Aim Government regulations can control the design features of tobacco products, including flavours. Understanding how cigarette and e-cigarette flavour availability affects purchasing behaviour among adults who smoke menthol cigarettes can help determine the impact of such policies. Conducted in Roanoke, Virginia, USA, this study investigated how restrictions on menthol cigarettes and non-tobacco e-cigarette flavours affect purchases in the Experimental Tobacco Marketplace (ETM), a simulated environment designed to mimic real-world tobacco purchasing behaviour. Methods In a within-subject design, 25 individuals who smoke menthol cigarettes completed purchasing trials with increasing cigarette prices in the ETM under different scenarios: (1) cigarette flavour restricted and e-cigarette flavour restricted, (2) cigarette flavour unrestricted and e-cigarette flavour restricted, (3) cigarette flavour restricted and e-cigarette flavour unrestricted and (4) cigarette flavour unrestricted and e-cigarette flavour unrestricted. Results Menthol cigarette flavour restrictions significantly decreased cigarette purchases (p<0.001) and increased substitution with e-cigarettes (p<0.002). E-cigarette flavour restrictions were associated with increased purchasing of nicotine replacement therapy (NRT) products (p<0.001). These findings suggest differential impacts of flavour restrictions across product types, highlighting complex substitution patterns among individuals who smoke menthol. Conclusion This study experimentally demonstrated that menthol cigarette bans reduce cigarette purchases. Additionally, flavour restrictions on cigarettes and e-cigarettes distinctly influence substitution patterns, with a menthol cigarette ban encouraging switching to e-cigarettes, while an e-cigarette flavour restriction increases NRT purchasing. As policymakers consider strategies to reduce tobacco-related harms, these findings highlight the need to carefully evaluate broader impacts of flavour restrictions on consumer behaviour.
Freitas-Lemos et al. (Wed,) studied this question.