Hypothetical demand for menthol and non-menthol cigarettes and substitution among people who smoke menthol cigarettes: A within subjects between group randomized controlled trial using the experimental tobacco marketplace.

Hypothetical demand for menthol and non-menthol cigarettes and substitution among people who smoke menthol cigarettes: a within subjects between group randomized controlled trial using the Experimental Tobacco Marketplace - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Drug Alcohol Depend . Author manuscript; available in PMC: 2026 Jun 1. Published in final edited form as: Drug Alcohol Depend. 2025 Apr 1;271:112667. doi: 10.1016/j.drugalcdep.2025.112667 Hypothetical demand for menthol and non-menthol cigarettes and substitution among people who smoke menthol cigarettes: a within subjects between group randomized controlled trial using the Experimental Tobacco Marketplace Amanda J Quisenberry 1, * , Lovina John 2 , Richard O’Connor 3 , Elizabeth G Klein 4 Author information Article notes Copyright and License information 1 Department of Health Behavior, Carlton House A-408, Roswell Park Comprehensive Cancer Center, Buffalo, NY 2 Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 3 Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 4 Heath Behavior and Health Promotion, The Ohio State University, 1841 Neil Avenue, 352 Cunz Hall, Columbus, OH 43210 * Corresponding author: Amanda.quisenberry@roswellpark.org Roles Amanda J Quisenberry : PhD , Assistant Professor of Oncology Assistant Member Richard O’Connor : PhD , Professor of Oncology and Member Elizabeth G Klein : PhD, MPH , Professor Issue date 2025 Jun 1. PMC Copyright notice PMCID: PMC12050197  NIHMSID: NIHMS2072355  PMID: 40203666 The publisher's version of this article is available at Drug Alcohol Depend Abstract Introduction: The Food and Drug Administration has recently released a final rule enacting a characterizing flavor ban in cigarettes and cigars. Similar efforts have been proposed for ecigarettes. The aim of this study was to evaluate the effect of a potential menthol cigarette ban, a fruit and mint flavored e-cigarette ban, and the interaction of the two among current adults who smoke menthol cigarettes. Methods: The Experimental Tobacco Marketplace was used to evaluate the within subject purchasing of participants who smoke menthol major name brand (n=64) and Native manufactured (n=37) cigarettes when fixed price alternatives and only: 1) menthol cigarettes and mint and fruit flavored e-cigarettes, 2) non-menthol cigarettes and mint and fruit flavored ecigarettes, 3) menthol cigarettes and tobacco flavored e-cigarettes, and 4) non-menthol cigarettes and tobacco flavored e-cigarettes were available. Results: Participants who smoked major name brand and Native manufactured menthol cigarettes showed greater cigarette demand (Q 0 ) and less sensitivity to price (α) when menthol cigarettes were available. For those who smoked major name brand cigarettes, the only substitute the emerged was moist snuff when non-menthol cigarettes and fruit and mint e-cigarettes were available. No substitutes were found for those who smoked Native manufactured cigarettes in any flavor availability condition. Conclusions and relevance: Demand for cigarettes is higher when preferred flavor is available. Substitutes for cigarettes among people who smoke menthol cigarettes are minimal and may indicate that removal of menthol from the landscape may not push people who smoke menthol cigarettes to products other than cigarettes. Data sharing statement: The data utilized in this paper are available by request from corresponding author, AJQ, given the participants in this study did not consent to have their data shared with the public. Following publication of primary and secondary results, the corresponding author will provide de-identified data and a data dictionary for requests. Introduction The addition of flavor to tobacco products increases the abuse liability, or addictive potential, of the product; removal of such characterizing flavors in tobacco products will benefit public health( Administration, 2013 ; Committee, 2011 ; Levy et al., 2023 ; Levy et al., 2011 ). The United States Food and Drug Administration (FDA) has set forth a draft finalized rule that aims to implement product standards to eliminate menthol as a characterizing flavor in cigarettes and all characterizing flavors in cigar tobacco products( Administration, 2022 ). Banning menthol-flavored cigarettes may lead to tobacco cessation( Hartman, 2011 ; O’Connor et al., 2012 ) or use of another product, also called product substitution( O’Connor et al., 2012 ; Quisenberry et al., 2017 ; Quisenberry et al., 2016 ). Flavored electronic (e-)cigarettes are likely substitutes( Bickel et al., 2018 ; Denlinger-Apte et al., 2021 ; Heckman et al., 2017 ; Nighbor et al., 2022 ; Quisenberry et al., 2017 ; Quisenberry et al., 