavored ENDS. Cigarette-incongruent ENDS flavors, especially menthol-flavored ENDS among people who smoke non-menthol cigarettes, may facilitate increased switching.