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. Author manuscript; available in PMC: 2023 Dec 1.
Published in final edited form as: Prev Med. 2022 Jul 1;165(Pt B):107122. doi: 10.1016/j.ypmed.2022.107122

Using an Experimental Tobacco Marketplace to Pilot Test the Substitutability of JUUL E-Cigarettes and Other Alternative Nicotine and Tobacco Products for Conventional Cigarettes among Vulnerable Populations

Tyler Nighbor 1, Kaitlyn O Browning 1,2, Ellaina N Reed 1, Anthony C Oliver 1, Michael J DeSarno 1,4, Allison N Kurti 1, Warren K Bickel 5, Stephen T Higgins 1,2,3,*
PMCID: PMC9724801  NIHMSID: NIHMS1853004  PMID: 35787842

Abstract

The Experimental Tobacco Marketplace (ETM) is an online research marketplace where increasing the cost of cigarettes is used to investigate the substitutability of other fixed-price tobacco products such as electronic nicotine delivery systems (ENDS). The ETM is useful for modeling effects of potential policy changes on use of various concurrently available products. To our knowledge, the ETM has not been used to investigate substitutability of newer generation e-cigarettes or populations at increased risk for smoking, heavy smoking, nicotine dependence, and smoking-attributable adverse effects. In the current pilot study, participants were 30 adult daily smokers with socioeconomic disadvantage or comorbid psychiatric conditions (substance-use disorder or mental illness). In each session, cigarette prices increased ($0.12, $0.25, $0.50, $1.00. and $2.00 per cigarette) while prices for alternative products remained fixed. Across three ETM sessions, either all products, all products except little cigars and cigarillos (LCCs), or all products except ENDS (JUUL e-cigarettes) were available. Linear regression was performed on individual participant data using log-transformed cigarette price to determine demand and substitution. Cigarette demand decreased as price increased across sessions (significantly non-zero slopes, ps≤.0001). When all products were available, ENDS substitution increased as cigarette price increased (significantly non-zero slope, p=.016). When LCCs were unavailable, ENDS again were a significant substitute (p=.008). When ENDS were unavailable, LCCs did not substitute (ps≥.48). In all sessions, participants rarely purchased other products (e.g., snus). Overall, ENDS were the most robust substitute for cigarettes, further underscoring the potential importance of ENDS availability on the impact of tobacco regulatory policies.

Keywords: Experimental Tobacco Marketplace; behavioral economics; substitution; vulnerable populations; ENDS; cigarettes, little cigars, cigarillos

Introduction

Although cigarette smoking has steadily declined in the general population, prevalence remains high among vulnerable populations, including individuals with substance use disorders, mental illness, or socioeconomic disadvantage, all of whom are at increased risk for smoking, heavy smoking, nicotine dependence, and smoking-attributable disease and premature death (Higgins, 2020; Higgins et al., 2019; Lasser et al., 2000; Lawrence, Mitrou, & Zubrick, 2009; Leventhal, Dai, & Higgins, 2021; Schroeder, 2016). Reducing this burden will require tobacco control and regulatory policies that are more effective at changing behavior in these vulnerable populations. One important challenge to tobacco control and regulation, however, is the rapidly changing tobacco landscape and the emergence of new products, such as Electronic Nicotine Delivery Systems (ENDS) and new generations of ENDS. Additionally, if conventional cigarettes become more expensive or less reinforcing (e.g., increased taxation; decreases in nicotine content) than other combustible tobacco products or restrictions to access are imposed on cigarettes but not on other combustible tobacco products (e.g., little cigars and cigarillos, or LCCs), this may lead to these other combustible products substituting for cigarettes (Quisenberry, Koffarnus, Hatz, Epstein, & Bickel, 2016).

