Sales of Nicotine-Containing Electronic Cigarette Products: United States, 2015

Abstract

Objectives. To assess the proportion of electronic cigarette (e-cigarette) products sold in the United States that contain nicotine according to retail scanner data.

Methods. We obtained unit sales data from January 11, 2015, to December 12, 2015, from The Nielsen Company for convenience stores; supermarkets; mass merchandisers; drug, club, and dollar stores; and Department of Defense commissaries. The data did not include purchases from tobacco specialty shops, “vape shops,” or online sources. Nicotine content was assessed by product type (disposables, rechargeables, and refills), region, and flavor status based on nicotine strength listed in the Universal Product Codes. For the 36.7% of entries lacking nicotine content information, we conducted Internet searches by brand, product, and flavor.

Results. In 2015, 99.0% of e-cigarette products sold contained nicotine, including 99.0% of disposables, 99.7% of rechargeables, and 98.8% of refills. Overall, 98.7% of flavored e-cigarette products and 99.4% of nonflavored e-cigarette products contained nicotine.

Conclusions. In 2015, almost all e-cigarette products sold in US convenience stores and other assessed channels contained nicotine.

Public Health Implications. Findings reinforce the importance of warning labels for nicotine-containing products, ingredient reporting, and restrictions on sales to minors.

Electronic cigarettes (e-cigarettes) are devices capable of delivering aerosolized nicotine, flavorings, and other substances to the user. E-cigarettes were the most commonly used tobacco product among US youths in 2015 and are more commonly used among high school students and young adults aged 18 to 24 years than among adults older than 25 years.^1–4 Youth use of e-cigarettes is a public health concern because nicotine exposure during adolescence can cause addiction, can harm brain development, and could lead to sustained tobacco use.^1,5

Prior to federal regulation in August 2016, the e-cigarette product market rapidly grew and diversified; US sales reached an estimated $3.3 billion in 2015, up from $2.5 billion in 2014.^6,7 A wide array of e-cigarette devices are available in disposable or rechargeable models. Some rechargeable models allow the end user to customize e-cigarette liquid (e-liquid) flavors and nicotine concentrations, including zero nicotine.

Demand for nicotine-containing e-cigarette products relative to zero-nicotine products is currently unknown but is of public health importance given the consequences of nicotine exposure for young people.^1,5 More than 80% of 266 e-cigarette brands analyzed in 2014 offered zero-nicotine varieties,⁸ and studies of self-reported use of e-cigarettes suggest some consumer demand for zero-nicotine products.^9,10 However, self-reported information on nicotine content may be susceptible to bias, especially among youths. To address this gap, we used retail sales data from 2015 to assess unit sales of nicotine-containing e-cigarettes.

METHODS

In 4-week aggregate periods from January 11, 2015, to December 12, 2015, we acquired nationally representative Universal Product Code (UPC) data on unit sales of e-cigarettes from The Nielsen Company (Nielsen) for convenience stores; supermarkets; mass merchandisers; club, drug, and dollar stores; and Department of Defense commissaries. Nielsen collects information when a product’s UPC is scanned at checkout, which includes detailed characteristics of text on the product packaging, such as brand, subbrand, flavor, nicotine content (if any), type of device, and quantity per package.

We categorized e-cigarette products into 3 mutually exclusive types: (1) disposables, (2) starter kits or rechargeable devices (“rechargeables”), and (3) refills, including prefilled cartridges and cartomizers, and e-liquid bottles (“e-liquids”). The analysis excluded accessories that do not contain e-liquid.

Nicotine Content

Each product was classified into 3 mutually exclusive categories: nicotine containing, zero nicotine, or missing. One researcher (E. M. C) coded the records; a second (D. G. G) reviewed and confirmed findings. For the entries lacking nicotine content information (“missing”: 36.7%), we conducted online searches by brand, product, and flavor to make a determination. When a determination could not be reliably made about the product’s nicotine status, it was coded as missing. After categorization, only 0.6% of the entries were missing nicotine status.

Flavor Content

Products were classified as flavored or nonflavored according to UPC descriptions. Products that were not fruit, spice, alcohol, menthol or mint, or candy flavored were categorized as nonflavored (e.g., Absolute Tobacco, classic, and robust). Ambiguous descriptions were researched on brand Web sites; for example, the descriptor Seedless was categorized as a watermelon flavor.

