New CDC Foundation Study Found Statewide Bans On Flavored E-Cigarettes Reduced Total Sales


E-cigarettes continue to pose a significant public health challenge among young people. Due to a surge in youth e-cigarette use through 2019, followed by the national outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI), several U.S. states imposed restrictions on flavored e-cigarette sales. Most of these restrictions focused on prohibiting the sale of flavored e-cigarettes, commonly cited by youth as a product of preference.

Massachusetts was the first state to impose such restrictions, initially restricting the sale of all e-cigarettes before narrowing the policy in December 2019 to specifically target the sale of non-tobacco flavored e-cigarettes. Since then, several other states including Rhode Island, New York and Washington also adopted statewide restrictions on the sale of non-tobacco flavored e-cigarettes. The policy in Washington was in effect for 120 days.

A new study published today evaluates statewide policies restricting flavored e-cigarette sales in these four states from 2014–2020. Led by Dr. Fatma Romeh M. Ali of the CDC Foundation, the study compared e-cigarette sales in Massachusetts, New York, Rhode Island and Washington State (pre- and post-flavor restrictions) to sales in 35 states with no statewide flavored e-cigarette restrictions.

The study accounted for policies and events that could impact e-cigarette sales, such as the EVALI outbreak and COVID-19 pandemic. Findings from the study show that statewide restrictions on non-tobacco flavored e-cigarette sales were associated with reductions in total e-cigarette unit sales ranging from 25 percent to 31 percent, depending on the state.

Though sales of tobacco-flavored e-cigarettes increased after the policy implementation, the magnitude of reduction in non-tobacco flavored sales led to an overall decline in total sales. These findings suggest that not all purchasers of non-tobacco flavored e-cigarettes switched to tobacco flavored e-cigarettes when non-tobacco flavored e-cigarettes were unavailable.

Accessibility of e-cigarette products is a major indicator of use among young people. Previous research indicates that retail stores are a significant source of e-cigarette sales to youth, and prior estimates indicate that between 20 percent and 30 percent of e-cigarette sales in 2019 were online. While this study could not assess the age of the purchasers, the decreased sales when restrictions were imposed would have likely included products most popular with youth, reinforcing how policies to restrict e-cigarette availability to young people can reduce use.

The findings of this study could inform other states and communities considering similar strategies to address youth e-cigarette use. The study was co-authored by CDC Foundation employees Elizabeth Seaman, PhD, and Jamie Cordova, MPH, along with Donna Vallone, PhD, and Megan Diaz, PhD, of the Truth Initiative, and Katrina Trivers, PhD, Brian King, PhD, and Michael Tynan, BA, from CDC’s Office on Smoking and Health.

This study builds on prior work coming out of the Monitoring E-Cigarette Use Among Youth project on e-cigarette sales, published in a Morbidity and Mortality Weekly Report and a series of National and State Data Briefs. This project will continue to assess changes in e-cigarette retail sales and youth behaviors. The CDC Foundation is grateful to Bloomberg Philanthropies for supporting this project.

Fatma Ali-headshot-image.jpg
Fatma Romeh Ali, PhD, is a health scientist for the CDC Foundation.
Elizabeth Seaman PhD, MHS is a project manager for "Monitoring E-Cigarette Use Among Youth in Select U.S. Cities and States".