Recent evidence has demonstrated the annual sales and consumption of cigars have increased steadily in the United States, doubling between 2000 and 2016 (Gammon et al., 2019). This increase in consumption is especially apparent among LCCs, perhaps due to their lower cost and notable similarities to cigarettes in the burn time, filters, packaging, marketing, tobacco pH, size, and appearance (Delnevo, 2006; Delnevo, Hrywna, Giovenco, Miller Lo, & O’Connor, 2017). Additionally, ENDS use is increasing sharply in the U.S., including among vulnerable populations (Cummins, Zhu, Tedeschi, Gamst, & Myers, 2014; Kurti et al., 2020; Spears, Jones, Weaver, Pechacek, & Eriksen, 2016; Stein et al., 2015). Thus, understanding how policies affecting cigarettes interact with other available combustible and noncombustible products in an already complex tobacco market is important to efforts to estimate potential impacts of regulatory policies on public health.

An emerging research model for experimentally determining how people purchase tobacco products under conditions with multiple concurrently available products is the Experimental Tobacco Marketplace (ETM). The ETM is an “Amazon”-like virtual store that allows investigators to offer a wide range of tobacco and nicotine products wherein product labeling, descriptions, and prices can be manipulated (Pope et al., 2019; Quisenberry, Koffarnus, Epstein, & Bickel, 2017; Quisenberry et al., 2016). In the ETM model, participants are assigned an individualized account balance (based on their average baseline weekly tobacco product use) that is used to make purchases in the ETM. Participants are asked to make purchases for five days’ worth of tobacco and nicotine products, assuming that these are the only products available to them for the next five days. This is done under four or five price conditions in which the price of cigarettes increases (e.g., $0.12, $0.25, $0.50, $1.00. and $2.00 per cigarette), while the prices of the alternative products remain fixed. The purpose of increasing price of cigarettes is to evaluate demand Intensity and Elasticity for cigarettes under increasing constraints (i.e., price) and to evaluate how purchasing of alternative products changes as a function of constraints on cigarettes. At each weekly purchase, one of the price conditions is “actualized” and the participant receives all the products purchased in that condition and is requested to exclusively use only those products for the next five days (see Bickel et al., 2018; Carroll et al., 2020, for reviews).

Using the ETM, Quisenberry et al. (2016) had participants make purchases among various tobacco and nicotine products (e.g., ENDS, LCCs, snus) across four conditions in which the price for their usual brand cigarette increased and the prices for all alternate products remained fixed. Overall, ENDS functioned as substitutes for cigarettes to a greater extent than other tobacco products as the price of cigarettes increased, although the purchasing of LCCs also increased (albeit not significantly so). Additional ETM studies (Pope et al., 2019; Quisenberry et al., 2017) confirmed earlier observations and demonstrated that substitutability is also modulated by factors such as ENDS nicotine content and consumer characteristics such as gender. However, none of these previous studies have studied pod-based ENDS, which have increased nicotine delivery and abuse liability compared to earlier generation ENDS (Voos et al., 2019; Wagener et al., 2017). Further, none of these prior studies has been explicitly focused on populations known to particularly vulnerable to smoking and related adverse outcomes. Given that a large portion of today’s cigarette smokers are overrepresented by these vulnerable populations (Lasser et al., 2000; Lawrence et al., 2009; Schroeder, 2016), a study aiming to explicitly understand how vulnerable populations interact with the tobacco marketplace is important for tobacco control and regulatory efforts. Our group has previously done work with three vulnerable populations particularly suspectable to cigarette smoking and associated adverse outcomes (Higgins et al., 2017; Higgins et al., 2020): 1) adults with a current mental using affective disorders as a highly prevalent exemplar; 2) adults with opioid-use disorder, a substance use disorder associated with a strikingly high prevalence of smoking; and 3) socioeconomically-disadvantaged adults using women of reproductive age with low educational attainment because of the concern for multi-generational adverse impacts.

