Volume 183, June 2024, 107954Author links open overlay panel, , , Highlights•

24–30% of people who smoked would seek illicit channels for banned flavored products.

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21–41% of dual users and 35–39% of e-cigarette users would seek illicit channels.

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Heavy users are more likely to seek illegal channels.

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Comprehensive bans may decrease users' likelihood of trying illegal channels.

AbstractBackground

Banning flavors in tobacco and nicotine products may reduce youth initiation and prompt quit attempts but such bans may lead to illicit markets. We examined how likely current users would be to seek flavored products from illicit channels under various ban scenarios.

Methods

Cross-sectional surveys of 2552 current users of menthol cigarettes or flavored cigars and 2347 users of flavored e-cigarettes were conducted between 2021 and 2022 in the United States. For each ban scenario, respondents reported if they would have intentions to seek the banned flavored products from any illicit channels and identified the specific illicit channel they would consider. Logistic regressions were used to estimate how the likelihood of having intentions to seek illicit channels was associated with demographics, ban scenarios, and status of tobacco use.

Results

Under various ban scenarios, 24–30% of people who smoked said they would seek illicit channels to obtain the banned products compared with 21–41% of dual users and 35–39% of users of flavored e-cigarettes. Online retailers were favored by people who smoked while users of flavored e-cigarettes favored local retailers. Heavy users were more likely to say they would try illicit channels. Under bans restricting more types of flavored tobacco products, users would be less likely to try illegal channels.

Conclusions

A significant proportion of users of flavored tobacco and nicotine products would not reject using illicit banned products. Tailored programs are needed to apply to the groups with a higher risk of seeking illicit channels for banned products.

Section snippetsBackground

Restricting and banning the characterizing flavors in tobacco and nicotine products are key tobacco regulatory strategies for encouraging cessation and preventing initiation, especially among young adults and youth, and low-income and African-Americans (U.S. Food and Drug Administration, 2013; Villanti et al., 2017; Rostron et al., 2020; Zare et al., 2018; Landry et al., 2019; Harrell et al., 2017). In 2009, all characterizing flavors except menthol and tobacco were banned by the U.S. Food and

Methods

Data were collected on Amazon Mechanical Turk (MTurk) (Keith et al., 2017) between December 2021 and May 2022 from respondents who smoked flavored tobacco products and those who used flavored e-cigarettes. The appendix contains quality control data for the survey. The Institutional Review Board at the University of Memphis approved this study. The first group constituted adults who currently smoked menthol cigarettes or flavored cigars at least once a week in the past 30 days (N = 2552), and

Results

As shown in Tables A1 and A2 in the Appendix, the majority of the respondents in our study were young adults and had a high level of educational attainment. After weights were added, the demographics and the status of tobacco and nicotine use of both those who smoked flavored tobacco products and those who used flavored e-cigarettes were consistent with the corresponding patterns in the sample of the 2018–2019 TUS-CPS. Overall, the majority of people who smoked smoked daily, either somewhat or

Discussion

Overall, among all respondents, about 20–40% of those who used flavored tobacco and nicotine products had the intention to seek illicit channels to obtain flavored products if they were banned. These levels are roughly consistent with one study that estimated about one-quarter of users might intend to seek illicit channels if menthol cigarettes were banned (O'Connor et al., 2012). Our findings suggest that a significant portion of users of flavored products would be open to using illicit

Ethics approval

The authors declare that they have obtained ethics approval from an appropriately constituted ethics committee/institutional review board where the research entailed animal or human participation.

The Institutional Review Board at the University of Memphis approved this study, with IRB ID: #PRO-FY2021-196.

Funding sources

This research received funding from the following sources.

(Please insert all funding source details including grant number(s) and who provided financial support for the conduct of the research and/or preparation of the article and briefly describe the role of the sponsor(s), if any, in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication).

The research was supported by the National Institute

CRediT authorship contribution statement

Yong Yang: Writing – review & editing, Writing – original draft, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization. Eric N. Lindblom: Writing – review & editing, Investigation. Kenneth D. Ward: Writing – review & editing, Investigation. Ramzi G. Salloum: Writing – review & editing, Investigation.

Declaration of competing interest

None.

Acknowledgments

This research was supported by the National Institute of Drug Abuse of the National Institutes of Health under Award Number R03DA048460 and also supported by the National Cancer Institute of the National Institutes of Health and FDA Center for Tobacco Products under Award Number U54CA229974. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

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