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KreslakeJM, etal. Tob Control 2024;0:1–8. doi:10.1136/tc-2024-058589
Youth and young adult flavour expectancies for new
‘non- menthol’ cigarettes introduced following
California’s ban on flavoured tobaccoproducts
Jennifer M Kreslake ,1 Jamie Cordova,2 Andrew B Seidenberg ,1
Fatma Romeh M Ali ,2 Barbara Schillo,1 Kristy Marynak3
Original research
To cite: KreslakeJM,
CordovaJ, SeidenbergAB,
etal. Tob Control Epub ahead
of print: [please include Day
Month Year]. doi:10.1136/
tc-2024-058589
►Additional supplemental
material is published online
only. To view, please visit the
journal online (https:// doi. org/
10. 1136/ tc- 2024- 058589).
1Truth Initiative Schroeder
Institute, Washington, District of
Columbia, USA
2CDC Foundation, Atlanta,
Georgia, USA
3Office on Smoking and Health,
Centers for Disease Control and
Prevention, Atlanta, Georgia,
USA
Correspondence to
Dr Jennifer M Kreslake;
jkreslake@ truthinitiative. org
Received 5 January 2024
Accepted 6 August 2024
© Author(s) (or their
employer(s)) 2024. Re- use
permitted under CC BY- NC. No
commercial re- use. See rights
and permissions. Published
by BMJ.
ABSTRACT
Background Following California’s statewide law
prohibiting the sale of flavoured tobacco products, some
cigarette brands introduced new variants advertised as
non- menthol, yet featuring design and text commonly
found in menthol cigarette marketing.
Methods Data are from the February–May 2023 wave
of the Tobacco Epidemic Evaluation Network (TEEN+)
national probability- based survey (aged 13–25 years).
Respondents (N=10 217) were shown images of two (of
four) ’new non- menthol’ brand ads or packaging and
two comparators (’classic’ non- menthol and menthol
cigarette brands). Respondents reported expected taste
of each (no or any minty/menthol taste; ’don’t know’).
Multinomial regression models tested associations
between predictors (age, gender identity, race and
ethnicity, perceived financial situation, smoking status)
and expectation of minty/menthol taste.
Results Younger age was associated with expectations
of minty/menthol taste, controlling for covariates.
Respondents aged 13–17 years had greater odds of
expecting minty/menthol taste than no minty/menthol
taste for all tested new non- menthol brands (Camel
Crush Oasis adjusted OR (aOR): 1.30, p<0.05; Camel
Crisp aOR: 1.47, p<0.001; Kool Non- Menthol Blue
aOR: 1.27, p<0.05; Kool Non- Menthol Green aOR:
1.43, p<0.01), compared to respondents aged 21 and
older. Respondents aged 18–20 years had greater
odds of reporting minty/menthol expectancies than
no minty/menthol expectancies for Camel Crush Oasis
(aOR: 1.35, p<0.05) and Kool Non- Menthol Green
(aOR: 1.29, p<0.05) compared to those aged 21–25
years. Compared to non- Hispanic white respondents,
non- Hispanic Asian respondents had greater odds of
expecting minty/menthol taste than no minty/menthol
taste for Camel Crush Oasis (aOR: 1.89, p<0.01), Kool
Non- Menthol Blue (aOR: 1.88, p<0.01) and Kool Non-
Menthol Green (aOR: 1.72, p<0.05).
Discussion Younger age was associated with
expectations of new non- menthol cigarettes having a
minty/menthol taste. Results raise concerns regarding the
potential appeal of these products to youth and young
adults.
INTRODUCTION
Menthol is a chemical compound with anaesthe-
tising properties that, when added to cigarettes,
produces a minty taste and cooling sensation.1
Menthol reduces the harshness of tobacco smoke
and facilitates trial and use.2–4 People who are
young and/or inexperienced with smoking are
more likely to use menthol than non- menthol ciga-
rettes, and thus, these products prompt concerns
regarding their role in youth initiation of tobacco
and nicotine use.5 6
California began enforcing a statewide law
prohibiting the sale of flavoured tobacco prod-
ucts on 21 December 2022. The law prohib-
ited the sale of menthol cigarettes, which are not
subject to federal restrictions on flavoured cigarette
sales.7 California is the second US state with such
a law, preceded only by Massachusetts, which was
effective June 2020.8 Following this, some major
menthol cigarette brands introduced new ciga-
rette variants advertised as ‘non- menthol’ in these
states.9 However, certain new brand variants were
marketed, through various channels including
outdoor ads, on brand websites and through direct
mail, with messaging suggesting they were designed
specifically for people who smoked menthol ciga-
rettes (eg, ‘Your answer to California’s menthol
ban’ and ‘Your favorite menthol styles are gone,
WHAT IS ALREADY KNOWN ON THIS TOPIC
⇒Youth perceive green colour schemes to
indicate that a cigarette is mentholated, and
blue to imply a mild, mellow, smooth and/or
menthol flavour. People who are young and/or
inexperienced with smoking are more likely to
use menthol than non- menthol cigarettes.
WHAT THIS STUDY ADDS
⇒More youth and young adults have inaccurate
flavour expectancies for “new non- menthol”
brands introduced in California following
statewide flavor restrictions, than for classic
non- menthol or menthol brands. Based on the
ads and/or packaging, new non- menthols were
frequently expected to have a menthol taste.