2016 ) if a menthol cigarette ban were to occur, and individuals may completely switch to the similar menthol- or mint-flavored e-cigarettes. Determining the level of substitutability of both mint, fruit, and tobacco flavored e-cigarettes when menthol cigarettes are available and restricted can help determine if a flavor ban (of either menthol cigarettes and/or mint and fruit flavored e-cigarettes) will lead to cessation and/or substitution of other nicotine and tobacco products. Although health risks are essentially equivalent for menthol and non-menthol cigarettes( Committee, 2011 ; Hoffman, 2011 ; Lee, 2011 ), menthol cigarettes are more appealing( Kim, 2011 ) and more difficult to quit( Foulds et al., 2010 ; Stahre et al., 2010 ; Trinidad et al., 2010 ). Moreover, while non-menthol cigarette use has been declining in recent years, menthol cigarette use has remained stable( Delnevo et al., 2020 ; Delnevo et al., 2011 ; Villanti et al., 2016 ) and increased among some subgroups( Villanti et al., 2016 ). One behavioral economic investigation using a purchase task, which evaluates only one product found that abuse liability was greater when participants were allowed to purchase their preferred flavor (e.g., menthol cigarettes in people who use menthol) compared to when they were required to purchase their non-preferred flavor (e.g., non-menthol cigarettes in people who use menthol)( Denlinger-Apte et al., 2021 ; O’Connor et al., 2016 ). Experimental Tobacco Marketplace studies have found that purchasing of nicotine replacement therapeutics( Freitas-Lemos et al., 2024 ) and e-cigarettes ( Denlinger-Apte et al., 2021 ; Freitas-Lemos et al., 2023 )were greater when menthol cigarettes were unavailable. Behavioral economic procedures provide methods to evaluate the abuse liability of products and drugs among humans( Bickel et al., 2014 ; Hursh, 1993 ; Hursh et al., 2005 ). The abuse liability of a product is measured by behavioral economic demand, which is obtained by evaluating purchasing or consumption of a product over changes in unit cost. The abuse liability of cigarettes among those who currently smoke cigarettes is well established using operant self-administration procedures( Johnson and Bickel, 2003 ; Johnson et al., 2004 ; Koffarnus, Mikhail N. et al., 2015; Stein et al., 2017 ; Wilson et al., 2016 ), purchase task questionnaires( Johnson et al., 2017 ; MacKillop et al., 2008 ; Snider et al., 2017 ) and the most recent method, the Experimental Tobacco Marketplace (ETM)( Bickel et al., 2018 ; Heckman et al., 2017 ; Quisenberry et al., 2017 ; Quisenberry et al., 2016 ; W; et al., 2017 ). The ETM is clinical abuse liability research tool that mimics an online storefront. This method provides a lens through which we can estimate the effects of ever-changing tobacco regulation and product landscape on purchasing and abuse liability prior to regulatory implementation (see Figure 1 for example). In the ETM, we can manipulate the availability of an array of tobacco products and product standards to determine the appeal, abuse liability, and potential for substitution of other tobacco products. A moderate (.56 to .64) correlation between hypothetical and real purchasing in the ETM has been found( Wilson et al., 2016 ). Purchasing was higher for the hypothetical task when compared to the real task with no difference in purchasing at zero cost (intensity) but purchasing decreased at a faster rate (elasticity) in the hypothetical versus the real ETM. Using the ETM as a real-world analog to determine the most likely actions of people who smoke when: 1) menthol-flavored cigarettes are removed from the marketplace and 2) flavored e-cigarette availability is manipulated, will provide behavioral data that can predict behavior in response to flavor-related regulation prior to implementation of such regulation. Figure 1. Open in a new tab An example of the Experimental Tobacco Marketplace when menthol cigarettes and fruit and mint flavored e-cigarettes are available The current study occurred in Western New York, with close proximity to multiple Native American reservations that sell deeply discounted tobacco products, including menthol cigarettes (referred to here as Native-manufactured cigarettes). Limited research shows that more frequent purchases on Native American land were associated with tax increases on products sold elsewhere( Hyland et al., 2004 ). In addition, the prevalence of use of cigarettes sold on Native American reservations in areas close to reservation land is 15% to 30%( Wang et al., 2017 ). The discrepancy between prices of the two cigarette products pose an interesting problem for ETM studies in which price is one of the manipulated variables. As a result, we created two ETMs for the current study (described below). The current research study evaluated mint, fruit, and tobacco flavored e-cigarette abuse liability in a within-subjects