Flavored e-cigarettes account for over 80% of a 47% sales surge from 2019 to 2023, with a CDC Foundation and Truth Initiative report urging stricter policies.

RT’s Three Key Takeaways:

1. E-Cigarette Sales Surge with Flavored Varieties Leading: E-cigarette sales in the US increased by 47% from 2019 to 2023, with more than 80% of sales driven by youth-appealing flavors such as fruit, candy, mint, and menthol.
2. Policy Effectiveness in Reducing Flavored E-Cigarette Sales: States like Massachusetts demonstrated a 98% reduction in flavored e-cigarette sales through policies that restrict flavored tobacco sales, highlighting the importance of enforcement and clear product definitions, according to the report.
3. Youth Use and High Nicotine Content Raise Concerns: Despite declines in youth e-cigarette use, nearly 40% of youth users report frequent use, with rising nicotine levels in disposable e-cigarettes contributing to concerns about addiction and the need for stricter regulations.

Data released in a report from the CDC Foundation and Truth Initiative reveal a 47% increase in e-cigarette unit sales at US retail outlets from 2019 through 2023, with flavor categories like fruit, candy, mint, menthol, and desserts accounting for more than 80% of those sales.

According to the report, the marked rise highlights the need for more states to adopt comprehensive statewide policies restricting sales of flavored e-cigarettes. In Massachusetts, sales restrictions, as well as a range of effective enforcement measures, reduced sales of flavored e-cigarettes by more than 98% in brick-and-mortar retailers. The report explores similar successful efforts in California and New York.

The report also finds the most effective policies to restrict sales of flavored e-cigarettes clearly define products and include comprehensive flavored tobacco restrictions without flavor or product exceptions, incorporate community and retailer education, and are supported by enforcement.

Policies to Curb Youth Access

While the recently released 2024 National Youth Tobacco Survey shows declines in youth e-cigarette use, the data in the report highlights the importance of continued action to reduce the availability of kid-friendly flavored e-cigarettes, the vast majority of which do not have US Food and Drug Administration (FDA) authorization. Despite these declines in youth use, nearly 40% of youth e-cigarette users—more than 620,000 teens—report using e-cigarettes frequently.

“The rise in e-cigarette sales, particularly those with youth-appealing flavors and graphics, is deeply concerning, especially as manufacturers evolve e-cigarette products to feature gamified devices and increased nicotine strength,” says Judy Monroe, MD, president and CEO of the CDC Foundation, in a release. “However, the data from states like Massachusetts, California, and New York demonstrate how comprehensive policies can effectively curb youth access. This report underscores the urgent need for widespread adoption of similar measures to protect our young people from the risks associated with e-cigarette use.”

Among the report’s highlights are:

• Disposable sales grew: Between 2019 and 2023, sales of disposable e-cigarettes are up more than 500%. Studies cited in the report indicate disposable e-cigarettes have become the most common type of device used by young people.
• Flavors surged: Studies quoted in the report found in 2024, 1.63 million youth reported using e-cigarettes over the previous 30 days. Nearly 90% of those users consumed one of the many flavored varieties.
• Sales of menthol and cooling flavors increased: According to CDC Foundation research, sales of menthol-flavored e-cigarettes rose more than 175% for all e-cigarettes. Sales of e-cigarettes marketed as “clear” (advertised as containing no flavorants but which contain menthol or other synthetic coolants) or other unflavored cooling products (often advertised with the words “naked” or “unflavored”) increased 872% between 2020 to 2023.
• Unauthorized products flourish: There are only 34 e-cigarette products in tobacco and menthol flavors authorized by the FDA to date. As of March 2024, these 34 products represent 13.7% of total dollar sales from brick-and-mortar US retail outlets according to a review of NielsenIQ sales data by researchers at the Truth Initiative.
• Nicotine content rose: Researchers at Truth Initiative found that disposable e-cigarettes can have nicotine levels similar to several cartons of cigarettes, with average nicotine strength increasing 294% in the span of five years. The rise in sales of high nicotine e-cigarettes coincided with an increase in the percentage of youth who reported using e-cigarettes frequently or daily from studies cited in the report, raising concerns about youth addiction. In 2024, nearly 30% of high school students who are e-cigarette users reported vaping daily as cited in the report.

“While the latest data from the CDC Foundation and Truth Initiative show a dangerous rise in sales of e-cigarettes, they also reveal a notable decline in sales where strong policies restricting flavored e-cigarettes are implemented,” says Kelly Henning, MD, public health program lead, Bloomberg Philanthropies, in a release. “The progress in states with strong policies underscores the urgent need for more action to swiftly and successfully combat the flavored e-cigarette epidemic among youth across the United States.”

Since 2019, the CDC Foundation and its partners—the Centers for Disease Control and Prevention, Truth Initiative, Campaign for Tobacco-Free Kids, and Bloomberg Philanthropies—have conducted research on the sales of tobacco products, e-cigarette use by young people, and the effectiveness of flavored e-cigarette restriction policies with the goal of keeping children and teens from accessing these addictive products.

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