The purpose of the current pilot experiment was to evaluate the substitutability of alternative tobacco and nicotine products for conventional cigarettes among non-treatment seeking adult daily smokers recruited from populations known to be highly vulnerable to cigarette smoking. In three experimental sessions, the price for usual brand cigarettes increased and the price for alternative tobacco and nicotine products remained fixed, with sessions differing in terms of availability of alternative products. Given the increased use of ENDS and LCCs in recent years (Delnevo, 2006; Delnevo, Hrywna, Giovenco, Miller Lo, & O’Connor, 2017; Gammon et al., 2019), the availability of ENDS and LCCs was the primary manipulation across these three sessions, in which either: (1) ENDS and LCCs were available for purchase, (2) ENDS were available but LCCs were not, or (3) LCCs were available but ENDS were not. Thus, through manipulating the availability of these popular alternative tobacco products, we hoped to assess the availability of one or multiple alternative products on substitution. We were particularly interested in JUUL because it had rapidly achieved a sizeable share of the ENDS marketplace at the time this study was planned. Smokeless tobacco (moist snuff, snus) and nicotine replacement therapy (NRT) gum and lozenges were also available in all sessions.

Methods

Participants

Participants were 30 adult daily smokers recruited from the community in Chittenden County, VT, and surrounding areas. These participants were recruited from populations known to be at increased risk for cigarette smoking and smoking-related adverse health effects (Higgins et al., 2019). This sample was similar to other tobacco regulatory research on vulnerable populations and included adults with current affective disorders (n = 7), opioid use disorder (n = 14), and socioeconomically disadvantaged women of reproductive age (n = 9) (see also Higgins et al., 2017; Higgins et al., 2020). To meet eligibility criteria, participants had to be 21 years or older, report smoking 5 or more cigarettes per day for the past year, and provide a breath carbon monoxide (CO) sample greater than 8 ppm at screening. Inclusion criteria specific to participants with affective disorders were individuals who met Mini-International-Neuropsychiatric-Interview (Sheehan et al., 1998) criteria for current or past-year affective disorder, participants with opioid use disorder were currently receiving opioid-maintenance treatment and stable on their maintenance dose, and women of reproductive age with socioeconomic disadvantage were females only, between the ages of 21–44 years, with an education level not greater than high school. Educational attainment represented socioeconomic disadvantage because it is an especially sensitive risk factor for smoking among women (Higgins & Chilcoat, 2009). Individuals were excluded if they had plans to quit smoking in the next month, were currently seeking treatment for smoking cessation, had used nicotine replacement therapy for the purposes to quit smoking in the past month, exclusively used roll-your-own cigarettes, were pregnant, trying to become pregnant and/or breastfeeding, or were currently taking anticonvulsant medications. In addition, participants had to report no current (within past year) serious psychiatric condition that would interfere with study results or completion and be sufficiently literate to complete study tasks and provide written informed consent (see Higgins et al., 2017; Higgins et al., 2020, for more details on inclusion/exclusion criteria).

Procedures

The University of Vermont Institutional Review Board reviewed and approved the protocol for this study. After an initial screening session to determine eligibility, participants attended three ETM purchasing sessions and one follow-up session (see Figure 1). Immediately following consent, participants were given a JUUL (JUUL Labs, San Francisco, CA) device and instructed in how to use it (e.g., charging, replacing pods, vaping). The JUUL pods used hold approximately 0.7 mL of e-liquid containing approximately 40 mg of nicotine or 5% nicotine by weight. Participants were asked to sample the currently available pod flavors (based on local market conditions) and select a flavor to use for the duration of the study. At the beginning of the study, Classic Tobacco, Rich Tobacco, Mint, and Menthol flavors were available; however, only Rich Tobacco and Menthol were available to participants by the end of the study. Participants were also given the opportunity to sample any other study products and were given a 2-day supply of pods and selected products (amount comparable to their reported cigarettes per day) to use prior to the first ETM session. However, despite this sampling opportunity, participants rarely sampled products aside from ENDS. Alternative tobacco/nicotine products included LCCs, smokeless tobacco, and NRT gum and lozenges. The LCCs included Swisher Sweet cigarillos (single count, Swisher International Group, Jacksonville, FL) and Black & Mild filtered-tip cigars (single count, John Middleton, Inc., Richmond, VA). Smokeless tobacco products included winterchill flavor Camel Snus (single pouch, R.J. Reynolds, Winston-Salem, NC) and classic flavor Skoal dip (single pouch, US Smokeless Tobacco Company, Richmond, VA). NRT products included white ice mint flavor Nicorette 4-mg nicotine gum (single count, McNeil Consumer Healthcare, Fort Washington, PA) and mint flavor Nicorette 4-mg nicotine lozenges (McNeil Consumer Healthcare, Fort Washington, PA).