between group factorial laboratory experiment using the ETM to identify the likely actions of participants who smoke menthol cigarettes when menthol cigarettes or e-cigarette flavors are restricted. In a 2 (menthol cigarette availability) X 2 (e-cigarette flavor availability) experiment, adults who smoke menthol cigarettes (n = 101; major name brand = 64; Native-manufactured = 37) underwent four experimental ETM conditions in a randomized order. Within each block pricing order was also randomized to be ascending, descending, or random. Adults who smoke menthol cigarettes purchased tobacco products under a predefined budget when presented with fixed price alternative products and only: 1) menthol cigarettes and four mint and fruit flavored e-cigarettes, 2) menthol cigarettes and tobacco flavored e-cigarettes, 3) non-menthol cigarettes and four mint and fruit flavored e-cigarettes, and 4) non-menthol cigarettes and tobacco flavored e-cigarettes. We hypothesized that compared to the menthol cigarettes available conditions, adults who smoke menthol cigarettes will purchase fewer non-menthol cigarettes and more alternative tobacco products when menthol-flavored cigarettes are not available in the ETM. We also hypothesized that compared to the non-menthol cigarettes available condition, participants who smoke menthol cigarettes will purchase more mint and fruit flavored e-cigarettes resulting in a greater degree of e-cigarette substitution in the ETM condition during which mint and fruit flavored e-cigarettes are available. Methods Design: Adults (18+; this study began before Tobacco 21 was passed( Administration, 2019 )) who use menthol cigarettes completed this one-session factorial study in a maximum of 1.5 hours (approximately 30-minute informed consent, 1 hour experiment). The allocation ratio was one to one for all conditions. During the within-subjects between group experiment, participants purchased hypothetical tobacco products during four distinctly different ETM conditions in which the availability of cigarettes and e-cigarettes was manipulated (2 × 2 design). In these randomly ordered conditions, participants were presented with fixed price alternatives and only: 1) menthol cigarettes and four flavored JUUL e-cigarettes (menthol, mint, fruit medley, mango), 2) menthol cigarettes and two tobacco flavored JUUL e-cigarettes (classic and Virginia tobacco), 3) non-menthol cigarettes and four flavored JUUL e-cigarettes, and 4) non-menthol cigarettes and two tobacco-flavored JUUL e-cigarettes. See Figure 1 for a visual depiction of the ETM in the menthol cigarettes and e-cigarette flavors available condition. The menthol cigarette brand (e.g., Marlboro, Newport) and type (e.g., reds, silvers) most often used by participants was presented as their own brand cigarette in the menthol cigarette availability conditions. During the non-menthol availability conditions, participants were presented with the non-menthol equivalent cigarette. That is, the cigarette of the same brand and type without the menthol flavoring. Due to the proximity to Native American reservations in Western New York, some participants smoked major name brand (e.g., Newport menthols, Marlboro menthols) menthol cigarettes and some smoked Native-manufactured (e.g., Seneca menthols) menthol cigarettes. Each of the ETM conditions was completed under five prices (in ascending, descending, or random order) for menthol cigarettes (packs of 20/legal selling quantity in the US) at market price (MP) and ¼, ½, 2x, and 4x MP. MP for major name brand menthol cigarettes was $10.86 and determined by averaging the cost of major name brand menthol cigarettes at three local markets (using Newport, Marlboro, and Camel brands). MP for Native-manufactured cigarettes was $3.00 and determined by comparison of cost to the local Native American reservation. Two ETMs were created and used for data collection: one for participants who smoked major name brand menthol cigarettes and one for participants who smoked Native manufactured menthol cigarettes. Alternative tobacco products were available in both ETMs (dependent on condition) at fixed prices based on the local market (four pack of JUUL e-cigarette pods (classic tobacco and Virgina tobacco in the tobacco flavors available condition and mint, menthol, fruit medley, and mango JUUL in the fruit and mint flavors available condition): $16.79; Nicorette Lozenges Mint: $18.99; Nicorette Gum Cinnamon Surge and White Ice Mint: $13.65; Skoal Moist Snuff Long cut mint: $7.34; Camel Snus Winterchill: $6.79). This study began before JUUL removed many fruit and mint flavors from the market. Participants: Adult (ages 18+) persons who smoke menthol cigarettes (n = 101; those who used Native manufactured = 37; those who used major name brands n = 64) were recruited from the Erie County, NY region between August 2019 and July 2023. All 101 participants were included in analysis