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In a survey of 12-17-year-olds fielded in 2017, 65% of tobacco users reported using flavored cigars as their first ever tobacco product

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Data availability All the data in the present analysis is available at NHANES website Abbreviations NHANES: National Health and Nutrition Examination Survey TST: testosterone EST: estrogens SHBG: sex hormone-binding globulin CDC: Centers for Disease Control and Prevention NCHS: National Center for Health Statistics ID-HPLC-APCI-MS/MS: isotope-dilution high-performance liquid chromatography/atmospheric pressure chemical ionization tandem mass spectrometric LLOD: lower limit of detection ID-LC-MS/MS: isotope dilution liquid chromatography tandem mass spectrometry BMI: body mass index RCS: restricted cubic spline SD: standard deviation References GBD 2019 Diseases and Injuries Collaborators

The 2009 Tobacco Control Act (TCA) did not include menthol in its ban on characterizing flavors in cigarettes, leaving menthol cigarettes as the only flavored combusted cigarettes still marketed in the U.S