⇒Menthol flavour expectancies of new non-
menthol brands were more likely among youth
compared to young adults, as well as among
Asian non- Hispanic individuals compared to
those who are white.
HOW THIS STUDY MIGHT AFFECT RESEARCH,
PRACTICE OR POLICY
⇒New non- menthol brand variants in jurisdictions
where menthol cigarettes are banned could
circumvent the intended effect of public health
policy.
on September 11, 2024 by guest. Protected by copyright.http://tobaccocontrol.bmj.com/Tob Control: first published as 10.1136/tc-2024-058589 on 10 September 2024. Downloaded from
2KreslakeJM, etal. Tob Control 2024;0:1–8. doi:10.1136/tc-2024-058589
Original research
but we’ve crafted two new non- menthol blends with you in
mind.’).9 10
Despite the use of the term ‘non- menthol’ on pack labels
and accompanying ads, both packaging and ads feature colour
schemes (ie, green, blue), terminology (eg, ‘fresh’, and ‘green’ or
‘blue’) and imagery (eg, water) commonly found in marketing
of menthol cigarettes.9 Previous studies have found that youth
recognise green cigarette packaging and colour schemes as
denoting menthol.11 12 The current study examines whether
young people in the USA expect ‘new non- menthol’ brand vari-
ants to have a minty or menthol taste based on their packaging
and/or advertising, and identify individual characteristics associ-
ated with these perceptions.
METHODS
Data collection
Data are from Wave 2 of the Tobacco Epidemic Evalua-
tion Network (TEEN+) study, an online survey of a national
probability- based cohort of youth and young adults (aged 13–25
years) administered by the CDC Foundation.13 The Wave 2
fielding period spanned February 2023 to May 2023. Survey
measures that are specific to new non- menthol brands were added
in Wave 2. The national sample of respondents (N=10 217)
were shown images of packaging and/or marketing materials
for two new non- menthol brands that were being marketed in
California as of December 2022: Camel Crisp and Kool Non-
Menthol Green (‘A’ and ‘C’) or Camel Crush Oasis and Kool
Non- Menthol Blue (‘B’ and ‘D’). They were also shown pack
images for two comparator cigarettes: a ‘classic’ non- menthol:
Marlboro Gold (‘E’) or Camel Regular (“G”); and a ‘classic’
menthol: Camel Menthol (‘F’) or Newport (‘H’). See figure 1 for
the ads and packs included in the study. Each image was shown
on a separate screen and the participants advanced to the next
screen after responding to the flavour expectancy question for
that brand. The images were not paired, but respondent received
four images that included at least two ‘new non- menthol’ images,
one classic non- menthol image and one classic menthol image.
The selection of images (A–H) and order in which the images
were presented were randomised by respondent.
All survey respondents were asked, Which do you think best
describes the taste of this product? Response options were: This
product has NO minty/menthol taste; This product has SOME
minty/menthol taste; This product has a STRONG minty/
menthol taste; do not know. ‘Some’ and ‘strong’ responses were
collapsed into an ‘any minty/menthol taste’ for the main analysis.
Statistical analysis
Data were weighted according to national demographic bench-
marks for age, race and ethnicity, and sex. Weighted proportions
were tabulated to identify perceptions (no minty/menthol taste;
some minty/menthol taste; strong minty/menthol taste; don’t
know) of each new non- menthol product and classic compara-
tors. To provide additional insight, results were examined when
stratified according to age group and smoking status (never vs
ever).
For each new non- menthol brand variant and each ‘classic’
menthol or non- menthol brand, multinomial logistic regression
was used to assess whether perceptions of any minty/menthol
taste (recoded by combining responses for ‘some’ or ‘strong’
taste expectancies) were associated with individual characteris-
tics found to be significant for at least one brand in bivariate χ2
tests of association: age group (13–17; 18–20, 21–25); gender
Figure 1 Marketing materials and packaging tested among youth and young adults in the USA to measure flavor expectancies of cigarette brand
variants.
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KreslakeJM, etal. Tob Control 2024;0:1–8. doi:10.1136/tc-2024-058589
Original research
identity (boy or man; girl or woman; non- binary, questioning,
or something else); race and ethnicity (white and non- Hispanic;
black and non- Hispanic; Asian and non- Hispanic; multira-
cial and other non- Hispanic; Hispanic); a subjective measure
of financial situation (lives comfortably; meets needs with a
little left over; just meets needs with nothing left over; does
not meet needs)14; and current smoking status (never smoked;
ever smoked, but not in the past 30 days; smoked a cigarette at
least 1 day in the past 30 days). To understand whether ‘don’t
know’ responses inform the study’s conclusions, the multino-
mial regression models included ‘don’t know’ as an outcome for
each brand (ie, ‘no minty/menthol taste’ vs ‘any minty/menthol
taste’ and ‘don’t know’).
RESULTS
The weighted demographic characteristics of the sample are
presented in table 1. Among the 10 217 youth and young adults
in the study sample, 40.9% were ages 13–17 years, slightly
less than one- quarter (22.2%) were ages 18–20 years and
slightly more than one- third (36.9%) were ages 21–25 years.