of all outcomes as this was a within-subjects design. Eligibility criteria included: 1) being 18 years of age or older and 2) smoking menthol cigarettes daily. Females who were pregnant or lactating were not eligible. Individuals with eye conditions such as glaucoma, cataracts, and glass eyes were not eligible to participate due to an eye-tracking portion of the experiment not reported here. Participants who smoked Kool or Salem brand menthol cigarettes were excluded because no non-menthol cigarette equivalent was available to display during the conditions in which only non-menthol cigarettes were available. Procedure: Research Assistants, including author LJ, completed randomized condition order allocation and enrolled participants. After providing informed consent, participants completed sociodemographic survey items and the timeline follow back interview( Sobell and Sobell, 1992 ). Based upon each participant’s average weekly tobacco product use calculated from the past 30-day tobacco product use reported in the timeline follow back interview, participants were endowed with an account balance for use during each of the ETM purchasing conditions. Account balance was determined by multiplying the market price of each tobacco product by units used and divided by four to get average weekly consumption over the previous month. Participants then viewed the online store (ETM) under four randomly ordered distinct product availability conditions when fixed price alternative and: 1) menthol cigarettes and four fruit and mint flavored e-cigarettes, 2) menthol cigarettes and two tobacco-flavored e-cigarettes, 3) non-menthol cigarettes and four fruit and mint flavored e-cigarettes, and 4) non-menthol cigarettes and two tobacco-flavored e-cigarettes. During each ETM product availability condition, participants purchased cigarettes (either menthol or non-menthol depending upon the condition being completed) under the five prices described previously. Each participant’s own brand menthol cigarette was displayed in two conditions and the non-menthol equivalent in two conditions. To allow for optimal comparisons, the description of the nicotine concentration, packaging, and position in the marketplace of all products was constant during all cigarette price manipulations and ETM conditions. Participants completed 20 shopping trips with the budget resetting at the beginning of each trip (condition and price). At the start of the ETM purchasing conditions, participants were presented with instructions (both orally and on screen) for purchasing. These included: participants will complete multiple conditions at different prices, purchasing can occur up to the budget limit, click on the picture to view more information about each product, answer as if they would not be able to purchase any other tobacco or nicotine products for the week. Participants were also instructed to imagine that they already owned the e-cigarette device necessary to use the JUUL pods available. An instruction screen appeared between prices and conditions alerting the participant that a new trial was beginning in which details may differ from the previous purchasing trial and to remember to only purchase for one week’s use. This study was approved by the Roswell Park Comprehensive Cancer center Institutional Review Board and participants were compensated with a $30 gift card for their time. The study was ended when we collected data from the required number of participants. Data Analysis: Analyses were carried out using GraphPad Software Inc and SPSS (Version 26.0). To determine if differences between groups (major name brand vs. Native manufactured) existed for demographic and tobacco use metrics, t-tests were conducted for continuous variables and chi-squares for categorical variables. Units of tobacco products purchased were transformed to milligrams (mg) of nicotine( Quisenberry et al., 2017 ; Quisenberry et al., 2016 ). Milligrams of nicotine were: 19.6 mg for major name brand cigarettes, 19.6 mg for Native manufactured cigarettes, 160 mg for four pack of JUUL, 147 mg for a pack of nicotine gum, 80 mg for nicotine lozenges, 110.5 mg for Skoal, and 22.5 mg for Snus. Values for the two tobacco flavored e-cigarettes were combined as were the values for the two flavors of Nicorette Gum. The values for fruit and mint flavored e-cigarettes (mint, menthol, fruit medley, and mango) were combined. Cigarette purchasing in mg of nicotine was log transformed with asymmetrical error. Then, to quantify the relationship between purchasing (mg) and the price of cigarettes, the data was fit to an exponential non-linear regression model ( Hursh and Silberberg, 2008 ; Koffarnus, M. N. et al., 2015): Q = Q 0 + 10 k e − α Q 0 C − 1 , (1) where Q is amount of the commodity purchased, C is the price, Q 0 is the derived initial consumption without cost constraints (i.e., demand intensity and a measure of abuse