January 2023 News and Research Roundup

\Welcome to CounterTobacco.org’s “News and Research Roundup!” Each month we post a summary of the latest research, reports, and news stories on counteracting tobacco product sales and marketing at the point of sale (POS). Keeping up with what’s happening in the POS movement all across the country can help you choose policies and strategies that work best for your community. New research can help provide support for your work and evidence for the importance of the “War in the Store.” Have a story you don’t want us to miss? E-mail it to us!

New Research

Tobacco Product Sales

Neighborhood distribution of availability of newer tobacco products: A US four-site study, 2021, Preventive Medicine Reports
- This study examined the correlation between tobacco retailers, neighborhood characteristics, and the availability of tobacco products with an emphasis on nicotine pouches and disposable e-cigarettes. From April – September 2021, 242 store audits were conducted in New Jersey, Kentucky, North Carolina, and New York to assess sales of tobacco products in the retail environment. Study findings showed that nicotine pouches and disposable e-cigarettes were sold in about half of the visited retailers. The availability of nicotine pouches was higher in chain convenience stores and in neighborhoods with a greater percentage of non-Hispanic White residents. Tobacco and vape stores were significantly more likely to carry disposable e-cigarettes compared to other store types. This type of data can help inform retail policies for these newer products as the FDA determines how best to regulate their sales and marketing.
- Learn more about nicotine pouches and e-cigarettes at the point of sale.

Trends in US E-cigarette Sales and Prices by Nicotine Strength, Overall and by Product and Flavor Type, 2017–2022, Nicotine & Tobacco Research
- This study assessed trends in sales and prices of e-cigarettes from January 2017 – March 2022 using retail sales data from IRI. The researchers categorized e-cigarettes by nicotine strengths, type of device, and flavor. The results found total monthly e-cigarette sales increased from 5.7 to 23.3 million units, and total dollar sales increased from $74.6 to $469.0 million between January 2017 – March 2022. Sales of e-cigarettes containing 5% or greater nicotine strength increased from 5.1% to 80.9% of total unit sales, and from 5.5% to 79.5% of total dollar sales. E-cigarettes with 1% or less nicotine strength (like zero-nicotine products) accounted for less than 0.1% of sales. During this period, the price of e-cigarettes with low-nicotine strength increased, while the price of high-nicotine strength e-cigarettes either decreased or did not change. E-cigarettes with >5% nicotine strength comprised a higher proportion of flavored e-cigarette sales (79.3% of menthol, 87.4% of mint, and 96.1% of other flavors) than tobacco-flavor sales (61.3%). E-cigarettes with >5% nicotine strength comprised 90.6% of sales for disposable e-cigarettes and 74.2% of sales for prefilled cartridges. High-nicotine strength products can contribute to initiation and addiction especially among youth, and the concentration of high nicotine strengths in flavored and disposable products, which are the most popular among youth, is concerning. As implemented in other countries, a national nicotine standard in the U.S. to limit nicotine concentrations in e-cigarettes, could be an effective strategy to reduce the addictiveness of these products.
- News story: High-nicotine e-cigarettes dominate the market, with sales increasing 15-fold in five years, The Truth Initiative
- Learn more about e-cigarettes at the point of sale.

Changes in State-Level Cigarette Sales During the COVID-19 Pandemic, JAMA Network Open
- This study measured changes in state-level cigarette sales in the years before (2008-2020) and during the pandemic (2020-2021) using cigarette sales volume filings of tobacco manufacturers and importers to the U.S. Department of Treasury. Changes in cigarette sales were calculated before and after the onset of the pandemic using a time series analysis based on observed and expected quarterly cigarette sales, with adjustments made for changes in pricing, seasons, and demographics. The results found that national cigarette sales per capita were higher before the pandemic versus during the pandemic period, in part due to inflation of cigarette prices. Quarterly national-level cigarette sales increased by 0.23 packs (a 1.9% increase). Colorado and Washington D.C. experienced the highest decreases; and New Hampshire and Pennsylvania had the highest increase in quarterly cigarette sales per capita. These differences in cigarette sales across states may reflect state-level variation in pandemic responses and tobacco control policy, and states where sales increased may need to strengthen tobacco control policies to return to progress made before the pandemic.