Analysis

Unit sales were standardized to represent the most common number of products sold per pack. After standardization, 1 unit was equivalent to 1 disposable e-cigarette, 1 rechargeable unit, or, within the combined refills category, either 5 prefilled cartridges or 1 bottle of e-liquid.

We calculated the proportion of unit sales by nicotine content status; we assessed estimates overall and by product category, flavor status, and US census region.

RESULTS

During January 11, 2015, to December 12, 2015, 99.0% of e-cigarette product sales contained nicotine (58 170 255 units), 0.4% were zero nicotine (214 350), and 0.6% were missing information (348 534; Table 1).

TABLE 1—

Unit Sales of E-Cigarette Products, by Nicotine Status and Census Region: United States, January 11, 2015–December 12, 2015

	Nicotine Containing		Zero Nicotine		Missinga
Region and Product	Unit Sales	%	Unit Sales	%	Unit Sales	%
United States
Total	58 170 255	99.04	214 350	0.36	348 534	0.59
Disposables	19 225 029	98.98	84 949	0.44	113 144	0.58
Rechargeables	13 351 954	99.69	659	0.00	40 916	0.31
Refills	25 593 273	98.75	128 742	0.50	194 475	0.75
Prefills	21 825 262	98.94	38 801	0.18	194 148	0.88
E-liquids	3 768 011	97.66	89 941	2.33	327	0.01
Flavor status
Flavored	28 848 143	98.69	173 176	0.59	210 416	0.72
Nonflavored	29 322 113	99.39	41 174	0.14	138 118	0.47
Northeast
Total	5 028 849	99.78	4 665	0.08	7 151	0.14
Disposables	1 855 086	99.56	1 253	0.07	6 403	0.37
Rechargeables	767 473	99.99	. . .	0.00	216	0.01
Refills	2 406 290	99.87	3 412	0.12	532	0.01
Prefills	2 109 130	99.95	997	0.04	532	0.01
E-liquids	297 160	99.33	2 415	0.67	. . .	0.00
Flavor status
Flavored	2 446 483	99.62	2981	0.13	3 852	0.25
Nonflavored	2 582 366	99.90	1684	0.05	3 299	0.05
Midwest
Total	4 153 216	98.29	23 534	1.05	8 147	0.66
Disposables	1 265 860	97.34	17 129	2.54	1 436	0.12
Rechargeables	942 557	98.47	2	0.00	3 282	1.53
Refills	1 944 799	98.96	6 403	0.37	3 429	0.67
Prefills	1 598 555	98.94	1 404	0.13	3 429	0.93
E-liquids	346 244	98.55	4 999	1.45	. . .	0.00
Flavor status
Flavored	1 996 924	97.84	16 694	1.63	3 136	0.53
Nonflavored	2 156 292	98.67	6 840	0.55	5 011	0.78
South
Total	7 733 785	99.66	15 397	0.28	2 545	0.06
Disposables	2 618 382	99.87	126	0.01	2 019	0.12
Rechargeables	1 570 316	99.89	1	0.00	493	0.11
Refills	3 545 087	99.47	15 270	0.53	33	0.00
Prefills	2 876 243	99.89	2 997	0.10	33	0.00
E-liquids	668 844	97.84	12 273	2.16	. . .	0.00
Flavor status
Flavored	3 763 837	99.47	12 053	0.44	1 910	0.09
Nonflavored	3 969 948	99.85	3 345	0.11	635	0.04
West
Total	4 418 245	97.08	62 876	0.90	88 391	2.03
Disposables	1 486 570	98.42	36 663	1.31	10 656	0.27
Rechargeables	929 416	98.69	322	0.30	8 059	1.02
Refills	2 002 259	96.18	25 891	1.01	69 677	2.81
Prefills	1 659 637	96.44	1 051	0.09	69 477	3.47
E-liquids	342 622	95.89	24 840	4.09	200	0.02
Flavor status
Flavored	2 218 575	97.02	51 335	1.26	40 179	1.72
Nonflavored	2 199 670	96.97	11 541	0.58	48 212	2.45

Note. E-liquids = e-cigarette liquid; prefills = prefilled cartridges and cartomizers. Calculations represent the proportion of standardized unit sales by nicotine status for each category. National sales totals are greater than the sum of regional totals because Nielsen uses different sampling methods to project national and regional sales.

