Flavored E-Cigarette Sales in the United States Under Self-Regulation From January 2015 Through October 2019.

Objectives. To describe the evolution of flavored e-cigarette sales since the expansion of the JUUL brand, and to describe the effect of JUUL's November 2018 decision to self-regulate the flavors it sold in stores on flavored e-cigarette sales.Methods. We used Scantrack data on sales of e-cigarettes in the United States from January 2015 to October 2019 provided by The Nielsen Company. National sales values were aggregated monthly in 5 flavor categories (fruit, menthol/mint, sweet, tobacco, and other).Results. The expansion of JUUL sales coincided with an expansion in fruit-flavor sales through October 2018. Once JUUL withdrew fruit and sweet flavors from stores, menthol/mint came to dominate the e-cigarette market, but through 2019, a new surge in fruit-flavor sales by non-JUUL brands was observed.Conclusions. After a decline in sales following JUUL's decision to withdraw some flavored products from stores, JUUL sales recovered within weeks and surpassed their previous maximum in those same channels, as consumption shifted to the menthol/mint and tobacco flavors that remained on shelves.Public Health Implications. These trends suggest shortcomings of self-regulation and highlight the utility of government regulation.