The average nicotine concentration in e-cigarettes sold in U.S. retailers more than doubled from 2013 to 2018, according to a study by Truth Initiative and Centers for Disease Control and Prevention researchers, who say the increase in the addictive chemical is an immediate public health concern as the country confronts an epidemic of youth e-cigarette use.
The study found that nearly all e-cigarettes sold contained nicotine, with the average nicotine concentration in e-cigarette products increasing from 2.10% to 4.34% between 2013 and 2018, a 106.7% increase. The data also show that sales of e-cigarette products almost tripled from 129.4 million units in 2013 to 365.3 million from March to September 2018, a 182.3% increase.
JUUL, the top-selling e-cigarette that debuted in 2015 with pods that contained 5% nicotine strength, drove much of the increase. Products with more than 5% nicotine concentration accounted for just 0.7% of the market share in 2015. Three years later in 2018, they represented more than two-thirds — 67.2% — of the market.
E-cigarette products containing no nicotine accounted for only 1% or less of the market share in every year examined. Yet the majority of youth e-cigarette users think they vaped only flavoring, not nicotine, the last time they used a product, according to the University of Michigan 2016 Monitoring the Future study. Nearly two-thirds — 63 percent — of JUUL users between 15 and 24 years old did not know that the product always contains nicotine, according to a 2017 Truth Initiative study.
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