Abstract and Introduction
Introduction
E-cigarette products, related policies, and use patterns change rapidly. In the United States, the prevalence of e-cigarette use is markedly higher among youths and young adults than it is among adults overall. In 2021, 4.5% of all adults aged ≥18 years (an estimated 11.1 million) and 11.0% of young adults aged 18–24 years (an estimated 3.1 million) currently (≥1 day during the previous 30 days) used e-cigarettes; during 2022, 14.1% of high school students (an estimated 2.14 million) currently used e-cigarettes.[1,2] E-cigarettes often contain high concentrations of nicotine. Nicotine is highly addictive and can harm the adolescent brain, which continues to develop through approximately age 25 years.[3] Since 2020, the availability of e-cigarette products has changed in response to multiple factors, including local and state policies to address flavored e-cigarette sales, actions undertaken by the Food and Drug Administration (FDA), COVID-19–related closures, and global supply chain disruptions. To assess trends in unit sales of e-cigarettes in the United States, by product and flavor, and top-selling brands, the CDC Foundation, Truth Initiative,* and CDC analyzed retail scanner data during January 26, 2020–December 25, 2022, from Information Resources, Inc. (IRI), a U.S. data analytics and market research company. Overall, unit sales increased by 46.6% during the study period. The unit share of menthol-flavored product sales remained relatively stable during this period, whereas nonmenthol flavor unit shares changed. During January 26, 2020–December 25, 2022, unit shares of tobacco-flavored and mint-flavored products decreased (from 28.4% to 20.1% and from 10.1% to 5.9%, respectively), whereas shares of other flavor sales increased (from 29.2% to 41.3%). In addition, during January 2020–December 2022, unit shares of prefilled cartridges decreased from 75.2% to 48.0%, and disposable e-cigarette unit share increased from 24.7% to 51.8% of total unit sales. The five top-selling e-cigarette brands for the 4-week period ending December 25, 2022, were Vuse, JUUL, Elf Bar, NJOY, and Breeze Smoke. Analysis of information on e-cigarette retail sales can guide strategies to prevent youth access to and use of e-cigarettes, including restrictions on flavored tobacco products.[4]
U.S. e-cigarette sales data were licensed from IRI, which included Universal Product Code sales from brick-and-mortar retailers only; sales from online retailers and tobacco specialty stores, including vape shops, were not available. For analyses other than top-selling brands, e-cigarette products were categorized as prefilled cartridges, disposable devices, or e-liquids†,[5] and e-cigarette accessories and devices sold without e-liquids (accounting for 9.5% of sales) were excluded. Product flavor names were categorized as tobacco, menthol, mint, or all other flavors (e.g., fruit, clove or spice, candy, desserts, other sweets, chocolate, alcoholic and nonalcoholic drinks). Ambiguous or concept flavors (e.g., "fusion"), which constituted 5.6% of sales, were searched online and back-coded into one of the four flavor categories. E-cigarette unit sales were standardized and summed during 4-week periods during January 26, 2020–December 25, 2022§. Analyses were performed for total unit sales and the proportion of total unit sales (unit share) by flavor and product type using Stata (version 17; StataCorp). Trends during the analysis period were analyzed using Joinpoint regression (version 4.9.1.0; National Cancer Institute), which detects points in time when changes in trend (or slope changes) are statistically significant. The average 4-week period percentage change (APPC) was calculated as the average of the slope coefficients of the Joinpoint regression line. P-values <0.05 were considered statistically significant. Total number of brands and a list of the top five brands with the highest unit sales, as provided in the IRI database without unit standardization or exclusions, were reported for the beginning and end of the study period. This study was reviewed by CDC and was conducted consistent with federal law and CDC policy.¶
During January 2020–December 2022, total U.S. e-cigarette unit sales increased by 46.6%, from 15.5 million to 22.7 million units per 4-week period (APPC = 1.1; p<0.05); however, sales fluctuated during this period (Figure 1). Although sales increased during January 2020–May 2022, the percentage of increase in sales slowed from 36.5% (15.5 million to 21.2 million; APPC = 6.9) during January 2020–June 2020 to 16.8% (21.2 million to 24.7 million; APPC = 1.3) during June 2020–June 2021 to 4.9% (24.7 million to 25.9 million; APPC = 0.4) during June 2021–May 2022 (p<0.05 for all APPCs). Overall, during January 2020–May 2022, total sales increased 67.2% (APPC = 1.8; p<0.05), from 15.5 million to 25.9 million units per period. During May–December 2022, total sales decreased by 12.3% (APPC = –1.8; p<0.05), to 22.7 million units per period.
Figure 1.
Total e-cigarette unit sales,* by flavor† — United States, January 26, 2020–December 25, 2022
*Retail sales data obtained from Information Resources, Inc. for convenience stores, gas stations, grocery stores, drug stores or pharmacies, mass merchandiser outlets, club stores, dollar stores, and military sales; Internet and vape shop sales were not recorded.
