A nicotine-free add-on can make it harder to quit smoking

Cigarette smoking remains the leading preventable cause of death in the United States, accounting for nearly 30 percent of all cancer deaths. Of the more than 28 million American adults who smoke daily, 35 percent use menthol-flavored cigarettes.  

Prohibiting the sale of menthol-flavored cigarettes may seem like a major step toward reducing the impacts of tobacco smoking, but outright retail bans of flavored tobacco in places like California and Massachusetts have led to a problematic workaround.

“There's been a big emergence of these after-market products that let you add menthol flavor to a non-menthol cigarette,” said Carol Bovo, a postdoctoral researcher with Virginia Tech’s Fralin Biomedical Research Institute at VTC.

The most popular versions are called menthol cards: small, flavored strips used to infuse menthol into a pack of cigarettes after purchase. The cards are often designed to be compatible with any tobacco brand. And they're in use.

Because menthol accessory products are nicotine-free and sold separately from tobacco, they fall outside of the scope of tobacco regulations.

“Studies indicate that up to 40 percent of pre-ban menthol smokers may adopt these accessories after restrictions take effect,” Bovo said. But she believes addressing regulatory loopholes in menthol cigarette bans can help remake public health gains lost to menthol-related accessories.

With support from a 2025-26 Postdoctoral Excellence Award, Bovo will continue to assess behavioral responses to menthol bans, hoping to identify the demographic, psychosocial, and dependence-related predictors that indicate who might decide to quit, who might switch to non-menthol cigarettes, and who might opt for accessories to maintain their menthol habit.

Bovo studied addiction science in Brazil before joining the Fralin Biomedical Research Institute, where she carries out her research under the mentorship of Assistant Professor Roberta Freitas-Lemos. She makes use of a tool called the Experimental Tobacco Marketplace, an e-commerce platform designed at the institute to simulate real-world tobacco choices.

“Menthol reduces the harshness of cigarettes because it has almost a numbing or refreshing effect when you're smoking,” Bovo said. Over time, this cooling masks early symptoms of respiratory disease and may incentivize users to smoke more.

“One of the things we study that we need to consider is that sometimes drugs work in a system,” Bovo said. Efforts to quit one substance can reduce overall drug use, but they can also lead individuals to compensate with another drug. “A majority of heavy users don’t use just one substance. So you have to be concerned about how that may affect the system as a whole.”

Bovo’s research will consider whether other dependencies influence menthol smokers’ decisionsto quit smoking, keep smoking, or change smoking habits. While policy interventions have effectively reduced smoking prevalence and increased overall smoking cessation rates, at least one-third of menthol smokers will continue smoking after bans take effect.

The Postdoctoral Excellence Awards are given annually to recognize postdoctoral trainees at the Fralin Biomedical Research Institute whose research proposals show potential for novel scientific contributions.