Introduction: Little is known about the beliefs that youth and young adults hold about menthol cigarettes or the influence of these beliefs on tobacco use initiation.
Methods: Online cross-sectional surveys with 13- to 17-year-old current nonsmokers (n = 553) and 18- to 25-year-old never (n = 586) and current tobacco users (n = 307) in the United States assessed the association between endorsing each of 9 pro-menthol beliefs and (a) intentions to smoke menthol cigarettes over the next year, (b) current use of menthol cigarettes, (c) intentions to use tobacco in general over the next year, and (d) current use of tobacco products in general.
Results: Menthols were perceived to be less harmful and addictive than nonmenthol cigarettes by between 13% and 23% of respondents. Between 20% and 58% believed that menthols had favorable sensory properties, and 7%-25% believed that menthol smokers were more popular and attractive than nonmenthol smokers. Logistic regression analyses (adjusting for confounders) indicated that, on the whole, those who endorsed pro-menthol beliefs were more likely to intend to use, and to currently use, both menthols and tobacco products in general. For example, respondents who believed that menthol cigarettes were more refreshing in sensation (one of the most frequently endorsed beliefs) were significantly more likely to (a) intend to smoke menthol cigarettes (13- to 17-year-olds, odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.03, 4.34; 18- to 25-year olds, OR = 2.62, 95% CI = 1.04, 6.60), (b) currently use menthol cigarettes (18- to 25-year olds, OR = 3.40, 95% CI = 2.20, 5.26), (c) intend to use tobacco (13- to 17-year-olds OR = 1.74, 95% CI = 1.14, 2.65), and (d) currently use tobacco (18- to 25-year olds, OR = 2.06, 95% CI = 1.44, 2.93).
Conclusions: Youth and young adults who do not currently smoke and who hold favorable beliefs about menthol cigarettes are at greater risk for beginning to use tobacco products, indicating that the availability of menthol cigarettes may contribute to tobacco use initiation. These findings support recent claims that the elimination of menthol cigarettes would improve public health in the United States.
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