In a study reported in Nicotine & Tobacco Research, Ali et al found that U.S. sales of e-cigarettes have increased, marked by sales of products with higher nicotine strength, and that prices have increased for products with lower nicotine strength while decreasing or not significantly changing for those with higher nicotine strength.
In the study, e-cigarette retail sales data were licensed from Information Resources, Incorporated, for the period of January 2017 to March 2022 for the 48 continental states and Washington, DC. Data consisted of universal product code sales from convenience stores, gas stations, grocery stores, drug stores/pharmacies, mass merchandiser outlets, retail chain stores, club stores, dollar stores, and military sales; data from Internet sales and vape shop sales were not available. Nicotine strength was categorized as: < 1%, 1% to < 2%, 2% to < 3%, 3% to < 4%, 4% to < 5%, and ≥ 5%. Flavors were categorized as tobacco, menthol, mint, or other. Product type was categorized as prefilled cartridge devices, disposable devices, or e-liquid bottles.
From January 2017 to March 2022, total monthly e-cigarette unit sales increased by 293.6%, from 5.7 million units to 23.3 million units (average monthly percent change [AMPC] = 2.1, 95% confidence interval [CI] = 1.5–2.6) and total dollar sales increased by 528.7%, from $74.6 million to $469.0 million (AMPC = 2.8, 95% CI = 1.9–3.7).
The proportion of total unit sales attributed to products containing ≥ 5% nicotine strength increased by 1,486.3%, from 5.1% to 80.9% (AMPC = 4.2, 95% CI = 3.7–4.6), with the proportion of total dollar sales increasing by 1,345.5% from 5.5% to 79.5% (AMPC = 3.8, 95% CI = 2.8–4.8). Products containing < 1% nicotine strength (including zero-nicotine products) accounted for < 0.1% of sales.
According to flavor, the proportion of units sold with ≥ 5% nicotine strength was 61.3% for tobacco-flavor sales, 79.3% for menthol sales, 87.4% for mint sales, and 96.1% for other flavor sales. According to product type, the proportions were 90.6% for disposable e-cigarette sales and 74.2% for prefilled cartridge sales.
The price of products increased by 180.2% (from $10.4 to $29.2; AMPC = 1.5, 95% CI = 1.1–2.0) for products with 1% to < 2% nicotine strength, increased by 57.1% (from $13.5 to $21.3; AMPC = 0.7, 95% CI = 0.1–1.4) for 2% to < 3% nicotine strength, and increased by 30.6% (from $17.8 to $23.3; AMPC = 0.4, 95% CI = 0.1–0.8) for 3% to < 4% nicotine strength. The price of products with 4% to < 5% nicotine strength decreased by 35.8%, from $20.0 to $12.8 (AMPC = −0.6, 95% CI = −0.9 to −0.3); a nonsignificant increase of 20.7%, from $16.4 to $19.8, was found for products with ≥ 5% nicotine strength.
The investigators stated, “The findings from this study indicate that previously reported increases in e-cigarette nicotine strength during 2013 to 2018 have continued through 2022. U.S. e-cigarette market sales continue to be dominated by relatively high-nicotine products. Strategies to address factors that make these products particularly appealing to youth, including flavors and product innovations, are critical. Such strategies are important—as part of a comprehensive approach alongside other evidence-based population-level actions—to address youth e-cigarette use. Importantly, actions to reduce e-cigarette use among youth are not mutually exclusive from actions to maximize the potential benefits of e-cigarettes for increasing smoking cessation among adults.”
They concluded, “Sales of high nicotine-strength e-cigarettes have dominated the U.S. e-cigarette market. Limiting the nicotine strength of e-cigarettes could be considered as part of a comprehensive tobacco control strategy to reduce youth access to and use of these products.”
Fatma Romeh M. Ali, PhD, of the CDC Foundation, Atlanta, is the corresponding author for the Nicotine & Tobacco Research article.
Disclosure: The study was supported by a Bloomberg Philanthropies grant to the CDC Foundation. For full disclosures of the study authors, visit academic.oup.com/ntr.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.