Background:
Little is known about the importance of flavored cigarettes for initiation among youth in Brazil, which has amongst the greatest number of smokers in the world. This study aimed at analyzing the relationship between trying to smoke mainly mentholated and flavored cigarettes and initiation and intensity of smoking among Brazilian students.

Methods:
A cross-sectional school-based survey that included a multistage probability sample of 12-17 years old students was conducted in cities with more than 100,000 inhabitants, who participated in the Study of Cardiovascular Risks Among Adolescents in 2013-2014 (ERICA) (n=70,589). Data was collected using self-administered questionnaires. Logistic models regressed current smoking (last 30 days) and days smoking (6 ore more vs 5 or fewer) on preference for flavored cigarettes, adjusting for gender, age, skin color, type of school (public vs private), family structure (with vs without two parents), having a paid job, time since experimentation, and geographic region.

Results:
Among the 18.5% of adolescents who ever tried cigarettes, 26.4% (95% confidence interval, CI 24.1, 28.9) of males and 28.8% (CI 26.4, 31.4) of females had flavored cigarettes as their first choice brand. Of the 5.7% who smoked in the past 30 days, flavored cigarettes were the first choice in 54.7% of males (CI 49.9, 59.4) and 60.6% (CI 55.6, 65.4) of females. In adjusted models, experimenters who preferred flavored cigarettes were more likely to have smoked in the past 30 days (adjusted Odds Ratio, adjOR = 1.62, CI 1.36; 1.92), and to smoke 6 or more days (vs 1-5 days) in the past 30 days (adjOR = 1.37, CI 1.01; 1.86) than experimenters who preferred non-flavor cigarettes.

Conclusions:
Preferences for flavored cigarettes among Brazilian adolescents is very high. Banning flavored cigarettes could reducing the palatability of cigarettes for youth and thereby reduce smoking initiation and prevalence.