E-Cigarette Sales Have Surged Immensely in the U.S.

 Gaby Galvin

SALES OF E-CIGARETTES have grown rapidly in recent years, a new study from the Centers for Disease Control and Prevention shows, underscoring concern among public health advocates about the impact of the devices.

E-cigarette sales skyrocketed by 132 percent while their prices fell substantially between 2012 and 2016, especially prices for rechargeable devices, according to the study. Researchers measured average monthly sales and prices for four types of e-cigarette products – including rechargeables, disposables and prefilled cartridges – in the 48 contiguous states and the nation's capital, and did not include online or vape shop sales. E-liquid sales were measured between 2014 and 2016.

E-cigarettes, which don't contain tar or ash but can still deliver nicotine and other potentially toxic substances, have been marketed as a smoking-cessation tool. But in 2015, more than half of people who vaped also smoked traditional cigarettes, according to the CDC.

While disposables were the first type of e-cigarette to hit the U.S. market last decade, rechargeables and their accompanying prefilled cartridges are now the products of choice among the millions of Americans who vape. Average monthly sales for rechargeables increased 154 percent between 2012 and 2016, according to the CDC, while the average price of the devices fell by nearly half.

In 2016, a monthly average of 766 prefilled cartridges were sold per 100,000 people – a higher rate than that of any of the other vaping products. The cartridges, also called pods, sold for an average of $14.36 per five-pack.

"It's ultimately reflective of the changing landscape, and we're seeing more of these pod mod devices such as Juul that are now entering the marketplace," says Brian King, senior author of the study and a deputy director in the CDC's Office on Smoking and Health. "It just reinforces the importance (for) us as a public health community to ensure that we're considering the diversity of different e-cigarette products … so we can implement evidence-based strategies to ensure we're preventing public health harm."

On average in 2016, the four products were most expensive in the nation's capital, the study said. According to the Tax Foundation, e-cigarettes in the District of Columbia are taxed at 60 percent of the wholesale price. West Virginia, one of the relatively few places with a form of statewide e-cigarette tax as of the beginning of this year, was the cheapest state for rechargeables in 2016. Illinois was least expensive for disposables, Oklahoma for prefilled cartridges and Alabama for e-liquids.

"There's a lot of strategies and efforts going on at the federal level to address e-cigarettes, but states and localities aren't pre-empted from acting in terms of implementing evidence-based strategies," King says. "States and localities can really use this type of data to help inform their own subnational efforts to address e-cigarette use from a public health lens."

The prevalence of adults who have tried e-cigarettes rose significantly between 2014 and 2016 even as the prevalence of those considered current users fell, indicating people may be trying e-cigarettes but not sticking with the habit, according to a separate research letter published in the Journal of the American Medical Association.

Young people also are more likely to vape than adults, according to the CDC. E-cigarette use among high schoolers spiked 900 percent between 2011 and 2015, and the devices are now more popular among teenagers than traditional cigarettes, the study noted.

Indeed, the teen smoking rate has been declining for decades, but anti-smoking advocates fear the advent of products like Juul – a sleek vaping device that now represents more than two-thirds of the e-cigarette market – could serve as a gateway into traditional cigarette smoking.

"What I'm really worried about is the rate of smoking decline could stall as e-cigarettes become more popular, especially a product like Juul that's taken off like a rocket," says Robin Koval, CEO and president of the anti-smoking organization Truth Initiative. "There could always be new studies, but with the evidence right now, e-cigarettes look like they're making young people more likely to use combustible cigarettes."

According to The Washington Post, lawsuits filed against Juul Labs, which makes the Juul device, allege the company deceptively marketed it as safe and targeted young people for its use. Juul also comes in flavors that may appeal to kids, such as creme brulee and mango.

Juul Labs has said it "does not believe the cases have merit and will be defending them vigorously."

Regardless of who uses e-cigarettes, what specific products they prefer or why they started, the increasing popularity of vaping means those in the public health arena should deliberately consider them when deploying tobacco-control interventions, King says.

Strategies such as increasing the age of sale and implementing smoke-free policies in public spaces have been deployed in efforts to reduce traditional smoking rates.

"When it comes to e-cigarettes, they're still a tobacco product, so regardless of whether you're talking about a conventional cigarette or an e-cigarette, youth use of tobacco is unsafe," King says. "So the same strategies … are ultimately going to help prevent youth initiation of these products."

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