Monitoring E-Cigarette Trends in the United States: Urgent Action Needed to Protect Kids from Flavored E-Cigarettes

Since the epidemic of youth vaping began in 2018, the e-cigarette market in the United States has changed dramatically. Products are both cheaper and stronger. Flavored products commonly used among youth continue to drive sales, defying regulations intended to curb youth use. Despite 2020 federal flavor restrictions, e-cigarette makers exploited a product loophole and continued to sell flavored products in disposable devices, which subsequently increased in use among young people. Over the period 2019-2023, e-cigarette sales increased 47.0%. While current federal efforts to regulate the marketplace of e-cigarettes have been slow to evolve, and regulation of menthol cigarettes and flavored little cigars have stalled, individual states have developed their own flavor restrictions to great effect. 

This report examined sales data on e-cigarettes sold at traditional retail outlets from January 2019 through December 2023. It also examined state flavor policies in Massachusetts, California and New York as case studies that highlight the successes and challenges of these state laws. 

The findings are clear: national e-cigarette sales remain high; the tobacco industry continues to develop new products and exploit a lack of comprehensive flavor restrictions; and states are leading the way in successfully reducing e-cigarette sales and subsequent youth use. 

Specifically, the report finds that between 2019 and 2023: 

• E-cigarette sales increased: E-cigarette sales surged nationwide, increasing 47.0% from 210.5 million units to 309.4 million units.
• Disposables took over the e-cigarette market: Sales of disposable e-cigarettes increased 541.3% and comprise 57.8% of the e-cigarette market. Disposable e-cigarettes have been the most commonly sold device type among youth since 2022.
• Flavors surged: E-cigarettes in non-tobacco flavors like fruit, candy, mint, menthol and desserts made up 80.6% of all e-cigarette sales in 2023.
• Nicotine content increased: Sales of high nicotine content e-cigarettes increased. Disposable e-cigarettes have nicotine levels similar to several cartons of cigarettes, with average nicotine strength increasing 294% in the span of five years.
• Menthol and cooling flavors increased: Sales of menthol-flavored e-cigarettes rose 175.8% for all e-cigarettes and 207.4% for menthol-flavored prefilled cartridges not covered by the 2020 flavor policy. Sales of e-cigarettes with “clear” or other cooling flavor names increased 872.1% between 2020 to 2023.
• State flavor policies can be effective: Statewide policies restricting flavored e-cigarette sales can reduce flavored e-cigarette sales. Massachusetts’ comprehensive statewide policy on flavored tobacco products reduced flavored e-cigarette sales by 98.2% and led to significant statewide decreases in youth access to and use of flavored tobacco products. Flavored e-cigarette sales decreased by 67.7% a year after California’s statewide flavored tobacco policy went into effect and 79.1% following implementation of New York’s statewide flavor tobacco policy in May 2020.

These findings make clear that flavor restrictions that remove all flavored e-cigarettes from the market and do not contain exploitable loopholes, combined with appropriate enforcement, can effectively reduce e-cigarette sales.

Lessons learned from effective state and local policies can help inform the field and encourage continued adoption of impactful public health policies.