Slightly less than half (46.8%) of respondents identified as a
girl or woman, half (49.7%) as a boy or man, and 3.5% as
non- binary, something else or questioning their gender iden-
tity. Approximately half (51.8%) of respondents identified as
white and non- Hispanic, 13.8% as black or African American
and non- Hispanic, 5.5% as Asian and non- Hispanic, and 4.9%
as another or multiple races and non- Hispanic. Nearly one-
quarter (24.0%) reported being of Hispanic or Latino ethnicity.
When providing a subjective measure of their financial situa-
tion, 47.6% reported living comfortably, 33.9% reported that
their needs were met with a little left over, 15.7% reported
just meeting basic expenses with nothing left over and 2.8%
reported not meeting basic expenses. Three- quarters (75.3%)
of respondents had never smoked a cigarette.
Expectations of minty/menthol taste of each brand variant
are summarised in table 2. Respondents were approximately
evenly divided according to whether they thought each new
non- menthol brand had no minty/menthol taste, any minty/
menthol taste or they did not know. For Camel Crisp, 20.8%
of respondents expected it would have ‘some’ minty/menthol
flavour, while 12.5% expected it to have a strong minty/menthol
taste. Slightly less than one- quarter (22.6%) of respondents
expected Camel Crush Oasis to have some minty/menthol taste
and 17.9% expected it would have a strong minty/menthol taste.
Nearly one- quarter (23.3%) of respondents expected Kool Non-
Menthol Blue to have some minty/menthol taste, and 16.3% felt
it would have a strong minty/menthol flavour. For Kool Non-
Menthol Green, 21.0% of respondents expected ‘some’ and
13.6% expected ‘strong’ minty/menthol taste.
Many respondents correctly expected the ‘classic’ menthol
brands (Camel Menthol and Newport) to have a minty/menthol
taste (62.9% and 47.1%, respectively). Slightly more than one-
quarter (27.3%) of respondents expected Newport to have some
minty/menthol taste, an additional 19.8% expected it to have
a strong minty/menthol taste, and 14.6% expected it to have
no minty/menthol taste. The plurality of respondents (40.8%)
expected Camel Menthol to have a strong minty/menthol taste,
and an additional 22.1% expected it to have ‘some’ minty/
Table 1 Sociodemographic characteristics of US youth and young
adults in Wave 2 of the TEEN+ study, February–May 2023 (N=10 217)
n (weighted %)
Age
13–17 years 4055 (40.9)
18–20 years 2518 (22.2)
21–25 years 3644 (36.9)
Gender identity
Boy or man 4444 (49.7)
Girl or woman 5303 (46.8)
Non- binary, questioning or other gender identity 454 (3.5)
Race/ethnicity
Asian, non- Hispanic 472 (5.5)
Black or African American, non- Hispanic 1149 (13.8)
Hispanic or Latino 1858 (24.0)
Multiracial or other, non- Hispanic 784 (4.9)
White, non- Hispanic 5954 (51.8)
Perceived financial situation
Lives comfortably 4278 (47.6)
Meets needs with a little left over 3731 (33.9)
Just meets needs with nothing left over 1819 (15.7)
Does not meet needs 363 (2.8)
Smoking status
Never smoked 7682 (75.3)
Ever smoked, but not currently 1946 (18.7)
Currently smokes 589 (6.0)
Table 2 US youth and young adults’ flavour expectancies in response to ads for cigarette brand variants, TEEN+ study, February–May 2023
Which do you think best describes the taste of this product?
No minty/menthol weighted %
(95% CI)
Some minty/menthol
weighted % (95% CI)
Strong minty/menthol weighted %,
(95% CI)
Do not know weighted %,
(95% CI)
New ‘non- menthol’
Camel Crisp 36.7 (34.9, 38.5) 20.8 (19.4, 22.3) 12.5 (11.3, 13.8) 30.0 (28.3, 31.8)
Camel Crush Oasis 25.1 (23.5, 26.7) 22.6 (21.1, 24.2) 17.9 (16.5, 19.5) 34.3 (32.6, 36.1)
Kool Non- Menthol Green 35.5 (33.7, 37.3) 21.0 (19.5, 22.6) 13.6 (12.4, 14.9) 29.9 (28.2, 31.7)
Kool Non- Menthol Blue 30.9 (29.2, 32.7) 23.3 (21.8, 24.9) 16.3 (15.0, 17.8) 29.5 (27.8, 31.2)
Classic menthol
Camel Menthol 6.3 (5.4, 7.2) 22.1 (20.6, 23.7) 40.8 (39.0, 42.7) 30.8 (29.1, 32.6)
Newport 14.6 (13.3, 16.0) 27.3 (25.6, 29.0) 19.8 (18.3, 21.3) 38.4 (36.6, 40.2)
Classic non- menthol
Marlboro Gold 51.0 (49.1, 52.8) 6.6 (5.8, 7.6) 4.6 (3.9, 5.4) 37.8 (36.0, 39.6)
Camel 52.4 (50.5, 54.2) 5.5 (4.7, 6.4) 4.4 (3.7, 5.2) 37.7 (35.9, 39.5)
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Original research
menthol taste. Few (6.3%) expected Camel Menthol to have no
minty/menthol taste.
Few respondents expected ‘classic’ non- menthol brands Marl-
boro Gold and Camel to have any minty/menthol taste; instead,
approximately half of sampled respondents correctly expected
that these would have none (51.0% and 52.4%, respectively).
