Elsevier

Drug and Alcohol Dependence

Volume 203, 1 October 2019, Pages 1-7
Drug and Alcohol Dependence

Patterns of nicotine concentrations in electronic cigarettes sold in the United States, 2013-2018

https://doi.org/10.1016/j.drugalcdep.2019.05.029Get rights and content

Highlights

  • Nicotine concentrations of e-cigarettes may influence their public health impact.

  • Average nicotine concentrations in U.S. e-cigarettes increased from 2013 to 2018.

  • 0% nicotine products accounted for <1% of market share across all years analyzed.

  • 5% or more nicotine products accounted for >66% of market share in 2018.

  • Findings reinforce importance of efforts to prevent youth access to e-cigarettes.

Abstract

Introduction

Considerable declines in cigarette smoking have occurred in the U.S. over the past half century. Yet emerging tobacco products, including e-cigarettes, have increased in popularity among U.S. youth and adults in recent years. Nicotine content is an important factor in weighing the potential benefits and risks of e-cigarettes on individual and population level health. This study examined how nicotine concentrations of e-cigarette products sold have changed from 2013 to 2018.

Methods

E-cigarette sales data aggregated in 4-week periods from March 2, 2013 to September 8, 2018 (66 months total) from convenience store and mass market channels were obtained from Nielsen. Internet and vape shop sales were not available. Internet searches were used to supplement information for nicotine concentration and flavor. Products were categorized by nicotine concentration, flavor, type (disposable or rechargeable), and brand. Dollar sales, unit sales, and average nicotine concentration were assessed.

Results

During 2013–2018, the average nicotine concentration in e-cigarettes sold increased overall, for all flavor categories, and for rechargeable e-cigarettes. The proportion of total dollar sales comprised of higher nicotine concentration e-cigarettes (>4% mg/mL) increased from 12.3% to 74.7% during 2013–2018, with a similar increase in unit share. Zero-nicotine products accounted for less than 1% of dollar market share across all years analyzed.

Conclusions

E-cigarettes with higher nicotine concentrations comprise a substantial and increasing portion of U.S. e-cigarette sales. Higher nicotine concentrations may influence patterns of e-cigarette use, including harms from e-cigarette initiation among youth and potential health benefits for adult smokers switching completely to e-cigarettes.

Introduction

Considerable declines in cigarette smoking have occurred among U.S. adults and adolescents over the past half century, representing a significant public health achievement (US Department of Health and Human Services, 2012; [HHS] et al., 2014; Johnston et al., 2018). However, emerging tobacco products, including e-cigarettes, have increased in popularity among U.S. youth and adults in recent years (HHS et al., 2016; King et al., 2015; Schoenborn and Gindi, 2015; Schoenborn and Clarke, 2017). Past-30 day use of e-cigarettes increased substantially among U.S. high school students during 2011–2015, and since 2014, e-cigarettes have been the most commonly used tobacco product among high school students (Cullen et al., 2018). Past-30 day e-cigarette use among high school students declined for the first time in 2016 (11.3%) and remained stable in 2017 (11.7%). However, use surged during 2017–2018, with 20.8% of high school students reporting past-30 day e-cigarette use in 2018 (Cullen et al., 2018). In contrast, prevalence of e-cigarette use has declined in recent years among U.S. adults, from 3.5% in 2015 to 2.8% in 2017 (Wang et al., 2018).

Both potential benefits and potential risks should be considered when determining e-cigarettes’ population level net public health effects. A 2018 Report of the National Academies of Science, Engineering, and Medicine found there is conclusive evidence that completely substituting e-cigarettes for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes (NASEM, 2018). However, the report also found conclusive evidence that in addition to nicotine, most e-cigarette products contain and emit numerous potentially toxic substances (NASEM, 2018). Furthermore, in 2016, the U.S. Surgeon General concluded that e-cigarette aerosol is not harmless, and that nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain (HHS et al., 2016). Thus, e-cigarettes have the potential to benefit adult smokers if used as a complete substitute for combustible products, but are not safe for youth, young adults, pregnant women, or adults who do not currently use tobacco products (HHS et al., 2016).

Nicotine content in e-cigarettes is an important factor in weighing the potential benefits and risks of e-cigarettes. Nicotine content and speed of nicotine delivery may influence both the rate at which adult smokers switch to e-cigarettes and the rate of initiation of e-cigarette use among youth (NASEM, 2018). Products with higher concentrations of nicotine may be more appealing to established adult smokers and facilitate complete switching; however, the available science on the effectiveness of e-cigarettes for promoting smoking cessation is presently inconclusive (NASEM, 2018). Higher nicotine concentrations may increase the rate of nicotine addiction in youth and young adults, as well as the number of youth moving on to established smoking of combustible tobacco products. Further, products with higher concentrations of nicotine may pose greater health risk by heightening the detrimental impact of nicotine on brain development for adolescent users or infants exposed prenatally (HHS et al., 2016; England et al., 2015).

