Abstract
INTRODUCTION: Concept flavor e-cigarettes, defined as products with vague/ambiguous flavor (tobacco flavor and non-tobacco flavor) names, may limit the intended impact and enforcement of flavored tobacco restrictions. This study assessed trends in unit sales of concept flavor e-cigarettes in the U.S. by volume, nicotine concentration levels (NCL), flavor and device type. METHODS: We analyzed NielsenIQ Retail Scanner point-of-sales data collected from 2182 Local Trade Areas in the contiguous 48 U.S. states and the District of Columbia aggregated weekly from August 10, 2019, through April 9, 2022. Concept flavors were categorized by: flavor type (tobacco, fruity, menthol, mint, and other); device type (pods/refillable cartridges, disposables, e-liquids, and other); and NCL (0 %-2.0 %, 2.1 %-4.0 %, > 4.1 %, unknown). Joinpoint regression was used to assess sales trends. RESULTS: Overall unit sales during the study period increased by 33.63 % from 1040.85 to 1390.88 thousand units per month (p = 0.006). Between August 2019 and September 2021, unit sales increased and peaked; between September 2021 and April 2022 sales decreased by 14.46 % (from 1626.02 to 1390.88 thousand units; p = 0.002). Sales of fruity, menthol and mint flavors concept flavor e-cigarettes increased by > 1000 %; disposable devices by 302.18 %; pods and refillable cartridges by 33.81 % overall; and products NCL > 4.0 % increased by 110.18 %. Tobacco flavor concept flavors (93.28 %), pods (94.63 %), and products with 2.1 %-4.0 % NCL (88.40 %) dominated unit share. CONCLUSION: Sustaining the recent overall decline in the unit sales of concept flavor e-cigarettes and monitoring the sales of products with nicotine concentration greater than 2.0%, non-tobacco flavor, and pod products warrant prioritization in tobacco control efforts.