Publications
Stay up to date with new project research about tobacco and e-cigarette sales and use and their impacts on public health in the United States.
Stronger flavor policies, better outcomes for young people: comparing youth and young adult tobacco use behaviors in areas with and without flavored tobacco sales restrictions, by strength of policy, 2022
By
Elizabeth L Seaman Jones, PhD, MHS, Fatma Romeh M Ali, PhD, Jennifer M Kreslake, PhD, MPH, Andrea S Gentzke, PhD, MS, Barbara A Schillo, PhD, Kristy Marynak, PhD, MPP ·
08/11/2025
- This study assessed state and local flavored tobacco restriction policies by strength and differences in tobacco product use among youth and young adults (13–24) using the nationally-representative Tobacco Epidemic Evaluation Network (TEEN+) Study.
- Only 1 in 12 young people are protected by strong flavored tobacco sales restrictions, with notable differences by sociodemographic characteristics.
- Compared with living in an area with no flavor policy, prevalence of any tobacco use was 24% lower (P<.001) and any flavored tobacco use was 30% lower (P<.001) for young people covered by strong flavor policies, after adjusting for individual- and state-level covariates.
Changes in E-Cigarette and Cigarette Sales in California and Neighboring States Following a Law Prohibiting Flavored Tobacco Product Sales
By
Fatma Romeh M. Ali, PhD, Adam M. Leventhal, PhD, Megan C. Diaz, PhD, Elisha W. Crane, MPH, Kristy Marynak, PhD, MPP ·
07/31/2025
- Prohibiting flavored tobacco product sales in California was associated with a 37% reduction in total milligrams of e-cigarette nicotine sold and a 10.6% reduction in cigarette pack sales in the first 18 months, compared with control states.
- There was no evidence of significant increases in cross-border cigarette or e-cigarette purchases in neighboring states after adjusting for additional variables.
- Declines in flavored product sales were partially offset by increased sales of products marketed as nontobacco flavored that contain synthetic cooling agents or other additives that deliver multisensory flavor experiences.
Trends in U.S. E-cigarette Sales Measured in Milligrams of Nicotine, 2019–2024
By
Fatma Romeh M. Ali, PhD, Megan C. Diaz, PhD, Brian S. Armour, PhD, Elisha Crane, MPH, Michael A. Tynan, MPH, Kristy L. Marynak, PhD ·
04/22/2025
- E-cigarette unit sales have traditionally been standardized based on the number of items typically sold in a package. However, measuring e-cigarette sales in milligrams of nicotine content sold could better account for rapid changes in product attributes and inform policy strategies.
- From February 2020 to June 2024, monthly milligrams of nicotine content sold surged by nearly 250%—an increase more than seven times greater than the increase in standardized unit sales.
- Disposable e-cigarettes have grown in size while remaining substantially cheaper than prefilled products. By June 2024, disposable e-cigarettes contained nine times more e-liquid than prefilled cartridges while costing only a quarter of the price of prefilled cartridges.
Youth and Young Adult Flavour Expectancies for New ‘Non-menthol’ Cigarettes Introduced Following California’s Ban on Flavoured Tobacco Products
By
Jennifer M Kreslake, PhD, Jamie Cordova, MPH, Andrew B Seidenberg, PhD, Fatma Romeh M Ali, PhD, Barbara Schillo, PhD, Kristy Marynak, PhD ·
09/10/2024
- Following California’s statewide law prohibiting the sale of flavoured tobacco products, some cigarette brands introduced new variants advertised as non-menthol, yet featuring design and text commonly found in menthol cigarette marketing.
- Younger age was associated with expectations of new non-menthol cigarettes having a minty/menthol taste, raising concerns about these products potential appeal to youth.
Developing a National Longitudinal Tobacco Cohort of Youth and Young Adults: The Tobacco Epidemic Evaluation Network (TEEN+) Study
By
Elizabeth L Seaman, PhD, MHS, Jennifer M Kreslake, PhD, MPH, Jamie Cordova, MPH, Barbara Schillo, PhD, Frances Barlas, PhD, Kristy Marynak, PhD, MPP ·
04/10/2024
- The TEEN+ study is a longitudinal cohort of youth and young adults (13-24 years); this paper provides an overview of study design and methods
- TEEN+ focuses on tobacco product use, including e-cigarettes, and includes questions about other substance use (marijuana, alcohol), physical health, mental health and social determinants of health.