Figure 1.

Figure 1.

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Order of study sessions. Note: ETM = Experimental Tobacco Marketplace.

Account Balance

Consistent with prior ETM studies (Pope et al., 2020; Pope et al., 2019; Quisenberry et al., 2017; Quisenberry et al., 2016), participants were assigned an individualized account balance to use during ETM sessions. A participant’s account balance was determined by multiplying the average number of tobacco products that they reported using per day at baseline and multiplying that number by the approximate local price of those products (e.g., $0.50 per cigarette). This number was then multiplied by 5 to provide an account balance for 5 days’ worth of purchases. This method for determining the account balance produces purchasing that is representative of the participant’s typical tobacco purchases (Koffarnus, Wilson, & Bickel, 2015).

ETM Sessions

Participants attended three ETM sessions which differed by the alternative products available to purchase. Usual brand cigarettes, smokeless tobacco, and NRT products were available in all sessions. In the All Products session, both ENDS and LCCs were available for purchase. In the No LCCs session, ENDS were available but LCCs were not. In the No ENDS session, LCCs were available but ENDS were not. Given that participants experienced multiple ETM sessions and that randomized versus nonrandomized session order has not been explored among vulnerable populations using the ETM, session order was randomly determined for a little over half of the participants (i.e., 17) while the remaining participants experienced sessions in the order listed above.

During each of the three ETM sessions, participants were seated in front of a computer where they could access the ETM via OpenCart, a website individualized with each participant’s usual brand of cigarette and pod flavor. Participants were asked to make 5 days’ worth of tobacco/nicotine product purchases under five escalating prices for their usual brand cigarettes (i.e., $0.12, $0.25, $0.50, $1.00. and $2.00 per cigarette), while the price of all alternative products remained fixed. Again, the alternative products available to purchase varied across sessions (see above). In each cigarette price condition, participants could purchase as many products as they would like up to the amount specified in their account balance. After completing this series of purchases, one cigarette price condition was randomly actualized, and the participant received all the products purchased and any remaining account balance from that condition. For the 5 days following each ETM session, participants were asked not to use or purchase any outside tobacco/nicotine products and not to sell or give away any of their products. At each subsequent session, participants could return any unused study products and receive the monetary equivalent for them. A single follow-up session was conducted following the last ETM session to collect any used products and note non-study product use.

Statistical Analyses

GraphPad Prism 9 was used to fit the demand equation to the data and SAS was used to conduct the statistical analyses. Consistent with prior ETM studies (Pope et al., 2019, 2020; Quisenberry et al., 2016, 2017), product purchases were converted to total mg of nicotine, which allows for evaluation of purchases of different product units on the same scale. Prior to formally evaluating demand for usual brand cigarettes, cigarette purchases in mg of nicotine across prices and sessions were first examined for nonsystematic cases according to the three criteria outlined by Stein, Koffarnus, Snider, Quisenberry, and Bickel (2015): (a) trend (i.e., no reduction in purchasing with increasing price), (b) bounce (i.e., purchases at a price that exceeds purchases at the lowest price by at least 25%), and (c) reversals from zero (i.e., inconsistent effects of price on purchasing). In total, two cases failed the trend criteria (one from the All Products session and one from the No LCCs session) and four cases failed the bounce criterion (two from the All Products session and two from the No LCC session). These cases were excluded from all following analyses.

