A cross-sectional study found that statewide restrictions on flavored e-cigarettes were associated with reduced total sales of e-cigarettes, suggesting that many users did not switch from nontobacco-flavored products to tobacco-flavorings. These findings were published in JAMA Network Open.
In reaction to the outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) in August 2019, some states implemented short-term restrictions on certain e-cigarette products. Statewide data about flavor-based tobacco purchases were assessed among states with statewide flavored e-cigarette sale restrictions (Massachusetts, New York, Rhode Island, and Washington) compared with 35 states which did not have bans.
Data collected prior to sale restrictions indicated that intervention and control states had similar trends, in which sales remained stable until the end of 2017, increasing through August of 2019.
Among control states, sales decreased by 28.4% between August 2019 to February 2020, and increased by 49.9% through the end of 2020. For intervention states, sales decreased after EVALI by 84.2% in Massachusetts, 46.6% in New York, and 39.6% in Rhode Island. For Washington, the ban appeared to have little effect, increasing sales by 1.8%.
Stratified by flavor, menthol flavors had the largest unit sales share (49%-59%) in control states and tobacco flavors dominated the market in intervention states (82%->99%), with the exception of Washington, in which menthol flavors dominated the market after February 2020 (30%-51%).
After adjusting for COVID-19 and EVALI measures, prohibition of some e-cigarette products associated with a 94.38% reduction in Massachusetts between November 3 and December 1, 2019. In New York, the bans associated with a 30.65% decrease from June 14 to December 27, 2020. Rhode Island’s ban decreased sales by 31.26% from November 3, 2019, to December 27, 2020. Washington’s ban was the weakest with a 25.01% reduction between November 3, 2019, to January 26, 2020.
This study was limited by not having access to data from online sales or vape shops. In addition, no demographic information from purchasers was available.
The study authors concluded, “In this study, statewide nontobacco-flavored e-cigarette restrictions were associated with a reduction in total e-cigarette sales in intervention states compared with control states. The reduction in total sales was attributable to a decrease in nontobacco-flavored e-cigarette sales, suggesting that not all e-cigarette users who purchased nontobacco-flavored e-cigarettes switched to purchasing tobacco-flavored e-cigarettes after policy implementation.”
Romeh F, Vallone D, Seaman EL, et al. Evaluation of statewide restrictions on flavored e-cigarette sales in the US from 2014 to 2020. JAMA Netw Open. 2022;5(2):e2147813. doi:10.1001/jamanetworkopen.2021.47813