liability), k is the logarithmic range of the function (shared across each data set 2.32 for major name brand cigarettes and 1.742 for Native manufactured cigarettes here), and α is the demand elasticity (i.e., sensitivity to price and a measure of abuse liability). Q and C are determined by the data and k is a set constant shared across conditions, leaving only Q 0 and α as free parameters to be fit, which are primary outcome variables. Second, the fit parameters, Q 0 and α were compared with a two-way ANOVA to determine how the abuse liability level of menthol and non-menthol cigarettes varies across the four ETM purchasing conditions. To analyze substitution (another primary outcome variable and the consumption of a particular product over decreasing cigarette price) of alternative tobacco products, we fit linear regressions for each product type. Slopes that differed from zero were considered substitutes for each specific flavor availability condition. We also calculated O max , which is a behavioral economic index of peak consumption output at P max (the price at which O max occurs) that has been shown to be associated treatment outcomes ( Bentzley et al., 2013 ). We conducted a 2 × 2 ANOVA between O max for each condition and each group (major name brand vs. Native manufactured). To test the secondary hypothesis that persons who smoke Native manufactured cigarettes will be more sensitive to price (α) and consume more at low cost (Q 0 ), a two-way ANOVA was conducted between Q 0 and α for each condition between major name brand and Native manufactured cigarettes. Sample size calculation: Sample size was determined by carrying out a power analysis with a repeated measures ANOVA with an effect size of .15, alpha value of .05, and 95% power. Results Participants See Table 1 for participant demographic and tobacco use characteristics. Participants who smoked major name brand menthol cigarettes were 60.9% male, 85.9% heterosexual, 57.8% Black or African American, 28.1% White and 10.9% reported Hispanic heritage. Average age was 43.53 (SD = 12.65), annual income was $29,492.00 (SD = $38,196.45), and ETM budget was $44.93 (SD = $25.60). Average number of cigarettes smoked per day was 10.56 (SD = 6.23) with a 4.14 (SD = 1.82) average on Fagerstrom’s Test for Nicotine Dependence (FTND) ( Heatherton et al., 1991 ). Approximately half of these participants had ever tried e-cigarettes. Table 1. Participant Demographics and Tobacco Use Measures Major Name Brand M (SD) or % Native Manufactured M (SD) or % Carbon monoxide level 17.25 (13.91) 18.03 (12.84) Age 43.53 (12.65) 46.97 (12.86) Income (annual) a 29,492 (38,196.45) 33215.5 (33,293.24) Cigarettes per day 10.56 (6.23) 12.05 (5.921) FTND Score * 4.14 (1.82) 4.95 (1.56) Quit ladder 5.60 (2.82) 5.46 (3.11) ETM Budget * $44.93 ($25.60) $15.22 ($11.66) Sex Male 60.90% 43.20% Sexual Identity Heterosexual 85.90% 78.40% Homosexual 0% 10.80% Bisexual 8.10% 5.40% Prefer not to answer 3.20% 5.40% Transgender 1.60% 2.70% Race American Indian/ Alaskan Native 3.10% 5.40% Asian 1.60% 0.00% Black or African American 57.80% 27.00% More than one race 6.30% 5.40% Native Hawaiian or other Pacific Islander 0% 0% White 28.10% 56.80% Unknown/Not reported 3.10% 5.40% Ethnicity * Hispanic 10.90% 2.70% Education Some high school 10.90% 2.70% GED 14.10% 21.60% High school graduate 17.20% 13.50% Some college 28.10% 24.30% Associate’s degree 9.40% 27.00% Bachelor’s degree 10.90% 10.80% Master’s degree 1.60% 0.00% Doctoral or Professional degree 1.60% 0.00% Ever e-cigarette use * Yes 53.10% 73.00% Frequency of e-cigarette use b Daily 14.10% 8.10% 4–6 times a week 1.60% 5.40% 2–3 times a week 4.70% 2.70% Once a week 1.60% 2.70% 2–3 time a month 3.10% 2.70% Once a month 0% 2.70% less than once a month 53.10% 48.60% Open in a new tab * p <.05 a 7 name brand missing; 1 Native missing b only asked of those who answered yes to ever e-cigarette use Participants who smoked Native manufactured menthol cigarettes were 43.2 % male, 78.4% heterosexual, 27% Black or African American, 56.8% White, and 2.7% reported Hispanic heritage. Average age was 46.97 (SD = 12.86), annual income was $33,215.50 (SD = $33,293.24). and ETM budget was $15.22 (SD = $11.66). Average number of cigarettes smoked per day were 12.05 (SD = 5.92) with a 4.95 (SD = 1.56) average on the FTND. 73 % of these participants reported ever trying e-cigarettes. Significant differences were found between those who smoked major name brand and Native brand cigarettes for FTND score, ETM budget, Hispanic identity, and previous e-cigarette use. Participants who smoked Native manufactured cigarettes had greater FTND score compared to participants who smoked major name brand cigarettes and there were a greater number of participants who self reported Hispanic identity in the group that smoked major name brand menthol cigarettes. Budget was higher for the group who smoked major name