Endgame

Relapse to problem drinking or trading up to spirits? Using U.S. national cross-sectional survey data to highlight possible negative impacts of potential tobacco retail changes, Substance Abuse Treatment, Prevention, and Policy
- This study tested a potential tobacco endgame strategy to restrict retail tobacco sales to state-run alcohol outlets. This scenario brings tobacco sales under the same government control system for alcohol enacted in twelve states (“control states”). Potential benefits of this policy shift include reductions in tobacco retailer density and tobacco product availability. Possible consequences include higher consumer demand for alcohol and tobacco products due to increased visual cues (like product displays) for both products in the retail environment. Using cross-sectional 2015 and 2020 U.S. National Alcohol Survey data from 14,821 adults, researchers estimated associations between the smoking and alcohol use status of these respondents (e.g., lifetime daily smoking, alcohol use disorder, beverage choices, etc.). In control states, 55.1% of people who smoked daily in the past year also reported an alcohol use disorder, and 58.8% of people in recovery from an alcohol and/or drug problem smoked daily. The analysis showed strong associations between alcohol and tobacco use overall, especially for women and people with lower levels of education. There may be negative impacts of moving all tobacco sales to state-run alcohol outlets for people with a history of tobacco and alcohol misuse, such as relapses, dual use, and other changes in alcohol consumption patterns. Tobacco endgame strategies are innovative ideas but need to be further evaluated and consider policy protections (e.g., restrictions on advertising and displays, minimum pricing, separate sales areas) to limit their potential unintended consequences.
- Learn more about endgame policies.

Menthol and Other Flavored Tobacco Products

Illicit cigarette purchasing after implementation of menthol cigarette bans in Canada: findings from the 2016–2018 ITC Four Country Smoking and Vaping Surveys, Tobacco Control
- With the proposed FDA rule to ban menthol cigarettes and local bans across the U.S., opponents argue banning menthol cigarettes will lead to an illicit market. Canada was one of the first countries to ban menthol cigarettes in all areas. This study used Canadian data to examine how menthol cigarette bans affect use and illicit purchasing among those who smoke. Pre and post ban data was collected using the 2016 and 2018 ITC Four Country Smoking and Vaping Survey results, with 1098 people who smoke non-menthol cigarettes and 138 who smoke menthol cigarettes considered. Brand validation confirmed the self-reported feedback of these survey respondents and showed that nearly half of Canadians who reported smoking menthol cigarettes were not actually smoking a menthol brand at post-ban. Results also showed that the menthol cigarette bans in Canada did not increase purchasing of illicit menthol cigarettes or non-menthol cigarettes from First Nations reserves. Findings were consistent with previous research showing no notable increase in illicit cigarette purchasing after menthol cigarette bans in Canada, England, and the Netherlands. These results from Canada provide a basis for understanding potential menthol cigarette ban impacts in the U.S., including low potential for an illicit market.
- Learn more about menthol.
Teens less susceptible to vaping when restricted to tobacco-flavored e-cigarettes: implications for flavored tobacco policies, Nicotine & Tobacco Research
- This study assessed how restricting e-cigarette flavors affects e-cigarette initiation and cessation among teens in Minnesota. Researchers asked 2,151 Minnesota teens about their e-cigarette use, including specific flavors and symptoms they experienced due to this use. Findings showed that susceptibility to e-cigarette use was highest for any flavor (38.2%) and lowest when the flavor was tobacco (21.0%), compared to menthol-flavored (26.7%) and unflavored (29.7%). For surveyed teens who had no experience or showed dependence on e-cigarettes, their susceptibility to using them was significantly lower when the flavor available was restricted. These findings show that restrictions on sales of flavored e-cigarettes can reduce their appeal and may be effective in reducing youth use.
- Learn more about e-cigarettes at the point of sale.