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Keck School of Medicine of USC Flavor and Menthol Tobacco Products and E-cigarettes There is inconsistent evidence regarding the use of e-cigarette as a cessation tool among youth, young adult, and adult smokers. • Studies have shown that many cigarette smokers, after using e-cigarettes, are likely to remain cigarette smokers rather than transitioning to e-cigarettes or quitting smoking, and this effect may be particularly salient in Hispanic young adults (19, 23-25)*. • More recently, a single clinical trial has shown that regular e-cigarette use alongside counseling services increased cessation relative to other cessation products among participants in England; similar findings have not been observed in the US to date (37). t Menthol products makes smoking cessation more difficult and are disproportionately marketed to vulnerable populations such as ethnic minorities. • Among adult smokers in California, 18% of white cigarette smokers smoke menthol cigarettes where as 70% of African American cigarette smokers use menthol. Additionally, almost 50% of LGB smokers use menthol cigarettes compared to 28%of straight smokers (31). t • Among Hispanic/Latino current adult smokers in the US, 46% smoke menthol cigarettes (27). t • Among Hispanic/Latino young adult current smokers (aged 18-25) in the US from 2008 to 2010, 47.3% smoked menthol cigarettes (28). t • Between 2008-2010 and 2012-2014, the largest increase in menthol cigarette use among race/ethnic groups was in found in Hispanic smokers (rising 9.8 percentage points) (29). t • The use of flavored products, such as menthol cigarettes, makes cessation more difficult (26). t • Studies have displayed negative associations among menthol cigarette use and successful cessation in Hispanic communities (30). t • Approximately 90% of all cigarettes have menthol in them regardless of if they are advertised as menthol cigarettes or not (34). t Implementing enforceable regulations can prevent youth initiation of e-cigarettes and other tobacco products. • In Southern California, strong enforcement preventing sales to minors was associated with lower rates of youth and adult initiation of combustible and e-cigarette use (35). Communities that had tobacco retail licenses with sufficient fees to conduct enforcement efforts (e.g., sting operations) had lower rates of youth cigarette and e-cigarette use. • A retail license ordinance to regulate e-cigarettes, flavored, and menthol tobacco products in Los Angeles County has tremendous potential to substantially reduce youth -use of tobacco products including e-cigarettes (35). • The availability of e-cigarettes in flavors, and current location of retailers in close proximity to areas where youth congregate increases use of these products among young people (35); policies to reduce availability of these products across the community will likely have a substantial impact on youth use of tobacco products. Current research suggests that it is important to considerthe overall impact of e-cigarettes on all segments of the population; however, the weight of the evidence points to a far more detrimental effect on youth. We hope that this research can educate and inform future decision -makers. For additional information, contact Yaneth Rodriguez at vlr@usc.edu tResearch conducted outside of USC *Both USC and Outside Research Updated 5/22/2019