Electronic cigarette sales are way up, and so are calls to poison-control centers about children's exposure to the devices

Truth Initiative photo

By Melissa Patrick

Kentucky Health News

Electronic cigarette sales are up, and so are calls to poison control centers, according to two new reports from the Centers for Disease Control and Prevention. 

E-cigarette sales increased by nearly 47% over the past three years, increasing from 15.5 million units per four-week period in January 2020 to 22.7 million in December 2022, according to a CDC market analysis published in the agency's June 23 Morbidity and Mortality Weekly Report. 

The data includes sales from brick-and-mortar retailers only and does not include sales data from vape shops and internet retailers.

The study also found that during the three-year period, the number of brands increased by 46%, from 184 to 269 brands. Sales of re-filled devices decreased (75% of total sales to 48%), while disposable devices increased (25% to 52% of sales); while sales of youth-appealing flavors—such as fruit, candy, and desserts—increased.

"The surge in total e-cigarette sales during 2020-22 was driven by non-tobacco-flavored e-cigarette sales, such as menthol, which dominates the prefilled-cartridge market, and fruit and candy flavors, which lead the disposable e-cigarette market," Fatma Romeh, lead author of the study, said in a news release. " Data from the 2022 National Youth Tobacco Survey also highlight the popularity of these flavored e-cigarettes among U.S. middle and high school students.”

The good news is that sales slowed down in the later months of the study, with overall monthly sales of e-cigarettes showing a decline from May to December 2022. The report says this decrease could be attributed to several factors, including local and state restrictions on sales of flavored tobacco products,  Food and Drug Administration regulatory actions, potential Covid-19 supply chain disruptions, inflation and a change in the products that allow more "puffs" and stronger doses of nicotine. 

In December 2022, the five top-selling e-cigarette brands were Vuse, Juul, Elf Bar, Njoy and Breeze Smoke, respectively, with Elf Bar (now marketed as EBDesign) emerging as the top-selling disposable brand in the United States. 

According to the 2021 Youth Behavioral Risk Factor Surveillance System data, 45% of Kentucky's high-school students said they had ever used an electronic vapor product, 22% of them were current users, 8% were frequent users, and 7% used the products daily. 

Asked how they got them, 11.7% of them said they usually got their electronic vapor products by buying them themselves in a convenience store, supermarket, discount store or gas station. 

All of these rates are higher than the national average. 

The FDA is working to address e-cigarettes that have high youth appeal, including flavored disposable products. On June 22 it issued a warning letter to 189 retailers it said were selling unauthorized tobacco products, specifically Elf Bar and Esco Bar, which are disposable products that come in flavors known to appeal to youth. 

“All players in the supply chain—including retailers—have a role in keeping illegal e-cigarettes off the shelves,” Brian King, director of the FDA’s Center for Tobacco Products, said in a news release. “This latest blitz should be a wake-up call for retailers of Elf Bar and Esco Bars products nationwide. If they’re waiting for a personal invitation to comply with the law, they might just get it in the form of a warning letter or other action from the FDA.”

Poison control calls doubled

In a separate CDC report, researchers from the FDA found that nationwide, from April 2022 to March 2023, poison-control centers received 7,043 e-cigarette exposure calls, representing a 32% increase, from 476 in April 2022 to 630 in March 2023. And, they had nearly doubled in 2018. 

The report says about 88%, or nearly nine in 10 cases, involved exposures to children under 5. Most of the calls involved inhalation (61%) and ingestion (40%). 

Overall, the study found that 43 cases of exposure resulted in hospital admission and 582 of them required treatment in a healthcare facility. One case resulted in death, a suspected suicide of a person 18 years or older. 

Among the limited number of cases with brand information reported from April 2022 to March 2023, the researchers found that  Elf Bar was cited more than all other brands combined, with nearly all Elf Bar cases occurring among children younger than 5 years old. 

According to data provided by the Kentucky Poison Control Center, housed at Norton Children's Hospital in Louisville, Kentucky saw a 93% increase in reported electronic cigarette exposures during that time frame, with 92 reports of e-cigarette exposure reported in 2018 and 178 reported from April 2022 and March 2023. 

"In general, during those years, 77% of the cases were under the age of 6, 10% were ages 6-18, and the rest were adults," Joe Hall, manager, Norton's public-relations manager, said in an email. 

That said, Hall offered a word of caution about the data: "Reporting is voluntary, and while the data may be representative of the trend in the general population, we do not know the true numerator, and many exposures are not reported. Additionally, exposure does not mean severe poisoning," he said. 

The researchers closed the CDC report by saying that continued surveillance is critical to prevent e-cigarette exposure, particularly among young children. 

The FDA explains in a consumer update about the report that e-liquids with even small amounts of nicotine can be dangerous to children if they touch or drink it. They stress that adults who use e-cigarettes should store them and e-liquids in a safe , elevated location, out of children's reach and view.

"Young children can be severely hurt by drinking e-liquids," the update says. "Harmful effects can include seizure, coma (long period of unconsciousness), respiratory arrest (which happens when a person stops breathing), and death. Children may also accidentally be exposed to e-liquids and their contents, including nicotine, through contact in the mouth, contact on the skin (i.e., spilled e-liquid), or by inhaling the e-liquid aerosol. It’s important to remember that containers for e-liquids can seem tempting to children of all ages for many reasons. But these products are not meant for children, teens, or young adults."