brand cigarettes. Lastly, a greater percentage of participants in the group that smoked Native manufactured cigarettes had tried e-cigarettes before participating in the study. Participants who smoked major name brand cigarettes A significant difference was observed between flavor availability conditions on Q 0 (demand intensity and purchasing at zero cost), F(1,16) = 11.31, p = .004, and α (demand elasticity and sensitivity to price), F(1,16) = 18.15, p = .0006, independent of e-cigarette flavor condition (see Figure 2 ). The main effect of menthol cigarette availability on Q 0 indicated differences between the conditions in which menthol cigarettes were available (menthol and fruit and mint e-cigarette flavors available: M= 174.8, SEM = 21.65; menthol cigarettes and tobacco flavored e-cigarettes available (M = 181.1, SEM = 22.63) and were not available (fruit and mint e-cigarette flavors available: M= 90.10, SEM = 11.75; non-menthol cigarettes and tobacco flavored e-cigarette flavors available (M = 134.7, SEM = 20.03), indicating greater purchasing at zero cost when menthol cigarettes are available. For α, the main effect of cigarette flavor was the only significant variable. When menthol cigarettes and fruit and mint e-cigarette flavors were available (M = .002484, SEM = .0003523) and when menthol cigarettes and tobacco flavored e-cigarette flavors were available (M = .002444, SEM = .003474) a significant difference was found when comparing to the conditions when non-menthol cigarettes were available (non-menthol and fruit and mint e-cigarette flavors: M = .005312, SEM = .0007622; non-menthol and tobacco flavored e-cigarettes: M = .004356, SEM = .006422). These results suggest greater sensitivity to price when non-menthol cigarettes were available independent of e-cigarette availability. Figure 2. Open in a new tab Major name brand and Native manufactured cigarette purchasing in the ETM under four experimental conditions manipulating flavor availability of cigarettes and e-cigarettes. Blue and green lines represent conditions in which menthol cigarettes were available. Red and brown lines represent condition in which only non-menthol cigarettes were available. Substitution results show no alternative products functioned as a substitute for menthol cigarettes in the condition in which menthol cigarette and e-cigarette fruit and mint flavors were available. When non-menthol cigarettes and fruit and mint e-cigarette flavors were available, Skoal moist snuff long cut mint was the only product that functioned as a substitute (slope = .65; p = .011) when menthol cigarettes were unavailable and fruit and mint flavored e-cigarettes were available. No alternative products functioned as substitutes when menthol cigarettes were available and only tobacco flavored e-cigarette flavors were available. No alternative products functioned as a substitute when non-menthol cigarettes were available and only tobacco e-cigarette flavors were available. Participants who smoked Native manufactured cigarettes A significant difference (main effect) in menthol cigarette availability was found for Q 0 F(1,16) = 46.67, p < .0001 (See Figure 2 ). When fruit and mint e-cigarette flavors and menthol cigarettes were available (M = 226.8, SEM = 14.39) and when menthol cigarettes and tobacco flavored e-cigarettes were available (M = 248.6, SEM = 17.08) there was significantly greater cigarette consumption compared to when non-menthol cigarettes and fruit and mint e-cigarettes were available (M = 143.1, SEM = 8.834) and when non-menthol cigarettes were available with no e-cigarette flavors (M = 155.7, SEM = 9.562). For alpha, a main effect of menthol cigarette availability was also found showing greater sensitivity to price when non-menthol cigarettes were available compared to when not available F(1,16) = 27.94, p < .0001. Means for the conditions are as follows: fruit and mint e-cigarette flavors and menthol cigarettes available (M = .009384, SEM = .006162), menthol cigarettes and tobacco flavored e-cigarettes available (M = .009672, SEM = .0006525), non-menthol cigarettes and fruit and mint e-cigarettes available (M = .01424; SEM = .0009268), non-menthol cigarettes and tobacco flavored e-cigarettes available (M = .01296, SEM = .0008424). For the group that smoked Native manufactured cigarettes, there were no significant substitutes found in any experimental condition (See Figure 4 ). Figure 4. Open in a new tab Substitution profiles of alternative fixed-price tobacco/nicotine products for participants who smoke Native brand menthol cigarettes by experimental condition. condition (4a = Menthol cigarettes and fruit and mint e-cigarettes available. 4b = non-menthol cigarettes and fruit and mint flavored e-cigarettes available. 4c = Menthol cigarettes and tobacco flavored e-cigarettes available. 