Public health concerns: monitoring e-cigarette sales key to preventing youth tobacco use

By Neha MathurReviewed by Lily Ramsey, LLMJun 26 2023

In a recent Morbidity and Mortality Weekly Report, the United States Centers for Disease Prevention and Control, under its Foundation, Truth initiative, analyzed retail scanner data gathered from Information Resources, Inc. (IRI), a market research company in the United States (US) between January 26, 2020, and December 25, 2022.

The study evaluated trends in e-cigarette unit sales stratified by product, flavor, and brand.

In the United States, IRI has access to e-cigarette sales data, including Universal Product Code sales from brick-and-mortar retailers only, although vape shops, online retailers, and tobacco specialty stores also sell e-cigarettes.

Study: E-cigarette Unit Sales by Product and Flavor Type, and Top-Selling Brands, United States, 2020–2022. Image Credit: Yarrrrrbright/Shutterstock.com

Background

E-cigarette use is substantially higher among youths and young adults (or adolescents) than adults, especially flavored products.

Accordingly, in 2021, nearly 11 million adults aged ≥18, comprising 4.5% of all adults, used e-cigarettes, of which ~3 million were below 24 years. In 2022, around two million high school students in the US used e-cigarettes. 

Intriguingly, e-cigarettes often contain high concentrations of nicotine, which is highly addictive and harmful to the adolescent brain, which continues to develop until age 25. 

Multiple factors, e.g., local and US state policies governing e-cigarette sales, the Food and Drug Administration (FDA) policies, coronavirus disease 2019 (COVID-19)–induced lockdowns, etc., disrupted the availability of e-cigarette products starting in 2020. Also, the e-cigarette market is highly dynamic.

Since e-cigarettes and the use of their products are rapidly changing in the US, so should the related policies. For this reason, it is important to monitor e-cigarette sales continuously. It could inform strategies to prevent its use among young adults and restrict the use of flavored tobacco products if needed.

About the study

In the present study, researchers used the StataCorp tool, Stata v17, to analyze total unit sales of e-cigarettes and the unit share stratified by flavor and product type.

Likewise, they used the Joinpoint regression v.4.9.1.0 tool to detect statistically significant changes in sales trend, i.e., with p-values <0.05, during the analysis period. 

It helped the researchers determine the average four-week period percentage change (APPC), i.e., the average of the slope coefficients of the Joinpoint regression line. In addition, they reported all e-cigarette-selling brands and the top five brands with the highest unit sales at the beginning and end of the study period. 

For analysis, they categorized e-cigarette products and flavor names as prefilled cartridges, e-liquids, or disposable devices and tobacco, menthol, mint, or other flavors, such as alcoholic and nonalcoholic drinks, respectively.

Notably, they included some fusion flavors, constituting 5.6% of sales, in this analysis. Further, the team standardized e-cigarette unit sales and summed them for four weeks, spanning January 26, 2020, and December 25, 2022.

Results

During the two-year study period, unit shares of tobacco- and mint-flavored e-cigarette products declined from 28.4% to 20.1% and 10.1% to 5.9%, respectively, whereas it increased for other flavors from 29.2% to 41.3%. 

In January 2020, FDA announced that it would prioritize enforcement against prefilled e-cigarettes in flavors other than tobacco and menthol. After this announcement, as expected, retail sales of mint- and other-flavored prefilled cartridges ceased, while the sales of fruit- and mint-flavored disposable products increased. 

Thus, stratified by product categories, while unit shares of prefilled cartridges decreased from 75.2% to 48% of total unit sales, that of disposable e-cigarettes increased from 24.7% to 51.8%.

In addition, stratified by flavors, the unit share sale of menthol-flavored e-cigarette products remained stable, whereas nonmenthol flavor unit shares changed. 

Intriguingly, in the four weeks ending December 25, 2022, of 184 e-brands, the top five e-cigarette brands were JUUL, Vuse, Breeze Smoke, Elf Bar, and NJOY. However, at the beginning of the study period, the top five e-cigarette brands in descending order of sales were JUUL, Vuse, NJOY, My Blu, and Puff.

Conclusions

At the end of the study period, i.e., in December 2022, e-cigarette unit sales were 7.2 million units higher than in January 2020. However, total unit sales declined briefly between May and December 2022.

In January 2020, disposable e-cigarettes constituted nearly less than one-fourth of total unit sales. However, its sale was still higher than refillable e-cigarettes in March 2022. 

A study among 4,142 individuals aged 16 to 19 years in the US reported that the highest-selling disposable brand at the end of 2022 was Elf Bar, which also drove sharp increases in e-cigarette use in people of the same age group in August 2022.

In the US, flavored disposable e-cigarettes have become the most commonly used e-cigarette device among US school students after 2020, demonstrating that the e-cigarette use patterns rapidly shifted in response to policy interventions and other factors.

Nonetheless, there is an urgent need to restrict the sale of all flavored tobacco products, including e-cigarettes, menthol cigarettes, and flavored cigars, all across the US.

These combined with data-based strategies to prevent tobacco use in youth, such as price increases and comprehensive smoke-free policies that encompass counter-marketing campaigns, are needed to reduce disparities in tobacco use inequities.