For all brand variants (new non- menthol, classic menthol, and
classic non- menthol), the proportion responding ‘don’t know’
ranged from 29.5% to 38.4%.
Online supplemental table 1 stratified flavour expectancies,
including ‘don’t know’ responses, by age group. Similar propor-
tions of respondents aged 13–17 and aged 18–20 years expected
any menthol taste for Camel Crisp (32.8% and 34.8%, respec-
tively) and Kool Non- Menthol Green (34.1% and 37.0%), while
the youngest respondents (aged 13–17) reported expectations
of any menthol taste less frequently for Camel Crush Oasis
(34.9% and 44.1%, respectively) and Kool Non- Menthol Blue
(37.6% and 43.6%) compared with respondents aged 18–20
years. For all brands included in the study, youth aged 13–17
years reported ‘don’t know’ more frequently than young adults
(35.7–47.7%, compared with 25.8–37.3% among 18–20 year
olds and 24.1–31.6% of 21–25 year olds).
Multinomial models of the relationship between individual-
level characteristics and respondents’ expectation of minty/
menthol taste of new non- menthol brands found significant
associations for age, controlling for gender identity, race and
ethnicity, perceived financial situation and smoking status
(table 3). Compared with respondents aged 21 years and older,
respondents aged 13–17 years had greater odds of reporting
minty/menthol flavour expectancies than no minty/menthol
expectancies for all new non- menthol brand variants: Camel
Crush Oasis (adjusted OR (aOR) 1.30, 95% CI 1.03 to 1.63);
Kool Non- Menthol Blue (aOR 1.27, 95% CI 1.02 to 1.59);
Camel Crisp (aOR 1.47, 95% CI 1.18 to 1.83); and Kool Non-
Menthol Green (aOR 1.43, 95% CI 1.15 to 1.79). Respondents
aged 18–20 years had greater odds of reporting minty/menthol
expectancies than no menthol expectancies for Camel Crush
Oasis (aOR 1.35, 95% CI 1.04 to 1.75) and Kool Non- Menthol
Blue (aOR 1.27, 95% CI 1.00 to 1.61) compared with those aged
21 and older. In the same models, respondents aged 13–17 years
had significantly greater odds of responding that they ‘don’t
know’ what they expected the new non- menthol brands to taste
like than having no minty/menthol expectancies compared with
those aged 21–25 years: Camel Crush Oasis (aOR 1.83, 95% CI
1.43 to 2.33); Kool Non- Menthol Blue (aOR 1.68, 95% CI 1.33
to 2.23); Camel Crisp (aOR 1.60, 95% CI 1.26 to 2.02); Kool
Non- Menthol Green (aOR 1.60, 95% CI 1.27 to 2.03).
Less consistent significant effects on expectations of minty/
menthol taste were found for most other individual character-
istics, controlling for all covariates listed above (table 3). One
exception was found among non- Hispanic Asian respondents;
this group had significantly greater odds of perceiving minty/
menthol taste than no menthol expectancies compared to those
who were non- Hispanic white for Camel Crush Oasis (aOR
1.89, 95% CI 1.20 to 2.98), Kool Non- Menthol Blue (aOR 1.88,
95% CI 1.17 to 3.01) and Kool Non- Menthol Green (aOR 1.72,
95% CI 1.10 to 2.70). Black non- Hispanic respondents were
significantly more likely to respond that they did not know what
each new non- menthol brand would taste like than no menthol
expectancies compared with white non- Hispanic respondents
(table 3). A similar pattern for the ‘don’t know’ response
outcome was observed among Asian non- Hispanic respondents
for each brand, and among Hispanic respondents for all brands
except Kool Non- Menthol Green.
Smoking status was not a significant predictor of of minty/
menthol flavour expectancies for most new non- menthol brands
(table 3), with the exception of Camel Crush Oasis where respon-
dents who had ever smoked (aOR 1.87, 95% CI 1.43 to 2.45) or
currently smoke (aOR 3.35, 95% CI 2.09 to 5.35) had signifi-
cantly greater odds of expecting any minty/menthol taste than
no minty/menthol taste compared with those who had never
smoked. Those who had ever or currently smoked were signifi-
cantly less likely to indicate that they ‘don’t know’ how they
expected Camel Crisp, Kool Non- Menthol Blue or Kool Non-
Menthol Green to taste than having no minty/menthol expec-
tancies, compared with respondents who had never smoked
(table 3). For most new non- menthol brands, a similar propor-
tion of those with and without smoking experience expected the
new non- menthol brands to have some or strong minty/menthol
taste for Camel Crisp (47.7% and 47.5%, respectively), Kool
Non- Menthol Blue (53.2% and 57.4%, respectively) and Kool
Non- Menthol Green (47.7% and 50.0%, respectively) (online
supplemental table 2).
Multinomial models of ‘classic’ brands show that the youngest
respondents (aged 13–17 years) have higher odds of inaccu-
rately expecting classic non- menthol brands Marlboro Gold
(aOR 1.42, 95% CI 1.04 to 1.93) and Camel (aOR 1.48, 95% CI
1.08 to 2.02) to have a minty/menthol taste than no minty/
menthol taste, compared with those aged 21–25 years (table 4).
