Background:
In recent years, accessories that can add flavor to tobacco products have been developed and marketed. These flavor accessories may increase attractiveness of tobacco products, particularly for inexperienced users.

Objective:
The RIVM aim was to assess the range of flavor accessories available on the Dutch market, how they are used and marketed and what aspects make them attractive to users.

Methods:
Information was acquired from Google and scientific search engines using relevant combinations of keywords. To obtain prevalence and user data, a questionnaire was disseminated among 3562 adult smokers. Sales data of tobacco products and accessories were obtained from the research agency NielsenIQ.

Results:
We identified 10 types of flavor accessories on the Dutch market, including flavored filters, cards, and sprays. All were available in menthol flavor, while some were also available in (a range of) other, mostly sweet, flavors. Approximately 11% of adult cigarette smokers were current users of flavor accessories and 21% had ever used one. Three-quarters of ever users of flavor accessories opted for a product with a menthol flavor. After the ban on menthol cigarettes in May 2020, sales of flavor accessories increased by 10%. All flavor accessories make smoking more attractive, but it is not clear whether the sales of flavor accessories have led to an increase in smoking prevalence overall or in specific subgroups of smokers.

Conclusions:
Flavor accessories are on the rise and potentially increase tobacco product appeal. We propose to restrict advertising and sales of these products in order to support tobacco control policies.