Changes in Sales of E-Cigarettes, Cigarettes, and Nicotine Replacement Therapy Products Before, During, and After the EVALI Outbreak

PEER REVIEWED

The highest monthly unit sale of e-cigarettes was 17,660,488 in August 2019 which occurred in the initial months of the “during” EVALI period; the lowest was 13,086,427 in February 2020 which was the last month of the “during” EVALI period. The average monthly unit sales of e-cigarettes decreased by 1.8% from before the outbreak (15,810,024) to during the outbreak (15,522,976) and decreased by 10.0% from during to post outbreak (13,953,473). The highest monthly unit sale of cigarettes was 739,473,399 in July 2019 which was the first month of “during” EVALI period; the lowest was 641,445,399 in February 2020 which was the last month of “during” EVALI period. The average monthly unit sales of cigarettes decreased by 3.2% from before the outbreak (709,145,992) to during the outbreak (686,417,973) and increased by 0.2% from during to post outbreak (688,120,050). The highest monthly unit sale of OTC-NRT products was 353,465,526 in March 2020 which was the first month of “after” the EVALI period. The average monthly unit sales of NRT products decreased by 0.1% from before the outbreak (312,026,992) to during the outbreak (312,418,838) and decreased by 3.3% from during to post outbreak (302,114,005).

Figure.
Monthly unit sales of A) e-cigarettes, B) cigarettes, and C) over-the-counter (OTC)–NRT, by product type before, during, and after the EVALI outbreak. Geometric shapes indicate observed sales, and lines indicate predicted sales based on the interrupted time series (ITS) model. The dates on the x axis are ending dates of each 4-week period. The dark-gray box indicates the period “during” the outbreak. Unit sales were calculated per 4-week period. One unit of e-cigarette products equals 1 disposable e-cigarette, 1 e-liquid bottle, or 5 prefilled pods/cartridges. Cigarette units were standardized as 1 unit equals 1 pack of cigarettes, which typically contains 20 to 25 cigarettes. OTC-NRTs included nicotine patch, gum, and lozenge. One unit of NRT products equals 1 nicotine patch with 7 mg nicotine strength, or 1 nicotine lozenge or 1 nicotine gum with 2 mg nicotine strength each. Abbreviations: FDA, Food and Drug Administration; NRT, nicotine replacement therapy; Tobacco 21, passage of federal legislation that increased the legal tobacco purchase age to 21.

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