^aNicotine content was not discernible from the Nielsen-provided information or further brand-level research.

By product type, 99.0% of disposables (19 225 029), 99.7% of rechargeables (13 351 954), and 98.8% of refills (25 593 273) contained nicotine. Within the refill category, 98.9% of prefilled cartridges and cartomizers (21 825 262) and 97.7% of e-liquids (3 768 011) contained nicotine. The largest proportion of zero-nicotine sales occurred among e-liquid bottles, with 2.3% of unit sales containing zero nicotine. However, only 0.5% of combined refill unit sales were zero nicotine.

Overall, 98.7% of flavored e-cigarette products (28 848 143) and 99.4% of nonflavored e-cigarette products (29 322 113) contained nicotine.

Nicotine-containing e-cigarette products constituted 99.8% of Northeast (5 028 849), 98.3% of Midwest (4 153 216), 99.7% of South (7 733 785), and 97.1% of West (4 418 245) regional sales. Convenience stores sold 5.8 times more total e-cigarette products than did all other Nielsen-tracked stores in 2015 (not shown).

DISCUSSION

These findings indicate that almost all e-cigarette products sold in assessed US convenience and other stores in 2015 contained nicotine. Thus, consumers, including youths, who purchase e-cigarette products directly from these retailers, or obtain them from others who purchase from these retailers, are likely using nicotine-containing products.

To our knowledge, this was the first study to use sales data to assess demand for nicotine-containing e-cigarette products. The findings suggest greater use of e-cigarettes to deliver nicotine than was self-reported in recent surveys. Although self-reported use of nicotine-containing e-cigarette products among adults is currently unknown, 2 nationally representative studies of youths have begun to explore the issue. A 2015 survey found that approximately 20% of high school students who had ever used e-cigarettes reported using nicotine the last time they used the device.⁹ However, another national survey found that one third of youth e-cigarette ever-users reported using e-cigarettes for substances other than nicotine, implying that the remaining majority used the products to consume nicotine.¹⁰ The current study’s findings suggest that self-reported nicotine consumption may be subject to bias, especially among youths who may not be aware that the products they are using contain nicotine.

At the time these data were collected, e-cigarette products sold in the United States were not required to disclose nicotine content or submit products for laboratory testing for safety, quality, or purity. Trace amounts of nicotine have been detected in products labeled as zero nicotine, and actual nicotine concentrations have differed from those reported on labels.¹¹ Thus, e-cigarette users may be unaware of or misinformed about nicotine content because of unregulated labeling and advertising. Accordingly, warning labels on the addictive nature of nicotine for nicotine-containing products, ingredient reporting, and restrictions on sales to minors are critical. In May 2016, the US Food and Drug Administration issued regulations that, among other provisions, prohibit sales to minors and require, by May 2018, that all e-cigarette product packages and advertisements contain the statement “WARNING: This product contains nicotine. Nicotine is an addictive chemical.”¹² Prevention efforts also could include high-impact media campaigns to educate the public on the consequences of e-cigarette use among young people, including the harms of nicotine on brain development.¹

These findings are subject to limitations. First, the sales data did not include purchases from tobacco specialty shops, “vape shops,” or online sources, which have been estimated to account for as much as two thirds of the total e-cigarette market as of early 2016.⁶ However, 58.2 million nicotine-containing e-cigarette units were sold in assessed stores in 2015, suggesting high demand. Second, nicotine content was not available in the UPC descriptions for more than one third of sales. However, proportions observed in the table were similar to proportions observed when restricting the analysis to the 63.3% of sales with nicotine content included in UPCs (not shown). Third, nicotine content reported on packaging and in UPCs may not reflect actual content.¹¹ Fourth, sales data do not convey purchaser age. Nevertheless, our results can serve as a baseline for assessing the effect of regulations on sales of nicotine-containing e-cigarette products.

PUBLIC HEALTH IMPLICATIONS

Almost all e-cigarette products sold in US convenience and other assessed stores contain nicotine. Given that nicotine exposure causes addiction and harms the developing adolescent brain, efforts are warranted to implement regulations requiring warning labels for nicotine-containing products, ingredient reporting, and strict enforcement of restrictions on sales to minors.