Substitution and complementarity among tobacco products: an experimental marketplace study in the USA

Objective To examine the interactions among cigarettes and nicotine vaping products (NVP), heated tobacco products (HTP) and nicotine pouch products (NPP) across mono or dual tobacco use, informing pricing strategies. Methods Individuals who smoke cigarettes exclusively (n=25) and individuals who smoke cigarettes and use NVP (n=28) completed purchasing trials in a within-subject design. Alternative product prices varied (½, 1 and 2× market price (MP)), and cigarette prices systematically increased. Results Individuals who smoke cigarettes exclusively showed substitution of NVPs and HTPs for cigarettes and complementarity of NPPs at lower NPP prices. Individuals who smoke cigarettes and use NVP purchased more NVP and less HTP with no significant effects of cigarette price. Among individuals who smoke cigarettes, purchasing intensity for NVPs, HTPs and NPPs was significantly greater than zero at ½ MP; among individuals who use both cigarettes and NVP, this occurred for NVPs at both ½ and MP. Conclusions Alternative tobacco/nicotine products may have different substitution/complementarity profiles by use types. For individuals who smoke cigarettes exclusively, reductions in smoking may increase NVP and HTP use, while for individuals who smoke cigarettes and use NVP, cigarette purchasing was not affected by the availability of other products. Identifying interactions among tobacco products helps forecast policy impacts on use and cancer risk. NCT05177848.