The exponentiated demand equation (Koffarnus, Franck, Stein, & Bickel, 2015) was fit to mean cigarette purchases in mg of nicotine across price for each ETM session:

Q=Q0×10k(e−αQ0P−1) Eq. 1

where Q is cigarette purchases, Q0 is demand Intensity (cigarette purchases at zero or minimal cost), k corresponds to the range of the function in logarithmic units, α represents demand Elasticity, and P is the price of the cigarette. For the fits, Q0 was fixed as the obtained mean cigarette purchases in the $0.12 price condition for each session and k was set as a constant common across all prices and ETM sessions (k = 1.53), which was determined by subtracting the log transformed average consumption at the highest price from the log transformed average consumption at the lowest price for the entire data set (i.e., all three sessions), and adding .5 to that range (Gilroy et al., 2018; Kaplan et al., 2018).

To further evaluate demand for cigarettes, linear regression was applied to cigarette purchases as a function of log transformed cigarette price in each session. To evaluate demand Intensity, empirically derived Q0 was compared between sessions using mixed model repeated measures analysis of variance. Prior to analysis, the Q0 data was square root transformed in order to meet the assumption of Normality.

To evaluate the substitutability of alternative products, linear regression was applied to each alternative-product purchase as a function of log transformed cigarette price in each session. Slopes that were statistically significantly different from zero indicated substitution.

Results

Participants

Table 1 shows participant demographics and smoking characteristics. Participants averaged ~37 years old, were largely White and female, had a high school education or some college, and were mostly never married. Participants smoked approximately 19 cigarettes per day, mostly non-mentholated, and the vast majority had some lifetime experience with ENDS or LCCs (e.g., used even once before) prior to the study but were not regular users as evidenced by few reporting past 30-day use of ENDS or LCCs (see Table 1).

Table 1.

Participant Characteristics. Values represent % unless otherwise noted.

Demographics n = 30
Age (M ± SD) 36.57 (10.09)
Gender (% Female) 23 (76.67%)
Race/Ethnicity
 Non-Latino White 29 (96.67%)
 Non-Latino Black 0 (0%)
 Latino 1 (3.33%)
 Non-Latino Other or >1 race 0 (0%)
 Non-Latino
 American Indian/Alaska Native 0 (0%)
 Non-Latino Asian 0 (0%)
Education
 8th Grade or Less 1 (3.33%)
 Some High School 2 (6.67%)
 High School Graduate/Equivalent 13 (43.33%)
 Some college 10 (33.33%)
 2-Year Associate’s Degree 1 (3.33%)
 College Graduate/4-Year Degree 2 (6.67%)
 Graduate or Professional Degree 1 (3.33%)
Marital Status
 Married 4 (13.33%)
 Never married 19 (63.33%)
 Divorced or Separated 7 (33.33%)
 Widowed 0 (0%)
Tobacco Use History
 Cigarettes smoked per day (M ± SD) 18.87 (9.10)
 Primary smoker of mentholated cigarettes 9 (30.00%)
 Past 30-day ENDS use 5 (16.67%)
 Past 30-day LCC use 3 (10.00%)
 Lifetime ENDS use 26 (86.67)
 Lifetime LCC use 20 (73.33%)
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Cigarette Demand in the ETM

Regarding session order, the only difference noted between those participants who experienced a random session order and those who experienced a non-random order was in cigarette demand Intensity in the All Products session (p = .02), with higher Intensity for random order vs non-random (all other ps ≥ .11).

Figure 2 depicts demand for usual brand cigarettes as a function of increasing cigarette price. When Eq. 1 was fit to mean cigarette purchases across cigarette price, obtained R2 values were 0.94, 0.92, and 0.93 for the All Products, No LCCs and No ENDS sessions, respectively. Demand Elasticity (i.e., best-fit α values) was .0002, .0002, and .0001 for the All Products, No LCCs and No ENDS sessions, respectively. Overall, cigarette demand decreased as a function of increasing price in all sessions, as evident by significant non-zero slopes in the All Products session, F(1, 133) = 106.10, p < .0001, r = −.93, No LCCs session, F(1, 133) = 135.70, p < .0001, r = −.88, and No ENDS session, F(1, 148) = 151.90, p < .0001, r = −.91, but the slopes did not differ between sessions (p = 0.16). However, cigarette demand Intensity did differ between sessions, F(2, 52) = 4.32, p = .018. Specifically, Intensity was significantly higher in the No ENDS session relative to the All Products session (p = .005) but did not differ between All Products and No LCCs (p = .166), and No LCCs and No ENDS (p = 0.142).