†The "All other flavors" category includes fruit, clove or spice, chocolate, alcoholic drink (such as wine, cognac, or other cocktails), candy, desserts, other sweets, or some other flavor. Unknown flavors were excluded from this figure (<0.1%).
Among total e-cigarette unit sales during January 2020–December 2022, the percentage of menthol flavor sales did not significantly change (<1%, from 32.3% in January 2020 to 31.9% in December 2022), whereas the percentages of tobacco, mint, and other flavor sales fluctuated. During the period of increasing total sales (January 2020–May 2022), decreases were observed in the percentages of sales of both tobacco flavor (from 28.4% to 20.5%; APPC = –1.1; p<0.05) and mint flavor e-cigarettes (10.1% to 5.6%; APPC = –1.9; p<0.05), while the percentage of other flavor sales increased from 29.2% to 40.8% (APPC = 1.1; p<0.05). During the period of declining total sales (May–December 2022), the percentage of sales of tobacco-flavored e-cigarettes decreased slightly, from 20.5% to 20.1% (APPC = –0.6; p<0.05), while slight increases in sales of mint-flavored (from 5.6% to 5.9%) and other-flavored e-cigarettes (40.8% to 41.3%) occurred (APPC = 1.3 and 0.4, respectively; p<0.05).
Among total e-cigarette unit sales during January 2020–December 2022, the percentage of prefilled cartridge sales decreased from 75.2% to 48.0% (APPC = –1.1; p<0.05). In contrast, the percentage of disposable e-cigarette sales more than doubled, from 24.7% in January 2020 to 51.8% in December 2022 (APPC = 1.9; p<0.05). Among prefilled cartridge e-cigarettes sales in January 2020, tobacco, menthol, and mint flavors accounted for 34.2%, 40.0%, and 10.5% of sales, respectively, whereas e-cigarette sales of other flavors accounted for 15.3% (Figure 2). During December 2022, the prefilled cartridge market was composed of tobacco- (37.3%) and menthol- (62.2%) flavored sales almost exclusively. Among disposable e-cigarette sales during January 2020, tobacco, menthol, mint, and other flavors accounted for 10.5%, 9.0%, 8.9%, and 71.4%, respectively (Figure 3). By December 2022, the disposable e-cigarette market was led by mint (11.1%) and flavors other than tobacco, menthol, or mint (79.6%); tobacco- and menthol-flavored sales accounted for 4.3% and 3.6%, respectively.
Figure 2.
Prefilled cartridge* e-cigarette unit sales,† by flavor§ — United States, January 26, 2020–December 25, 2022
*Prefilled cartridges include tanks, cartridges, and pods used in rechargeable and reusable e-cigarette devices; the cartridges are not intended to be refilled after the liquid has been depleted. Unit sales were standardized to reflect the most common package size for each product type; a standardized unit was equal to five prefilled cartridges.
†Retail sales data obtained from Information Resources, Inc. for convenience stores, gas stations, grocery stores, drug stores or pharmacies, mass merchandiser outlets, club stores, dollar stores, and military sales; Internet and vape shop sales were not recorded.
§The "All other flavors" category includes fruit, clove or spice, chocolate, alcoholic drink (such as wine, cognac, or other cocktails), candy, desserts, other sweets, or some other flavor.
Figure 3.
Disposable e-cigarette* unit sales,† by flavor§ — United States, January 26, 2020–December 25, 2022
*Disposable devices include nonrechargeable and nonreusable e-cigarette devices that are not intended to be refilled with e-liquid after being depleted; the device is disposed of once the e-liquid has been consumed. Unit sales were standardized to reflect the most common package size for each product type; a standardized unit was equal to one disposable device.
†Retail sales data obtained from Information Resources, Inc. for convenience stores, gas stations, grocery stores, drug stores or pharmacies, mass merchandiser outlets, club stores, dollar stores, and military sales; Internet and vape shop sales not captured.
§The "All other flavors" category includes fruit, clove or spice, chocolate, alcoholic drink (such as wine, cognac, or other cocktails), candy, desserts, other sweets, or some other flavor.
During the 4-week period ending January 26, 2020, among 184 brands, the top five in descending order of sales were JUUL, Vuse, NJOY, My Blu, and Puff.** During the 4-week period ending December 25, 2022, the top five brands were Vuse, JUUL, Elf Bar, NJOY, and Breeze Smoke. The total number of e-cigarette brands increased 46.2% during the study period, from 184 to 269. Vuse, JUUL, NJOY, and My Blu are prefilled cartridge brands; Puff, Elf Bar, and Breeze Smoke are disposable.
Morbidity and Mortality Weekly Report. 2023;72(25):672-677. © 2023 Centers for Disease Control and Prevention (CDC)
