Abstract
Significance Restrictive e-cigarette policies may increase purchases from illegal sources. The Illegal Experimental Tobacco Marketplace (IETM) allows examination of how restrictions impact illegal purchases. We investigated (1) the effect of a vaping ban, total flavour vaping ban and partial flavour vaping ban on the probability of purchasing illegal vaping products among different regulatory environments (USA, Canada and England) and tobacco user types (cigarette smokers, dual users and e-cigarette users); and (2) the relation between ban endorsement and illegal purchases.
Methods Participants (N=459) from the International Tobacco Control Survey rated their support of bans and chose to purchase from a hypothetical legal experimental tobacco marketplace or IETM under control and the three ban conditions.
Results In total, 25% of cigarette smokers, 67% of dual users and 79% of e-cigarette users made IETM purchases. Cross-country comparisons depicted dual users from Canada (OR: 19.8), and e-cigarette users from the USA (OR: 12.9) exhibited higher illegal purchases odds than the same user type in England. Within-country comparisons showed e-cigarette and dual users are more likely to purchase from the IETM than cigarette smokers in the most restrictive condition, with the largest effects in e-cigarette users (England—OR: 1722.6, USA—OR: 22725.3, Canada—OR: 6125.0). Increased opposition towards partial or total flavour ban was associated with increased IETM purchasing in the corresponding condition.
Conclusions Vaping restrictions may shift users’ preference to the illegal marketplace in a regulatory environment. Evidence of the IETM generalisability in a geographically dispersed sample enhances its utility in tobacco regulatory science.
Introduction
Considerable evidence confirms widespread use of illegal tobacco.1 Globally, 1 in every 10 cigarettes and tobacco products is purchased illegally.2 Illegal tobacco and nicotine products may contain toxic and dangerous adulterants3 and are widely available through online purchases.4 5 Illegal tobacco trade undermines tobacco control efforts, fuels the tobacco epidemic, poses a serious threat to public health beyond authentic products and results in substantial losses in government revenues.6
More recently, an outbreak of vaping-associated lung disease in the USA7 was traced to the use of illegal non-commercial adulterated e-cigarettes.8 Governments are concerned with the increased vaping rates, estimated to be 68 million people worldwide,9 driven by youth and young adults uptake.10–15 Policies limiting access to vaping products have recently been implemented or are under debate in many countries. European Union member states have recently banned flavours. In Canada, no ‘dessert’ or ‘confectionery’ flavours may be promoted on product packaging. In the USA, the Youth Tobacco Prevention Plan proposes that flavours (except tobacco, mint and menthol) should be sold in age-restricted in-person locations.15 Most recently, the Food and Drug Administration banned any JUUL products, the leading e-cigarette brand in the USA.16
Some evidence suggests that flavour bans have increased illegal purchases. For example, reports from Massachusetts16 and San Francisco17 have indicated the presence of illegal trade after their flavoured vaping bans. However, prospective analyses of how policies affect illegal e-cigarette purchasing are scarce.18 19 Therefore, a scientific understanding of the consequences of regulation on consumer behaviours prior to policy implementation is warranted.
Towards this goal, the Illegal Experimental Tobacco Marketplace (IETM), a modification of the Experimental Tobacco Marketplace (ETM), may offer relevant information. The ETM mimics the real-world tobacco marketplace20 where virtual purchases can be made among various tobacco and nicotine products differing in prices,21 22 flavours,19 nicotine concentration23–25 and taxes and subsidies26 27 (see Bickel et al 20 for illustrative images of the ETM). The ETM and its extension, the IETM, constitute an experimental model developed to forecast public health policies prior to implementation. As an experimental model, the ETM is not a detailed replication of real-world circumstances, rather a scientific model that can identify some of the core relationships between tobacco and nicotine products and potentially relevant environmental variables. Such initial experimental evidence can prevent or mitigate unintended consequences, which are encountered with considerable frequency. As such, models provide important insights and forecasts that can contribute to the evidentiary basis for policy formation and reform.
In the IETM model, two concurrent marketplaces are available, the IETM and the Legal Experimental Tobacco Marketplace (LETM). Cheaper products or products not available in the LETM may be purchased in the IETM. This methodological extension permits measurement of the unintended consequences of regulation thereby allowing policymakers to prevent or mitigate these consequences.
Previous IETM research in the USA examined illegal purchasing as a function of three e-cigarette policy scenarios (ie, vaping ban, total flavour vaping ban and no vaping ban) across increasing cigarette prices in three tobacco user types (ie, exclusive e-cigarette users, frequent dual users and exclusive cigarette smokers).19 The likelihood of purchasing in the IETM was increased by (1) the two bans in all users, with the largest effect among exclusive e-cigarette users; (2) increasing cigarette prices in exclusive cigarette smokers and frequent dual users; and (3) a vaping ban compared with a total flavour vaping ban. Generally, the illegal marketplace substituted for the legal tobacco marketplace when accessibility (determined by product bans) and affordability (influenced by high prices) decreased. Of course, illegal market purchasing may be modulated by country-specific regulations. Moreover, the degree to which these regulatory environments influence both legal and illegal activities is unknown.
The current study replicates and extends Freitas-Lemos et al 19 using a larger and geographically dispersed sample, an additional policy scenario and policy opinion data. First, we used a between (user types; see online supplemental material for between-countries comparisons) and within (conditions) repeated measures design to examine the probability of purchasing vaping products in an IETM under three e-cigarette policy scenarios and increasing cigarette prices in different regulatory environments (England, USA and Canada). The policy scenarios included a vaping ban, a total flavour vaping ban (including menthol) and a partial flavour vaping ban (excluding menthol). The effects were evaluated across different tobacco user types (exclusive e-cigarette user, dual users and exclusive cigarette smokers). Second, we examined the impact of individuals’ policy opinions, that is, prior support/opposition for bans, on purchasing in the IETM.
Roberta Freitas-Lemos et al. – Tobacco Control – 2022-11-01.
Want More Investigative Content?