Figure 2.

Figure 2.

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Mean obtained (symbols) and Eq. 1-predicted (lines) cigarette purchases in mg of nicotine as a function of cigarette price, shown in log scale on the x-axis, for each of the three sessions. Error bars represent SEM. Note ENDS = electronic nicotine delivery systems, LCC = little cigars and cigarillos.

Substitution for Cigarettes in the ETM

Figure 3 depicts the alternate fixed-priced product purchases in each session, as a function of increasing cigarette price. When all products were available, ENDS substituted for cigarettes as evident by a significant non-zero slope of ENDS purchases as a function of increasing cigarette price, F(1, 133) = 5.95, p = .016, r = .96, while LCCs did not (ps ≥ .12). When LCCs were unavailable, ENDS again substituted for cigarettes, F(1, 133) = 7.37, p = .008, r = .79. When ENDS were unavailable, LCCs did not substitute for cigarettes (ps ≥ .48). The other products did not function as substitutes (ps ≥ .30), with participants rarely purchasing smokeless tobacco or NRT products.

Figure 3.

Figure 3.

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Mean obtained alternative product purchases in mg of nicotine as a function of cigarette price, shown in log scale on the x-axis, in each of the three sessions. Error bars represent SEM. Note overlapping near-zero consumption for Snus, Skoal, Gum, Lozenges.

Discussion

The purpose of the current pilot experiment was to determine the substitutability of newer generation ENDS and LCCs among smokers from non-treatment seeking vulnerable populations. ENDS functioned as the most robust substitute for cigarettes when the price for cigarettes increased under conditions in which both ENDS and LCCs were available for purchase and under conditions in which ENDS were available but LCCs were not. Thus, even under conditions in which alternative combustible products were available, ENDS proved to be the most robust substitute. Conversely, although some purchasing of LCCs occurred in both sessions in which they were available, this occurred for a select few participants and did not meet the formal definition of substitution (i.e., a significant non-zero slope of product purchasing as a function of increasing cigarette price). Regarding the effects of session order, there was only one significant difference (in demand Intensity) for one session between those experiencing a randomized versus non-randomized session order; therefore, it is possible either method may be appropriate for use among vulnerable populations, but future studies may confirm the effects of session order.

The current findings replicate and extend those of previous research (Quisenberry et al., 2016) in which early generation ENDS (Blu® disposable ENDS) substituted for conventional cigarettes, and LCCs did not. The consistency in these findings held despite different participant characteristics between the current and prior studies, including a greater proportion of women in the current study versus Quisenberry et al. (76.67% versus 54%, respectively) and a more predominately White population in the current study sample (96.67% versus 73.0%, respectively). The current findings also extend the substitution effects observed by Quisenberry et al. to vulnerable populations and pod-based ENDS that have increased nicotine delivery and abuse liability compared to earlier generation ENDS (Voos et al., 2019; Wagener et al., 2017). Additionally, similar to the findings of Quisenberry et al., the current study did not find a significant substitution effect of LCCs. Unlike Quisenberry et al., ENDS were made unavailable during one session in which LCCS remained available to test if the removal of ENDS increased substitution of LCCs. Still, LCCs did not function as a substitute, although both studies reported some minimal level of purchasing of these products. Possibly neither study included the population(s) for whom LCCs are most likely to function as substitutes. Additionally, although one participant in the current investigation purchased 30 cigarillos, the majority of participants did not purchase cigarillos or filtered cigars; thus, the conditions under which this occurs is still unclear. Previous research has demonstrated greater use of cigarillos and filtered cigars among men than women (Azagba, King, & Shan, 2021; Corey et al., 2017) and some evidence suggests greater cigar use among African American/Black participants than White participants (Azagba et al., 2021; c.f. Corey et al., 2017; Nyman, Sterling, Weaver, Majeed, & Eriksen, 2016). Therefore, future research on the substitution of LCCs for cigarettes would be useful in understanding the extent of LCC substitutability across different populations.

