Sales of Electronic Nicotine Delivery Systems (ENDS) and Cigarette Sales in the USA: A Trend Break Analysis

Abstract

Electronic nicotine delivery systems (ENDS) are a potentially lower-risk tobacco product which could help smokers switch completely away from cigarettes. However, the lack of strong evidence to date of a measurable, population-level effect on reducing smoking has generated skepticism about ENDS’ potential benefits. This study examines whether increased US ENDS sales have been associated with reduced cigarette sales. Retail data on weekly per-capita cigarette and ENDS purchases in the USA during 2014–2019 were obtained from a national sample of brick-and-mortar retail outlets. Trends in cigarette sales were modeled before (2014–2016) ENDS had a substantial market share, and, after adjusting for macroeconomic factors, projected into the post-period (2017–2019). Actual cigarette sales were lower than projected sales (by up to 16% across the post-period), indicating a substantial “cigarette shortfall” in the post-period. To explore whether general (i.e., inclusive of potentially many mechanisms) substitution by ENDS can explain the cigarette shortfall, its association with per-capita ENDS volume sales was examined. Higher ENDS sales were significantly associated with a greater cigarette shortfall: for every additional per-capita ENDS unit, cigarette sales were 1.4 packs-per-capita lower than expected (B = 1.4, p < .0001). Error correction models which account for spurious correlation yielded similar results. These findings support ENDS serving as a substitute for cigarettes (through potentially many mechanisms including cigarette price), causing cigarette consumption to decline. Since ENDS potentially pose lower risk than cigarettes, this general substitution effect suggests that risk-proportionate tobacco regulation could mitigate the tobacco-related health burden.

Population-level counterfactual trend modelling to examine the relationship between smoking prevalence and e-cigarette use among US adults

“…These lower-than-expected smoking prevalences, correlated with e-cigarette use, suggest population-level displacement of cigarettes by e-cigarettes, consistent with extant modelling literature [28,29]. A significant overall decline in adult cigarette smoking is observed, above what was otherwise expected, even for younger adults, among whom the reported 'gateway' effect is claimed to be strong and e-cigarette use is relatively high [1].…”

“…Another useful approach to determining the overall impact of e-cigarette use on smoking prevalence (i.e., the combination of gateway and substitution effects) at the population level is to model expected trends in smoking prevalence, and then assess whether the introduction of e-cigarettes was associated with a net deviation from the expected smoking prevalence, either an increase (gateway) or decrease (substitution). Such modeling studies have generally found that the introduction of e-cigarettes was associated with more rapid declines in smoking prevalence [9,[26][27][28][29]. The present study uses this approach to assess whether and how much the introduction of e-cigarettes in the US may be correlated with declining smoking prevalence among adults in the following ways.…”

Comprehensive E-cigarette Flavor Bans and Tobacco Use among Youth and Adults

“…These exclusions omit a large share of tobacco sales. For instance, Selya et al (2023) conclude that about 50% of the e-cigarette market is not recorded by IRI. Analyses with the PATH data, in terms of where users purchase their e-cigarette products, show that about 60% of youth purchases of vaping products occur through tobacco specialty stores; the corresponding shares for young adults and adults are 70.24% and 67.26%, respectively.…”

Constraining electronic nicotine delivery systems (ENDS) nicotine dose by controlling nicotine flux at a limited puff duration.

“…Since their introduction to the U.S. market in the 2000s, electronic nicotine delivery systems (ENDS; Bandi et al, 2023;Brouwer et al, 2023;Romeh et al, 2023;Selya et al, 2023), a diverse class of products intended to deliver aerosolized nicotine to people who use them, have experienced considerable uptake. Between 2016 and 2019, ENDS sales increased roughly 300% in the United States (Ali et al, 2020).…”