4d = non-menthol cigarettes and tobacco flavored e-cigarettes available). Comparison of the two groups on ETM parameters There were no statistically significant differences between major name brand and Native-manufactured purchasing (Q 0 and α) in any condition. There was, however, a main effect of group for the Omax parameter F(1,3) = 16.31, p = .0273. Persons who smoked major name brand cigarettes had a higher O max (M = 22.98, SEM = 4.30) than those who used Native manufactured cigarettes (M= 9.56, SEM = .981). Portion of participants that purchased e-cigarettes. Table 2 describes the percent of participants that purchased e-cigarettes by condition and price. The greatest amount of participants purchased e-cigarettes at high cigarette prices, however among the group that smoked Native manufactured cigarettes few participants purchased ecigarettes (2.7% – 10.8%) whereas more participants who smoked major name brand cigarettes purchased e-cigarettes (7.8% – 21.9%). Table 2. Percent of participants who purchased JUUL e-cigarettes by condition and price. Major Name Brand Native-Manufactured Menthol cigarettes and mint- and fruit-flavored JUUL available % (n) Non-menthol cigarettes and mint- and fruit-flavored JUUL available % (n) Menthol cigarettes and tobacco-flavored JUUL available % (n) Non menthol cigarettes and tobacco-flavored JUUL available % (n) Menthol cigarettes and mint- and fruit-flavors available % (n) Nonmenthol cigarettes and mint- and fruit-flavored JUUL available % (n) Menthol cigarettes and tobacco-flavored JUUL available % (n) Non menthol cigarettes and tobacco-flavored JUUL available % (n) Price per cigarette a Level 1 15.6 % (10) 21.9 % (14) 10.9 % (7) 10.9 % (7) 2.7 % (1) 5.4 % (2) 2.7 % (1) 2.7 % (1) Level 2 12.5 % (8) 20.3 % (13) 9.4 % (6) 10.9 % (7) 2.7 % (1) 8.1 % (3) 2.7 % (1) 2.7 % (1) Level 3 7.8 % (5) 23.4 % (15) 7.8 % (5) 10.9 % (7) 2.7 % (1) 10.8 % (4) 2.7 % (1) 2.7 % (1) Level 4 9.4% (6) 17.2 % (11) 9.4 % (6) 14.1 % (9) 2.7% (1) 10.8 % (4) 2.7 % (1) 2.7 % (1) Level 5 20.3% (13) 21.9 % (14) 17.2 % (11) 20.3 % (13) 5.4 % (2) 10.8 % (4) 2.7 % (1) 2.7 % (1) Open in a new tab a Price levels: 1 - $0.14 (Major name brand) or $0.04 (Native-manufactured); 2 - $0.27 or $0.08; 3 - $0.54 or $0.15; 4 - $1.09 or $0.30; 5 - $2.17 or $0.60 Discussion Based on cigarette demand indices (Q 0 and α) generated in the ETM, we observed greater abuse liability for menthol cigarettes compared to non-menthol cigarettes among people who smoke menthol cigarettes independent of e-cigarette flavor availability. Our results regarding the purchasing of menthol cigarettes among people who smoke menthol cigarettes are similar to other studies using purchase tasks ( O’Connor et al., 2012 ) and the Experimental Tobacco Marketplace( Denlinger-Apte et al., 2021 ). Less sensitivity to price (lower elasticity) and high initial consumption in the menthol available conditions is indicative of greater abuse liability and more substance use risk( Strickland and Lacy, 2020 ). The only product that functioned as a substitute in this paradigm was Skoal moist snuff long cut mint in the condition in which non-menthol cigarettes and fruit and mint e-cigarettes were available. These data are not in line with the hypothesis that more e-cigarette flavors would be purchased and thus function as a substitute when menthol cigarettes were not available. We expected menthol or mint products, particularly e-cigarettes, to be substitutes in the non-menthol availability condition with flavored e-cigarettes available ( Denlinger-Apte et al., 2021 ; Freitas-Lemos et al., 2024 ). A few possible explanations for these discrepancies exist. Those participants who smoked Native manufactured menthol cigarettes did not have a high budget and weren’t allowed to exceed their budget calculated from weekly tobacco product use. The e-cigarettes, nicotine lozenges, and nicotine gum presented in the ETM were relatively high priced and in large packages. This may have rendered purchasing, and thus substitution, less likely among this group and even in participants who smoke major name brand menthol cigarettes who had lower cigarettes consumption and budget. In addition, pricing strategies were different and the implementation of two different pricing procedures for the two groups of people who smoke menthol cigarettes was different. We also found no statistically significant differences between those who smoked major name brand and Native manufactured menthol cigarettes on abuse liability measures of purchasing in the ETM indicating that the abuse liability of menthol and non-menthol cigarettes are not different between these two groups. We did find differences, however, in the substitution profiles between these two groups. The people who smoked Native manufactured cigarettes did not purchase substitutes for cigarettes in any flavor availability condition at any price. This is in contrast to consistent e-cigarette purchasing across cigarette prices that was shown in the group