Introduction:
Menthol accessories (i.e., separate flavourings in the form of cards, capsules, filters, etc. used to mentholate cigarettes) are a regulatory loophole of menthol cigarette bans implemented in the United Kingdom and European Union. This study examined prevalence and sociodemographic correlates of menthol accessory use among youth smokers in England after the May 2020 menthol cigarette ban.

Material and Methods:
Cross-sectional weighted data from the 2021 (August/September) ITC Youth Survey were limited to past 30-day smokers aged 16-19 in England (N=715). A logistic regression model estimated menthol accessory use (reporting usual cigarette brand was menthol AND used any menthol accessories within the past 30 days), adjusting for sex, age, race/ethnicity, perceived family income adequacy, and perceived addiction to cigarettes, with results presented as adjusted odds ratios (aORs) with 95% CIs.

Results:
Among youth who smoked in the past 30 days, 24.2% (95%CI: 20.5-28.3%) reported that their usual cigarette brand was menthol and were using menthol accessories. The most common type of menthol accessories reported were menthol filters with roll-your-own tobacco (16.5%, 13.4-20.2%). Other types of menthol accessories reported were menthol flavour cards (7.7%, 5.6-10.5%), menthol crush balls (6.1%, 4.2-8.7%), and liquid menthol drops (5.4%, 3.6-7.9%). The likelihood of using menthol accessories was significantly greater among those who identified as Black (49.5%, aOR=3.90, p<0.001) and multiracial/other (32.9%, aOR=2.23, p=0.023) compared to White (20.6%, 16.8-24.9%).

Conclusions:
Use of menthol cigarette accessories among youth who smoke was prevalent after the menthol cigarette ban in England, with disproportionately higher use among those who identified as Black and multiracial/other. More comprehensive menthol bans that also restrict accessories are likely be more effective in reducing flavoured tobacco use among young people and in advancing health equity.