In contrast to the results observed for some new non- menthol
brands (table 3), respondents aged 18–20 years did not signifi-
cantly differ from those aged 21–25 years in their flavour
expectancies for any classic brands (table 4). No relationship
was found between age and flavour expectancies for the classic
menthol brands Camel Menthol or Newport, although respon-
dents aged 13–17 years were significantly more likely to indicate
that they did not know what they expected Newport to taste like
than expect no menthol taste (OR 1.56, 95% CI 1.17 to 2.07)
compared to those aged 21–25 years.
Respondents who had ever smoked reported accurate flavour
expectancies with greater frequency for all ‘classic’ menthol
and non- menthol brands compared with those who had never
smoked. In multinomial models, those who had ever or currently
smoked were significantly more likely to expect classic menthol
brands to have a minty/menthol taste than have no minty/menthol
taste compared with those who had never smoked (table 4), and
significantly less likely to expect the classic non- menthol brand
Camel to have a minty/menthol taste than no minty/menthol
taste compared with those who had never smoked. No differ-
ence was found in multinomial models for flavour expectancies
of the classic non- menthol Marlboro Gold according to smoking
status. Those who had ever or currently smoked had signifi-
cantly lower odds of indicating that they did not know whether
each ‘classic’ brand had a minty or menthol taste than no minty/
menthol taste compared with those who had never smoked,
with the exception of Camel Menthol where no difference in the
likelihood of ‘don’t know’ responses was observed according to
smoking status (table 4).
DISCUSSION
Results indicate that at least one- third of respondents viewing the
ads/packages for new non- menthol brand variants in this study
(Camel Crisp, Camel Crush Oasis, Kool Non- Menthol Green
or Kool Non- Menthol Blue) expected each to have a minty or
menthol taste, despite non- menthol descriptors featured on the
packaging and ad copy. Respondents were particularly inclined
to feel that Camel Crush Oasis and Kool Non- Menthol Blue
on September 11, 2024 by guest. Protected by copyright.http://tobaccocontrol.bmj.com/Tob Control: first published as 10.1136/tc-2024-058589 on 10 September 2024. Downloaded from
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Original research
Table 3 Multinomial regression models of individual characteristics that predict US youth and young adult expectancies of minty/menthol flavour based on advertising or packaging for ‘new non-
menthol’ cigarette brand variants, TEEN+ study, February–May 2023
Camel Crush Oasis Camel Crisp Kool Non- Menthol Blue Kool Non- Menthol Green
Any minty/menthol
taste Do not know
Any minty/menthol
taste Do not know
Any minty/menthol
taste Do not know
Any minty/menthol
taste Do not know
aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI)
Age group (years)
13–17 1.30 (1.03, 1.63)* 1.83 (1.43, 2.33)*** 1.47 (1.18, 1.83)*** 1.60 (1.26, 2.02)*** 1.27 (1.02, 1.59)* 1.68 (1.33, 2.23)*** 1.43 (1.15, 1.79)** 1.60 (1.27, 2.03)***
18–20 1.35 (1.04, 1.75)* 1.31 (0.99, 1.73) 1.22 (0.95, 1.56) 1.06 (0.81, 1.38) 1.27 (1.00, 1.61) 1.10 (0.84, 1.46) 1.29 (1.01, 1.65)* 1.09 (0.84, 1.43)
21–25 Ref Ref Ref Ref Ref Ref Ref Ref
Gender identity
Boy or man Ref Ref Ref Ref Ref Ref Ref Ref
Girl or woman 0.97 (0.80, 1.18) 0.86 (0.70, 1.05) 1.21 (1.01, 1.45)* 1.06 (0.88, 1.29) 1.12 (0.93, 1.35) 1.01 (0.82, 1.23) 0.94 (0.78, 1.12) 1.04 (0.86, 1.26)
Non- binary, questioning or other gender identity 0.95 (0.63, 1.44) 0.73 (0.46, 1.15) 0.71 (0.44, 1.15) 1.19 (0.72, 1.97) 2.01 (1.28, 3.13)** 1.39 (0.86, 2.23) 0.82 (0.51, 1.32) 1.30 (0.78, 2.15)
Race/ethnicity
Asian, non- Hispanic 1.89 (1.20, 2.98)** 2.11 (1.30, 3.44)** 1.46 (0.94, 2.27) 1.62 (1.03, 2.53)* 1.88 (1.17, 3.01)** 1.91 (1.12, 3.24)* 1.72 (1.10, 2.70)* 1.75 (1.11, 2.78)*
Black or African American, non- Hispanic 0.99 (0.71, 1.39) 2.52 (1.84, 3.45)*** 0.83 (0.61, 1.14) 1.76 (1.31, 2.35)*** 0.84 (0.62, 1.14) 2.15 (1.59, 2.90)*** 0.92 (0.67, 1.25) 1.60 (1.20, 2.14)**
Hispanic or Latino 1.19 (0.92, 1.54) 1.59 (1.22, 2.06)*** 1.11 (0.88, 1.41) 1.51 (1.18, 1.92)** 0.95 (0.75, 1.21) 1.36 (1.05, 1.76)* 0.97 (0.77, 1.23) 1.19 (0.93, 1.51)
Multiracial or other, non- Hispanic 0.89 (0.62, 1.27) 1.00 (0.69, 1.47) 1.00 (0.79, 1.41) 1.13 (0.78, 1.64) 0.65 (0.46, 0.92)* 0.96 (0.67, 1.38) 0.93 (0.65, 1.33) 1.08 (0.74, 1.56)
