Interchange Intro Unit 9

[Kristy Suzuki]

Becauseof the range of interests among the Fellows, it was agreed in the course of two meetings of the full group to divide it into three working groups: one dealing with issues in American domestic affairs and led by Assistant Professor Richard W. Fox, one focusing on aspects of American foreign policy and led by Professor Henry A. Turner, the third concentrating on the feminine experience as revealed in various forms of literature and led by Lecturer Cynthia E. Russett. The seminars were conducted within the framework of these working groups, which permitted each fellow to present drafts of his or her curriculum unit for extensive criticism and suggestions by the others. The result was a high level of interchange between the fellows of each working group.

Few studies have explored patterns of electronic cigarette (e-cigarette) sales and prices by product type over time. We used US retail scanner data to assess national and state-specific trends in e-cigarette unit sales and prices for 4 product types sold from 2012 through 2016.

Using retail scanner data from the 48 contiguous states and Washington, DC, for convenience stores; supermarkets; mass merchandisers; drug, dollar, and club stores; and military commissaries, we assessed data on monthly unit sales and inflation-adjusted prices by 4 products (rechargeables, disposables, prefilled cartridges, and e-liquids) sold during the 5-year study period. We evaluated national and state trends by using Joinpoint regression (P From 2012 through 2016, average national monthly unit sales significantly increased for all products, while average monthly prices of rechargeables, disposables, and prefilled cartridges significantly decreased. In 2016, prefilled cartridges had the highest average sales (766 units per 100,000 people) and the lowest average price ($14.36 per unit). By state, average monthly sales significantly increased for at least 1 of 4 e-cigarette products in all 48 states and Washington, DC. However, during the same period, average monthly prices significantly decreased in 39 states for rechargeables, in 31 states for disposables, in 20 states for prefilled cartridges, and in 8 states for e-liquids.

Overall, US e-cigarette unit sales generally increased as product prices decreased. These findings demonstrate the rapidly evolving landscape of US e-cigarette retail marketplace. Ongoing surveillance of e-cigarette unit sales and price is critical for informing and evaluating evidence-based tobacco control strategies.

Electronic cigarettes (e-cigarettes) are a diverse product class of battery-powered devices designed to deliver a combination of nicotine, flavorings, and other additives via an inhaled aerosol (1). Since their entry into the US marketplace in 2007, e-cigarettes have rapidly evolved in product design, marketing, and availability (2,3). In 2014, researchers identified more than 460 e-cigarette brands and 7,700 e-liquid flavors (4). These products are now widely distributed through traditional retail outlets, vape shops, and online retailers (5).

This surge in product availability coincided with increased e-cigarette use, particularly among current and former adult smokers (6). E-cigarette use increased 900% among US high school students from 2011 to 2015, and e-cigarettes surpassed conventional cigarettes as the most commonly used tobacco product among this group (7). The prominent use of e-cigarettes among US youth has been attributed in part to the heavy marketing of these products with youth-resonating themes, as well as the widespread availability of youth-appealing flavors (7,8).

We acquired data on Universal Product Code (UPC) retail sales for e-cigarette products from The Nielsen Company (www.nielsen.com/us/en.html). These data include data on sales from convenience stores (franchise, chain, and independent convenience stores that may or may not sell gasoline) and all other outlets combined (a category that includes mass merchandisers; supermarkets; drug, dollar, and club stores; and military commissaries). Sales are reported in approximately monthly (4-week) aggregates; these period-to-period changes are referred to as monthly changes.

Average prices by product were calculated by using adjusted dollars and nonstandardized units. To generate inflation-adjusted dollar sales, we indexed dollar sales to the 2016 Consumer Price Index from the US Bureau of Labor Statistics (15). Prices were then calculated by using only items sold in the most common package size for each product. For example, only prefilled cartridges that were sold in a pack of 5 were included in price calculations for prefilled cartridges. Although standardizing a pack of 10 prefilled cartridges to represent 2 packs of 5 is appropriate for reflecting sales volume, these sales were excluded from price calculations to avoid the introduction of bias due to discounts associated with buying in bulk.

We evaluated the overall trend from 2012 through 2016 by using Joinpoint models that controlled for autocorrelation to quantify and test the direction and significance (P Despite overall sales growth, sales fluctuated across time by product type (Figure 1). Specifically, sales of rechargeables, prefilled cartridges, and e-liquids grew relatively steadily over time, while sales for disposables were less consistent. In the final 4 weeks of the study period, prefilled cartridge sales rate peaked at more than 856 units. In contrast, sales of disposables increased sharply in late 2012 before peaking in 2013 as the product with the highest sales rate. Disposables later decreased in sales from 2014 to 2016.

