Trends in U.S. E-cigarette Sales Measured in Milligrams of Nicotine, 2019-2024.

Abstract

E-cigarette unit sales have been estimated using the number of items typically available in a package to standardize unit sales of each product type. However, recent market changes, such as increases in e-liquid volume and nicotine concentration, challenge the validity of assessing sales according to item count without accounting for product attributes. This study measured nicotine content (mg) in e-cigarettes sold as a function of e-liquid volume (mL) and nicotine concentration (mg/mL), compared with e-cigarette unit sales standardized by item count. U.S. e-cigarette retail sales data from Circana (February 2019 to June 2024) were analyzed. Trends in mg nicotine sold were compared with standardized unit sales. Additionally, sales-weighted average e-liquid volume, nicotine concentration, and price per milligram of nicotine were measured by product type. Trends were assessed using Joinpoint regression. Analyses were conducted in 2024. From February 2020 to June 2024, monthly milligrams of nicotine content sold increased by 249.2% (p<0.001)-an increase 7.2 times greater than the 34.7% increase in standardized unit sales. Disposable e-cigarettes experienced the greatest increase in mg nicotine sold, which was largely driven by the rise in e-liquid volume. By June 2024, a disposable device contained 9.0 times more e-liquid than a prefilled cartridge. However, the price per milligram of nicotine in prefilled cartridges was 3.7 times greater than that of disposable devices. Nicotine is an addictive drug added to most e-cigarettes. Measuring e-cigarette sales in milligrams of nicotine content sold could better account for rapid changes in product attributes and inform policy strategies.