White, non- Hispanic Ref Ref Ref Ref Ref Ref Ref Ref
Perceived financial situation
Lives comfortably Ref Ref Ref Ref Ref Ref Ref Ref
Meets needs with a little left over 1.05 (0.85, 1.31) 1.15 (0.92, 1.44) 1.18 (0.97, 1.44) 0.98 (0.79, 1.22) 0.88 (0.71, 1.07) 0.96 (0.77, 1.20) 0.97 (0.79, 1.18) 0.95 (0.77, 1.18)
Just meets needs with nothing left over 1.36 (1.02, 1.81)* 1.18 (0.88, 1.59) 1.09 (0.83, 1.44) 1.36 (1.03, 1.80)* 0.77 (0.59, 1.01) 0.78 (0.58, 1.05) 1.12 (0.85, 1.47) 1.42 (1.07, 1.88)*
Does not meet needs 2.15 (1.23, 3.77)** 2.57 (1.36, 4.83)** 0.87 (0.51, 1.47) 1.39 (0.80, 2.42) 0.76 (0.45, 1.30) 1.51 (0.87, 2.62) 0.74 (0.44, 1.23) 1.06 (0.61, 1.83)
Smoking status
Never smoked Ref Ref Ref Ref Ref Ref Ref Ref
Ever smoked, but not currently 1.87 (1.43, 2.45)*** 0.91 (0.67, 1.24) 1.15 (0.91, 1.46) 0.61 (0.46, 0.81)*** 1.04 (0.81, 1.32) 0.61 (0.45, 0.82)** 1.00 (0.79, 1.27) 0.59 (0.45, 0.77)***
Currently smokes 3.35 (2.09, 5.35)*** 0.71 (0.40, 1.28) 1.18 (0.80, 1.73) 0.23 (0.14, 0.38)*** 0.79 (0.55, 1.15) 0.31 (0.18, 0.51)*** 1.32 (0.90, 1.94) 0.36 (0.21, 0.61)***
*p<0.05; **p<0.01; ***p<0.001.
aOR, adjusted OR.
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Table 4 Multinomial regression models of individual characteristics that predict US youth and young adult expectancies of minty/menthol flavour based on advertising or packaging for ‘classic’ menthol
and non- menthol cigarette brand variants, TEEN+ study, February–May 2023
Camel Menthol Newport Marlboro Gold Camel
Any minty/menthol
taste Do not know
Any minty/menthol
taste Do not know Any minty/menthol taste Do not know
Any minty/menthol
taste Do not know
aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI)
Age group (years)
13–17 0.69 (0.46, 1.04) 1.08 (0.71, 1.64) 1.27 (0.97, 1.68) 1.56 (1.17, 2.07)** 1.42 (1.04, 1.93)* 1.70 (1.39, 2.08)*** 1.48 (1.08, 2.02)* 1.43 (1.16, 1.75)***
18–20 0.77 (0.49, 1.20) 0.69 (0.43, 1.11) 1.22 (0.90, 1.66) 1.23 (0.90, 1.68) 1.29 (0.92, 1.80) 1.05 (0.83, 1.34) 1.24 (0.85, 1.80) 1.05 (0.83, 1.33)
21–25 Ref Ref Ref Ref Ref Ref Ref Ref
Gender identity
Boy or man Ref Ref Ref Ref Ref Ref Ref Ref
Girl or woman 0.67 (0.48, 0.92)* 0.66 (0.46, 0.92)* 1.06 (0.84, 1.34) 1.06 (0.84, 1.34) 1.20 (0.93, 1.54) 1.05 (0.88, 1.25) 1.08 (0.83, 1.41) 1.04 (0.88, 1.23)
Non- binary, questioning or other gender identity 0.81 (0.42, 1.58) 0.55 (0.27, 1.13) 0.81 (0.42, 1.56) 1.19 (0.62, 2.29) 1.58 (0.95, 2.65) 0.88 (0.59, 1.32) 0.99 (0.52, 1.88) 1.72 (1.09, 2.70)*
Race/ethnicity
Asian, non- Hispanic 0.48 (0.26, 0.88)* 0.95 (0.50, 1.82) 0.61 (0.37, 0.99)* 0.64 (0.39, 1.04) 1.05 (0.56, 1.98) 1.13 (0.74, 1.73) 1.36 (0.77. 2.40) 1.15 (0.78, 1.69)
Black or African American, non- Hispanic 0.50 (0.31, 0.80)** 1.57 (0.97, 2.54) 1.05 (0.72, 1.53) 1.16 (0.80, 1.69) 3.39 (2.33, 4.92)*** 3.21 (2.42, 4.24)*** 4.40 (2.97, 6.52)*** 2.78 (2.11, 3.67)***
Hispanic or Latino 0.53 (0.36, 0.78)** 1.04 (0.69, 1.58) 0.84 (0.62, 1.12) 0.90 (0.67, 1.22) 1.73 (1.27, 2.39)*** 1.52 (1.22, 1.89)*** 1.76 (1.27, 2.44)*** 1.14 (0.92, 1.41)
Multiracial or other, non- Hispanic 0.58 (0.33, 1.03) 0.73 (0.40, 1.33) 1.11 (0.73, 1.69) 1.05 (0.68, 1.61) 1.18 (0.76, 1.82) 1.15 (0.85, 1.57) 0.95 (0.53, 1.71) 0.97 (0.81, 1.31)
White, non- Hispanic Ref Ref Ref Ref Ref Ref Ref Ref
Perceived financial situation
Lives comfortably Ref Ref Ref Ref Ref Ref Ref Ref
Meets needs with a little left over 1.31 (0.92, 1.86) 1.25 (0.87, 1.81) 1.07 (0.83, 1.37) 0.98 (0.76, 1.27) 1.14 (0.86, 1.51) 1.10 (0.90, 1.33) 1.12 (0.84, 1.50) 0.99 (0.82, 1.19)
Just meets needs with nothing left over 1.17 (0.73, 1.88) 1.00 (0.61, 1.66) 1.20 (0.84, 1.73) 1.25 (0.86, 1.80) 1.23 (0.86, 1.77) 0.89 (0.69, 1.14) 0.89 (0.59, 1.34) 1.21 (0.95, 1.55)
Does not meet needs 2.58 (0.65, 10.19) 4.08 (0.97, 17.12) 1.45 (0.75, 2.79) 1.42 (0.70, 2.87) 0.69 (0.24, 1.40) 1.36 (0.83, 2.23) 1.43 (0.66, 3.09) 1.20 (0.74, 1.92)
Smoking status
Never smoked Ref Ref Ref Ref Ref Ref Ref Ref
Ever smoked, but not currently 2.59 (1.68, 4.23)*** 1.40 (0.82, 2.36) 1.80 (1.33, 2.43)*** 0.70 (0.50, 0.98)* 0.87 (0.62, 1.21) 0.39 (0.30, 0.51)*** 0.48 (0.32, 0.71)*** 0.47 (0.37, 0.59)***
Currently smokes 1.65 (0.62, 4.41) 0.60 (0.20, 1.79) 2.41 (1.43, 4.06)** 0.30 (0.16, 0.56)*** 0.60 (0.33, 1.10) 0.17 (0.10, 0.29)*** 0.38 (0.20, 0.71)** 0.26 (0.17, 0.40)***
*p<0.05; **p<0.01; ***p<0.001.
aOR, adjusted OR.
