Sales of electronic cigarettes spiked during the first two years of the COVID-19 pandemic, driven largely by fruity- and candy-flavored disposable products, according to data released Thursday by the Centers for Disease Control and Prevention (CDC) and the advocacy organization Truth Initiative.

E-cigarette sales rose by 46.6 percent from January 2020 to December 2022 — from 15.5 million units in January 2020 to 22.7 million units in December 2022, researchers found. During that time, sales of tobacco-flavored and mint-flavored products decreased, whereas sales of other flavors increased.

E-cigarettes often contain high concentrations of nicotine, and the U.S. sets no limits on the nicotine content of any tobacco product.

The 2022 National Youth Tobacco Survey found that more than 2.5 million people younger than 18 use e-cigarettes, and 85 percent of them use flavored products.

Advocacy groups said the data show a disheartening picture of attempts to regulate the e-cigarette market.

The Food and Drug Administration (FDA) announced in January 2020 that it would prioritize enforcement against prefilled e-cigarettes in flavors other than tobacco and menthol because of the popularity of sweet flavors with underage people.

Yet the new data show the market changed. After the FDA’s announcement, retail sales of mint- and other-flavored prefilled cartridges effectively stopped, while there were notable increases in sales of fruit- and mint-flavored disposable products.

Disposable e-cigarettes in youth-appealing flavors are now more commonly sold than prefilled units, the study found.

“Today’s study underscores that we will not end the youth e-cigarette crisis until the FDA clears the market of all flavored e-cigarettes. When the FDA takes action only against some flavored products, as it did in February 2020, sales — and kids — shift to the flavored products that are left,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

The survey looked at the brands and flavors of e-cigarettes sold, but it did not differentiate between legal adult sales and unlawful underage sales. It also only included sales from brick-and-mortar retailers.

During the two years analyzed in the study, the number of e-cigarette brands shot up from 184 to 269, an increase of nearly 50 percent

In January 2020, JUUL was the top monthly seller, followed by Vuse, NJOY, My Blu and Puff. By the end of the study period in December 2022, Vuse was the top-selling brand, followed by JUUL, Elf Bar, NJOY and Breeze Smoke.

The study found that Elf Bar was the top-selling disposable brand in the United States and has been responsible for driving sharp recent increases in e-cigarette use among youth in England.

“The dramatic spikes in youth e-cigarette use back in 2017 and 2018, primarily driven by JUUL, showed us how quickly e-cigarette sales and use patterns can change,” said Deirdre Lawrence Kittner, director of the CDC’s Office on Smoking and Health, in a statement. “Retail sales data are key to providing real-time information on the rapidly changing e-cigarette landscape, which is essential to reducing youth tobacco use.”

The FDA was given the authority to regulate the marketing, manufacturing and distribution of tobacco products in 2009 when Congress passed the Tobacco Control Act, and the agency said it would regulate e-cigarettes beginning in 2016.

The FDA struggled to review companies’ applications for marketing and allowed all e-cigarettes already on the market to stay while their manufacturers applied for permission.

Public health groups sued the agency in 2018, and while a court ordered the FDA to finish the job by September 2021, the FDA missed the deadline.

The FDA issued its first marketing denial orders for approximately 55,000 flavored e-cigarette products in August 2021, and its first marketing denial order for a menthol-flavored, cartridge-based e-cigarette on October 2022.

Thursday’s report was released at the same time the FDA announced a new crackdown on vape shops for selling unauthorized disposable vapes, specifically Elf Bar and Esco Bars products.

Both brands come in flavors known to appeal to youth, including bubblegum and cotton candy, the FDA said.

The agency said it issued 189 formal warning letters to vape shops.

“This latest blitz should be a wake-up call for retailers of Elf Bar and Esco Bars products nationwide,” Brian King, the head of the FDA’s tobacco center, said in a statement.

Elf Bar and Esco Bars products are illegal to sell because they don’t have the required FDA marketing permission. To date, the FDA has authorized 23 tobacco-flavored e-cigarette products and devices. These are the only e-cigarette products that currently may be lawfully sold in the U.S.

Esco Bars and Elf Bar products are made in China, and the FDA said an import alert gives the agency the authority to detain the products without physically examining them at the time of entry.

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