E-Liquid Flavor Availability Significantly Affects Cigarette and E-Liquid Purchasing in an Experimental Marketplace Simulating a Low Nicotine Product Standard

Introduction This study evaluated whether e-liquid nicotine concentration and non-tobacco flavor availability affected very low nicotine content (VLNC) and normal nicotine content (NNC) cigarette purchasing within an online experimental tobacco marketplace (ETM). Aims and Methods Adults who smoked daily (n =67) completed four study visits. At each visit, using a pre-allocated balance, participants completed successive ETM shopping trips to purchase a week’s worth of cigarettes, e-cigarette e-liquid, and nicotine gum. In one trip, the only cigarettes available had VLNC. In others, both NNC and VLNC cigarettes were available, with the price of NNC cigarettes escalating across trips ($0.12 to $2.00 / cigarette) while VLNC cigarette price remained constant ($6.00 / pack). Across visits, e-liquid available in the ETM varied by nicotine concentration (50 mg/mL, 25 mg/mL) and flavor availability (multiple flavors, one tobacco flavor). We compared cigarette purchasing by a linear mixed model with a random effect for subject. Results When the only cigarettes available had VLNC, participants purchased fewer cigarettes when multiple e-liquid flavors (vs. one tobacco flavor) were simultaneously available in the ETM (−8.55 cigarettes, 95% confidence interval [CI] = −15.85, −1.25). The nicotine concentration of available e-liquid (50 vs. 25 mg/mL) did not significantly affect cigarette purchasing. NNC cigarette demand across escalating prices was similar regardless of e-liquid condition, except average maximum expenditure was lower when multiple e-liquid flavors were available (−$2.54, 95% CI = −$4.08, −$1.00). Conclusions Within an ETM where NNC cigarettes were unavailable, participants purchased fewer VLNC cigarettes when non-tobacco e-liquid flavors were available versus only a tobacco flavor. Implications Access to a variety of non-tobacco (eg, fruit, mint, and dessert) flavored e-liquids could moderate initial VLNC cigarette and nicotine e-liquid purchasing if a low nicotine product standard for cigarettes is implemented. Future studies should investigate how the nicotine concentration, the flavor variety, and risk perceptions of vaping products affect VLNC cigarette purchasing and use over time.