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7
KreslakeJM, etal. Tob Control 2024;0:1–8. doi:10.1136/tc-2024-058589
Original research
would taste like mint or menthol. By contrast, few respondents
provided discordant responses for the classic brand variants;
only 6–15% incorrectly identified classic menthols (Camel
Menthol or Newport) as having no minty or menthol taste, and
approximately 10% incorrectly thought classic non- menthols
(Marlboro Gold or Camel) would have a minty or menthol
taste. At least half of the youth and young adults in the sample
were able to correctly identify whether or not each of the classic
brand variants would taste like mint or menthol. The proportion
of respondents who said they ‘don’t know’ whether the brand
variant would have a mint or menthol flavour was relatively
similar (ranging from 30% to 38%) for all tested ads and pack-
ages—including the classic menthol and classic non- menthol
cigarettes.
Consistent with cross- sectional nationally representative
surveys in the USA,15 16 most (about three- quarters) of the youth
and young adults surveyed in this study had never smoked ciga-
rettes. Nonetheless, the majority of respondents were able to
accurately distinguish the expected flavours of classic menthol
and classic non- menthol cigarette brand variants. Few reported
inaccurate flavour expectancies for classic brand variants, poten-
tially due to the brands’ marketing strategies and established
advertising cues, such as pack colour.11 12 Their flavour expec-
tancies of the ‘new non- menthol’ brand variants were notably
more mixed.
Younger age was the most consistent and significant factor
associated with respondents’ expectations that new non- menthol
brand variants would have a minty or menthol taste rather than
none, controlling for other demographic factors. In fact, the
youth in our sample answered ‘don’t know’ more frequently
when asked about flavour expectancies for ‘classic’ non- menthol
brands (Marlboro Gold and Camel) and the ‘classic’ menthol
brand that lacked a menthol descriptor (Newport) than they did
for new non- menthol brands. Respondents aged 18–20 years
also expressed significantly greater odds of expecting minty/
menthol taste than no minty/menthol taste for two new non-
menthol brands compared with those aged 21–25, yet did not
differ from older respondents in their flavour expectancies of
classic brands.
Previous research has shown that green colour schemes effec-
tively communicate to youth that a cigarette is mentholated, and
youth in these studies describe blue as denoting a mild, mellow,
smooth and/or menthol flavour.11 12 These sensory characteris-
tics appeal to youth, as they reduce the harshness of cigarette
smoke and mask the bitter taste of nicotine that can make early
smoking experiences more aversive.17–19 The new non- menthol
ads and packaging tested in this study prominently featured
green and blue colour schemes. Chemical analyses have detected
the presence of a synthetic cooling agent (WS- 3) in some new
non- menthol brand variants marketed in California—including
Camel Crisp, which was among the ads tested in the present
study.20 21 Neither WS- 3 nor menthol was found in the Kool
Non- Menthol or Camel Crush Oasis products sampled from
California in previous studies,20 21 but researchers have detected
flavour chemicals such as vanillin in Camel Crush Oasis that
have the potential to impart a sweet or candy flavour at suffi-
cient levels.20 Although research that tests consumer flavour
perceptions after smoking these new brand variants has yet to be
published, the advertising and packaging imply youth- appealing
sensory characteristics and thus may encourage trial and use of
these brands among youth and young adults. State and national
tobacco use surveys may consider measuring youth and young
adult use of new non- menthol brand variants to determine
whether these products are being used in trial and initiation of
cigarette smoking among young people, to inform the implemen-
tation and enforcement of policies restricting menthol tobacco
products. Additional research on product design features that
differentiate new non- menthols from classic brand variants is
also warranted. Finally, further study is warranted of our finding
that non- Hispanic Asian youth and young adults had a greater
likelihood of mint/menthol flavour expectancies of new non-
menthol brand variants compared with those who are white.