who smokes major name brand menthol cigarettes. This may be because of the lower market price for Native manufactured cigarettes, higher alternative product prices, or lower budget allocation. Another possibility is that people who smoke Native manufactured cigarettes must put more effort into obtaining their product (i.e., drive to a reservation) and purchasing alternative tobacco and nicotine products may not be in their current repertoire. This study is not without limitations. The sample size is small and recruited from the Western New York region so findings may not be generalizable to the general population, but do provide important information about people who smoke Native-manufactured cigarettes. While the within-subjects design adds more power to the study, it is possible that the participants could have been bored or burdened while completing 20 different purchasing sessions; instructions screens between purchasing conditions alerting the participants that some features would be changing were implemented to help alleviate the potential burden. In a previous study comparing consumption using real, potentially real, and hypothetical purchase tasks, a heightened amount of consumption was found in the hypothetical purchase task( Wilson et al., 2016 ). A moderate correlation was found between methods. These data suggest there may be an increased amount of consumption for cigarettes in hypothetical tasks that do not allow for a redeemable budget such as the current ETM. Another limitation is that all participants’ experience with the fixed-priced alternative products may not be similar and may impact their purchasing decisions. For ETM development, different pricing strategies were not used for the e-cigarettes or alternative products presented to participants. This is a limitation given the different pricing used for Native manufactured versus major name brand cigarettes. Participants who spend less money on cigarettes may be less likely to purchase any tobacco product at regular/high price. All ETMs were not directly reflective of the current e-cigarette marketplace. That is, either tobacco-flavored or fruit- and mint- flavored were available at one given time and they were not available together in any shopping trip. In addition, e-cigarettes were only available in 4-pod packs, which are more expensive than the now popular disposable e-cigarettes limiting the ability to discuss e-cigarette substitution. Abuse liability is greater for menthol cigarettes when compared to non-menthol cigarettes in people who smoke menthol cigarettes regardless of e-cigarette flavor availability. No substitutes were found for people who smoke Native manufactured cigarettes and only one substitute was found for the group that smoked major name brand cigarettes in only one condition: Skoal moist snuff mint in the condition in which non-menthol cigarettes were available and fruit and mint e-cigarettes were available. E-cigarettes didn’t function as a substitute in this group because purchasing was similar across all cigarette price conditions and higher than any other alternative product. This study provides insight into the likely actions of people who smoke menthol cigarettes in the face of a menthol or e-cigarette flavor ban. There doesn’t appear to be an interaction between the two types of potential bans. Figure 3. Open in a new tab Substitution profiles of alternative fixed-price tobacco/nicotine products for participants who smoke name brand menthol cigarettes by experimental condition (3a = Menthol cigarettes and fruit and mint e-cigarettes available. 3b = non-menthol cigarettes and fruit and mint flavored e-cigarettes available. 3c = Menthol cigarettes and tobacco flavored e-cigarettes available. 3d = non-menthol cigarettes and tobacco flavored e-cigarettes available). Highlights. People who smoke Native brands are not likely to substitute with other products Substitutes in people who smoke name brand cigarettes are minimal No differences in demand for cigarettes in those who use name and Native brands Funding: This research was funded by National Institutes of Health National Cancer Institute and Food and Drug Administration Center for Tobacco Products under R03CA228930. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. Footnotes Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Declaration of Interest Statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ClinicalTrials.gov ID and title: NCT03897530 ; Experimental Tobacco Marketplace in Regulating Flavored Tobacco Products in Menthol Cigarette Smokers Contributor Information Amanda J. Quisenberry, Department of Health Behavior, Carlton House A-408, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Lovina John, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Richard O’Connor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Elizabeth G. 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