In 2020, most high school and middle school students reporting current electronic cigarette use used flavored cigarettes, while total e-cigarette sales increased 122.2 percent from September 2014 to May 2020, according to two studies published in the Sept. 9 early-release issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.

Teresa W. Wang, Ph.D., from the CDC in Atlanta, and colleagues from the CDC and U.S. Food and Drug Administration examined current e-cigarette use using data from the 2020 National Youth Tobacco Survey. The researchers found that 19.6 and 4.7 percent of high school and middle school students, respectively, reported current e-cigarette use in 2020. Overall, 82.9 percent of all current e-cigarette users used flavored cigarettes, including 84.7 and 73.9 percent of high school and middle school users, respectively. By comparison, in 2019, 27.5 and 10.5 percent of high school and middle school students (4.11 million and 1.24 million), respectively, reported e-cigarette use. "Although these data reflect a decline in current e-cigarette use since 2019, 3.6 million U.S. youths still currently used e-cigarettes in 2020, and among current users, more than eight in 10 reported using flavored e-cigarettes," the authors write.

Fatma Romeh M. Ali, Ph.D., from the CDC Foundation in Atlanta, and colleagues examined trends in unit sales by product and flavor type using retail scanner data during Sept. 14, 2014, to May 17, 2020. The researchers found that total e-cigarette sales increased by 122.2 percent, from 7.7 to 17.1 million units per four-week interval. During September 2014 to August 2019, there was an increase in the proportion of prefilled cartridge product sales (47.5 to 89.4 percent). From August 2019 to May 2020, the proportion of disposable product sales increased from 10.3 to 19.8 percent, while the proportion of prefilled cartridge product sales decreased from 89.4 to 80.2 percent.

In a statement released Sept. 9, the FDA said it is taking enforcement action against any electronic nicotine delivery system product that has not received premarket authorization, and the agency has issued warning letters to three such companies. "Although the decline in e-cigarette use among our nation's youth is a notable public health achievement, our work is far from over," CDC Director Robert R. Redfield, M.D., said in a statement.

"The overall reduction in e-cigarette use among youth is a positive sign, but the continued popularity of flavored products that are still allowed on the market is troubling," the American Heart Association said in a statement. "These numbers confirm what we already knew, the e-cigarette epidemic in our country is far from over."