Our findings among this group are particularly relevant to Cali-
fornia, a state where more than fifteen percent of the population
is Asian or Asian- American.22
Limitations
This study is subject to limitations. First, it did not include
ads for all of the new non- menthol brand variants introduced
onto the market in California following the flavour ban. Other
brands introduced in California include Newport EXP and a
Newport Non- Menthol in green packaging (a departure from
the brand’s classic non- menthol in red packaging); both variants
were found to contain WS- 3, but not menthol, in laboratory
analyses.20 21 Second, there is a possibility that the greater like-
lihood of youth to expect minty/menthol taste across both new
non- menthol and classic non- menthol brands was due to greater
susceptibility to survey priming or acquiescence bias at younger
ages. Our survey item was designed to mitigate the potential for
response bias, including a neutral question prompt (‘Which do
you think best describes this product?’) and the inclusion of a
‘don’t know’ response option. Indeed, respondents aged 13–17
years used the ‘don’t know’ option with greater frequency
than any other age group. Third, our study did not control for
whether respondents had previously tried new non- menthol
brand variants, which would inform their flavour expectancies.
However, this limitation is unlikely to have influenced the find-
ings for several reasons. Three- quarters of the sample had never
smoked cigarettes, and only 6% had smoked in the past 30 days.
As a nationally representative sample, most respondents did not
live in California or Massachusetts (the only other state with a
comprehensive flavour ban); these brand variants are not avail-
able nationally and thus most respondents who smoke would
not have had access to them. Furthermore, ads promoting the
impending ‘new arrivals’ onto the California market appeared
within weeks of the survey launch. It is unknown how widely
available these brand variants were within the California market
at the time of the survey. A third limitation is that our findings
do not reflect the perspectives of older adults who may have
different expectancies than young people of new non- menthol
brands based on their interpretation of the advertising or pack-
aging. Additional research is needed on expectations that people
with more extensive smoking histories will have of new non-
menthol products based on marketing, and whether the prod-
ucts appeal to those who preferred menthol but are unable to
obtain menthol cigarettes due to policy restrictions. Finally, our
study did not include a measure of appeal as an outcome for
each tested brand, which is an important area of future research
so long as such products remain on the market in jurisdictions
where menthol tobacco products are restricted.
New non- menthol products are being marketed as a direct
response to California’s restrictions on flavoured cigarettes,
purportedly offering new, specially formulated alternatives
to menthol flavours.9 The introduction of new non- menthol
brand variants in jurisdictions where menthol cigarettes are
banned represents the latest example of tobacco product devel-
opment that could circumvent the intended effect of public
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8KreslakeJM, etal. Tob Control 2024;0:1–8. doi:10.1136/tc-2024-058589
Original research
health policy.23–25 The results of this study suggest that youth
and younger adults are more likely than those age 21 years or
older to assume these products have minty or menthol taste.
These brands may hold more appeal for youth and young adults
during smoking trial and experimentation than ‘classic’ non-
menthol brands. It is important for evaluations of flavour poli-
cies to account for new non- menthol brand variants and their
marketing, including their potential to undermine efforts to
prevent smoking initiation among young people.
Contributors KM and BS conceptualised the study and designed the survey
measures. JMK, AS, FRMA and KM developed the analytical plan. JC coordinated
data collection and conducted all data analyses. JMK drafted the manuscript. KM
serves as the guarantor of the study. All authors contributed edits and provided
critical reviews of the manuscript and revisions.
Funding Financial support provided by the Bloomberg Initiative to Reduce Tobacco
Use through the CDC Foundation with a grant from Bloomberg Philanthropies.
Disclaimer The findings and conclusions of this report are those of the authors and
do not necessarily represent the official position of the Centers for Disease Control
and Prevention or the CDC Foundation.
Competing interests None declared.
Patient consent for publication Not applicable.
Ethics approval This study involves human participants and was approved by
Advarra Institutional Review Board (Pro00064406). Participants gave informed
consent to participate in the study before taking part.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
Supplemental material This content has been supplied by the author(s). It
has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have
been peer- reviewed. Any opinions or recommendations discussed are solely those
of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and
responsibility arising from any reliance placed on the content. Where the content
includes any translated material, BMJ does not warrant the accuracy and reliability
of the translations (including but not limited to local regulations, clinical guidelines,
terminology, drug names and drug dosages), and is not responsible for any error
and/or omissions arising from translation and adaptation or otherwise.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non- commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the use
is non- commercial. See:http://creativecommons.org/licenses/by-nc/4.0/.
ORCID iDs
Jennifer MKreslake http://orcid.org/0000-0001-6605-1327
Andrew BSeidenberg http://orcid.org/0000-0001-5001-2067
Fatma Romeh MAli http://orcid.org/0000-0001-5017-1869
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