While some e-cigarette brands offer nicotine-free products, 99% of e-cigarette products sold in U.S. convenience stores and mass retail locations in 2015 contained nicotine, (Marynak et al., 2017a) and products labeled as 0% or <1% nicotine constituted <2% of sales during 2013–2015 (Day et al., 2017). Over that same time period, the percentage of sales attributed to products with 4.0–4.9% nicotine, the highest available at the time, increased from 12.3% to 33.5% (Day et al., 2017). More recently introduced products have featured higher nicotine concentrations. For example, NJOY, which offers a variety of nicotine concentrations, sells some products with 6% nicotine. In September 2018, JUUL e-cigarettes accounted for the majority of e-cigarette sales in the U.S (Herzog and Kanada, 2018). JUUL entered the market in 2015 with a USB shaped e-cigarette and nicotine “pods,” that, until August 2018, were exclusively available in a 5% concentration. The manufacturer has stated that the amount of nicotine in a single JUUL 5% pod is equivalent to about a single pack of conventional cigarettes (JUUL.com, 2018a). JUUL held approximately 75% of the U.S. e-cigarette market share by December 2018 and has been cited as a major contributor to the 78% increase in prevalence of e-cigarette use among U.S. high school students that occurred during 2017–2018 (Cullen et al., 2018; Jackler and Ramamurthi, 2019). JUUL contains nicotine salts, which allow particularly high levels of nicotine to be inhaled more easily and with less irritation than the free-base nicotine that has traditionally been used in tobacco products, including e-cigarettes (Bowen and Xing, 2014). These high levels of nicotine, delivered in the form of nicotine salts, could enhance the efficiency of nicotine delivery and potentially increase the likelihood that adult smokers are able to use these products to quit smoking completely. On balance, these products are of particular concern for young people, because it could make it easier for them to initiate the use of nicotine through these products and also could make it easier to progress to regular e-cigarette use and nicotine dependence (HHS et al., 2018).

The dramatic changes in the e-cigarette market, (Cullen et al., 2018; King et al., 2018) the recent introduction of products with higher concentrations of nicotine, and the recent surge in e-cigarette use among youth, (Cullen et al., 2018) underscore that the availability to youth and young adults of e-cigarettes with high nicotine concentrations are of immediate public health concern and warrant remedial action. Therefore, this study assessed how nicotine concentrations of e-cigarette products have changed from 2013 to 2018, among brands, flavors, and product types, as reflected by both absolute and relative market shares.

Section snippets

Data source

E-cigarette sales data in the contiguous United States from March 2, 2013 through September 8, 2018 were obtained from the Nielsen Company. The data were available for independent, chain, and gas station convenience stores; and mass merchandisers including supermarkets, discount stores such as Walmart, club stores such as BJ’s and Sam’s Club, dollar stores, and military commissaries. Nielsen uses a proprietary sample-based methodology to estimate representative sales data for retail outlets by

Total and unit sales

Total sales of e-cigarettes tracked by Nielsen grew 92.3%, from $746 million to $1,434 million, during 2013–2017; and increased 58.9% during 2016–2017 alone (Table 1). In 2018, total sales increased again to $1,719 million, an additional 20% increase for the 28-week period.

Unit sales increased 124.3% overall over the 5-year period, from 129.4 million units to 290.3 million units, and 43.0% during 2016–2017 alone (Table 2). The total number of individual products sold through Nielsen tracked

Discussion

This study reveals that the e-cigarettes sold in U.S. convenience stores and mass merchandisers contained, on average, significantly higher nicotine concentrations in 2018 than in 2013. Overall unit sales of e-cigarette products in the assessed channels more than doubled over this period, increasing by more than 40% during 2016–2017 alone. Furthermore, weighted average nicotine concentrations in e-cigarette products increased by more than 80% and all flavor categories increased in average

Conclusions

This study found that higher nicotine e-cigarette products account for a large and increasing share of U.S. e-cigarette sales. Public health implications of these changes could be positive for adult smokers seeking complete substitutes for combusted tobacco products, but negative for youth and young adults for whom nicotine exposure can cause adverse consequences for brain development and place them at risk for addiction. As the e-cigarette marketplace in the U.S. continues to evolve, further

Role of funding source

This study was funded by Truth Initiative. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Contributors

All authors were involved in the conceptualization of the study and design of analyses. E Miller Lo and H Xiao implemented the data analyses. All authors collaborated on the interpretation of findings and placement in context. The manuscript was drafted by E Miller Lo, A Cuccia, A Romberg, K Marynak, and B King, and all authors were responsible for significant revisions and refinement of the manuscript’s content. All authors read and approved the final manuscript.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Declaration of Competing Interest

No conflict declared.

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