Background:
In May 2020, the European Union (EU) banned menthol as a characterizing flavor in cigarettes. Tobacco industry strategies to undermine the ban have included claims that it will increase illicit trade and lead to new products, such as flavor accessories.

Objective:
This study aimed to examine pre-post ban changes in illicit purchasing and to assess prevalence and correlates of using flavor accessories among a sample of Dutch smokers.

Methods:
Cohort data come from the ITC Netherlands Surveys among adult smokers before the menthol ban at Wave 1 (February–March 2020, N=2067) and after the ban at Wave 2 (September–November 2020, N=1752) and Wave 3 (June–July 2021, N=1721). Those lost to follow-up were replaced with a replenishment sample of smokers. Bivariate and logistic regression analyses were conducted on weighted data.

Results:
Overall, reported purchasing of cigarettes that may have been smuggled remained low from Wave 1 (2.4%, 95% CI: 1.8–3.2) to Wave 2 (1.9%, 95% CI: 1.3–2.7) and Wave 3 (1.7%, 95% CI: 1.2– 2.5). At Wave 3, 4.4% (95% CI: 3.5–5.5) of smokers reported using any flavor accessory (i.e. flavor cards, frutasticks, filters, drops, and/ or another product). After adjusting for gender, age, education level, and flavor of usual brand, those aged 25–39 years were significantly more likely to use accessories compared to those aged ≥55 years (AOR=3.16; 95% CI: 1.53–6.52). Unsurprisingly, menthol smokers were much more likely to use accessories than non-menthol smokers (42.5% vs 3.0%, AOR=17.33; 95% CI: 9.33–32.19).

Conclusions:
Despite industry arguments, the EU menthol ban did not result in increased use of illicit cigarettes. While use of flavor accessories was generally low among smokers, this was higher among young adults and menthol smokers, and warrants continued monitoring. Policy makers should be encouraged to adopt flavor bans. Impact may be maximized by also including flavor accessories, if feasible.