Another notable observation from the current investigation was the increases in demand Intensity for cigarettes when ENDS and/or LCCs were unavailable. Thus, not only was cigarette demand sensitive to price but also to the availability of alternative products. This observation is also consistent with the findings in Quisenberry et al. (2016). An implication of these findings is that decreases in availability of alternative non-combusted substitute products such as ENDS may increase demand for cigarettes, at least under some conditions and in certain user populations. That potential outcome may be an important consideration when regulating availability of ENDS and other alternative non-combusted tobacco products.

The current investigation, to our knowledge, is the first study to use the ETM to (a) examine the substitutability of later generation ENDS or (b) to explicitly focus on individuals recruited from populations known to be at increased risk for smoking, heavy smoking, nicotine dependence, and smoking-attributable adverse effects (Higgins et al., 2019; Lasser et al., 2000; Lawrence et al., 2009; Schroeder, 2016). Considering the consistency between the current results and results from prior ETM studies recruited from the general population of smokers (e.g., decreased cigarette demand as a function of increased cigarette price; increased substitution of alternative products), these results provide further support for the construct validity and generality of the findings from the ETM. Further, the current results also highlight the practical utility of the ETM for experimentally investigating cigarette smoking and substitution. Lastly, results from the present study supported a strong substitution effect of ENDS in the context of increasing cigarette price. This finding underscores the considerable potential for harm reduction among vulnerable populations from increasing constraints on conventional cigarettes (Nitzkin, 2014; Notley, Ward, Dawkins, & Holland, 2018).

In terms of study limitations, several merit mention. First, the current study was a pilot study to examine the initial feasibility of using the ETM with vulnerable populations. Therefore, the study sample was small, primarily rural, White (as is representative of the population of Vermont), largely female (one of the populations was exclusively women of reproductive age), and a convenience rather than a nationally representative sample. Furthermore, those with opioid-use disorder were also overrepresented in the current sample. Thus, results may not be generalizable to populations with other sociodemographic or smoking characteristics, although the consistency with results observed by Quisenberry et al. lessen this concern. Second, study participants were not regular users of alternative tobacco products, including ENDS or LCCs, and thus results may not represent the degree or pattern of substitution that may be observed with more experienced users of these products. Future studies examining these same questions in more ethnically/racially diverse samples and those with greater ENDS and LCC experience appear to be warranted.

These limitations notwithstanding, we believe that the present pilot study represents an important step in using the ETM as a tool to examine how tobacco regulatory changes may impact cigarette smoking and other tobacco use in vulnerable populations.

Highlights.

  • First study to use the Experimental Tobacco Marketplace with vulnerable populations.

  • Pod-based e-cigarettes were the most robust substitute for cigarettes.

  • E-cigarette availability may impact tobacco regulatory policies on cigarettes.

Funding:

Centers of Biomedical Research Excellence (COBRE) award P20GM103644 from NIGMS; Tobacco Centers of Regulatory Science (TCORS) award U54DA036114 from NIDA and FDA; and T32 DA007242 from NIDA.

Footnotes

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CRediT author statement

Tyler Nighbor: Conceptualization, Methodology, Investigation, Data Curation, Formal Analysis, Writing-Original and Reviewing and Editing; Kaitlyn Browning: Investigation, Data Curation, Formal Analysis, Writing-Original and Reviewing and Editing; Ellaina Reed: Investigation, Writing- Reviewing and Editing; Anthony Oliver: Investigation, Writing- Reviewing and Editing: Michael DeSarno: Data Curation, Formal Analysis, Writing-Reviewing and Edition; Allison Kurti: Conceptualization, Supervision Writing-Reviewing and Edition, Warren Bickel: Writing- Reviewing and Editing; Stephen Higgins: Conceptualization, Funding acquisition, Writing- Reviewing and Editing, Supervision

Declaration of interests

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.

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