AMPC is the average monthly percentage change, or the average percentage change per 4-week period. For rechargeables, disposables, and prefilled cartridges, calculations included all periods from 2012 through 2016 (n = 65). For e-liquids, calculations included all periods from 2014 through 2016 with non-zero sales.

Similar to national trends in unit sales, national trends in e-cigarette prices fluctuated over time (Figure 2). Rechargeable e-cigarette prices fluctuated during the beginning of the study period, peaking in early 2013 around $27. Prices then decreased by more than 55% to approximately $12 in October 2014, before decreasing more steadily throughout 2015 and 2016. Despite fluctuations shortly after they first appeared in convenience stores and all other outlets combined, e-liquid prices averaged approximately $7 from late 2013 through the end of the study period.

From 2012 through 2016, e-cigarette unit sales in the United States significantly increased for all assessed product types, including rechargeables, disposables, prefilled cartridges, and e-liquids. At the state level, monthly unit sales significantly increased for at least 1 product type in all 48 states and Washington, DC. During the same period, national e-cigarette prices significantly decreased for all product types with the exception of e-liquids, which increased in price in 5 states and Washington, DC. Taken together, these findings underscore the rapidly evolving landscape of the US e-cigarette retail marketplace, with decreases in unit price accompanying increases in sales trends overall. Furthermore, prominent shifts occurred by product type, with prefilled cartridges having the highest average sales and the lowest average price in 2016.

Price gaps for e-cigarette devices have narrowed over time. During the 4-week period ending on June 29, 2013, the national average price of rechargeables ($25.69) was more than 3 times the average price of disposables ($9.26). Rechargeable prices have since plummeted; in 2016, the average price difference between a rechargeable unit and a disposable unit was less than $2. In contrast, although the average price of both prefilled cartridges and e-liquids decreased, a unit of prefilled cartridges was approximately twice the average price of a bottle of e-liquid throughout the study period. Overall, the increase in e-cigarette sales and decrease in price is consistent with previous studies demonstrating that e-cigarette sales are responsive to their own price changes (19). These trends suggest that, if e-cigarette prices continue to decrease, their sales may also continue to rise. However, other factors, such as the pricing and consumption of other conventional or newer tobacco products, will affect e-cigarette demand (1).

Sales data at the federal and subnational levels can help inform and evaluate efforts to regulate e-cigarettes at the national, state, and local levels. In 2009, the Family Smoking Prevention and Tobacco Control Act (20) gave the US Food and Drug Administration (FDA) the authority to regulate the manufacturing, distribution, and marketing of cigarettes, roll-your-own cigarette tobacco, and smokeless tobacco sold in the United States. In May 2016, the FDA subsequently issued a deeming rule to extend its authority over all tobacco products, including e-cigarettes and their components and parts (eg, cartridges) (21).

The Family Smoking Prevention and Tobacco Control Act preserves state and local authority over implementing certain regulations in addition to some actions not otherwise covered by the Act that are expressly under the purview of state and local authority. These actions include restricting tobacco use in public places, levying taxes on tobacco products, raising the age of sale above 18, and restricting sales by certain retailers (1,21). With regard to e-cigarettes, some states and localities have implemented strategies to both minimize the potential harms of e-cigarette consumption at the population level, particularly among youth and young adults, and to maximize any potential benefits for current adult smokers (1,2). As of June 2017, 46 states and Washington, DC, have minimum legal age restrictions on the purchase of e-cigarettes; 15 states require a retail license to sell e-cigarettes over the counter; 8 states (California, Delaware, Hawaii, New Jersey, North Dakota, Oregon, Utah, Vermont), Washington, DC, and Puerto Rico have comprehensive smoke-free indoor air laws that prohibit smoking and using e-cigarettes in indoor areas of private worksites, restaurants, and bars; and 7 states (California, Kansas, Louisiana, Minnesota, North Carolina, Pennsylvania, West Virginia) and Washington, DC, have enacted e-cigarette taxation policies (22,23). Although the long-term impact of these population-based strategies on e-cigarette sales in US retail outlets continues to be assessed, cross-sectional audits from nationally representative samples of tobacco retailers suggest that e-cigarettes are more likely to be available in retail outlets in areas with lower e-cigarette prices and less comprehensive smoke-free air policies (24). Moreover, the US Surgeon General indicated that higher prices and comprehensive smoke-free air policies are among the most effective methods to prevent initial use of conventional tobacco products among adolescents and young adults (2).

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