- TEEN+ data can be used to evaluate flavored tobacco product policies and help inform tobacco control efforts.
E-cigarette Unit Sales by Product and Flavor Type, and Top-Selling Brands, United States, 2020–2022
By
Fatma Romeh M. Ali, PhD, MA, Andrew B. Seidenberg, PhD, Elisha Crane, MPH, Elizabeth L. Seaman, PhD, Michael A. Tynan, MPH, Kristy Marynak, MPP ·
06/23/2023
- From 2020-2022, e-cigarette unit sales increased by 46.6%.
- From 2020-2022, the percentage of disposable e-cigarette sales more than doubled (from 24.7% to 51.8%).
- From 2020-2022, sales of mint and other flavored prefilled cartridges ceased, and disposable e-cigarettes in fruit, sweet, and other flavors increased.
- The total number of e-cigarette brands increased 46.2% from 2020-2022 (from 184 to 269 brands).
Evaluation of Statewide Restrictions on E-cigarette Nicotine Strength—United States, 2017–2022
By
Fatma Romeh M. Ali, PhD, MA, Barbara A. Schillo, Elisha Crane, MPH, Elizabeth L. Seaman, PhD, Brian A. King, PhD, MPH ·
04/11/2023
- E-cigarette nicotine strength has increased over time.
- Statewide policies restricting e-cigarette nicotine strength only are associated with reductions in average nicotine strength in units sold with no impact on total unit sales.
- Statewide policies restricting both e-cigarette nicotine strength and flavors are associated with reductions in average nicotine strength and unit sales.
- Tobacco control policies should consider lowering nicotine strength and restricting access to flavored e-cigarettes to reduce e-cigarette consumption.
Use of a Multi-method Approach to Rapidly Assess the Impact of Public Health Policies at the State and Local Level: A Case Study of Flavored E-cigarette Policies
By
Elizabeth L. Seaman, PhD, Jennifer Kreslake, PhD, MPH, Katrina F. Trivers, PhD, Fatma Romeh M. Ali, PhD, Jamie Cordova, MPH, Sarah Mills, PhD, MPH, Bidisha Sinha, MPH, Brian King, PhD, MPH, Donna Vallone, PhD, MPH ·
04/04/2023
- E-cigarettes are the most commonly used tobacco product among youth; many cities, states and localities have enacted.
- Flavored tobacco restriction policies in an effort to prevent and reduce youth e-cigarette use.
- Timely surveillance can impact tobacco policy implementation, especially at the state level.
- This paper describes the methods for a multi-methods policy evaluation strategy, triangulating retail sales data and survey data to glean a complete picture of flavored e-cigarette use among youth and young adults before and after policy implementation in a number of sites.
Trends in US E-cigarette Sales and Prices by Nicotine Strength, Overall and by Product and Flavor Type, 2017–2022
By
Fatma Romeh M Ali, PhD, MA, Elizabeth L Seaman, PhD, Elisha Crane, MPH, Barbara Schillo, PhD, Brian A King, PhD, MPH ·
12/29/2022
- Nicotine strength of e-cigarettes has increased over time.
- From 2017-2022, the percentage of sales with products containing more than 5% nicotine strength increased from 5% to 80% of total unit sales.
- Over 90.6% of disposable e-cigarette sales were composed of products containing ≥5% nicotine strength.
- High-nicotine strength e-cigarettes were getting cheaper over time, while the price of low-nicotine products increased.
- Limiting e-cigarette nicotine strength should be part of policy considerations to reduce access and use among youth.
Impact of Massachusetts Law Prohibiting Flavored Tobacco Products Sales on Cross-border Cigarette Sales
By
Fatma Romeh M. Ali, PhD, MA, Brian A. King, PhD, MPH, Elizabeth L. Seaman, PhD, Donna Vallone, PhD, MPH, Barbara Schillo, PhD ·
09/13/2022
- In June 2020, Massachusetts implemented a law prohibiting the sale of all flavored tobacco products, including menthol cigarettes.
- Prohibiting menthol cigarette sales in Massachusetts reduced total cigarette sales in Massachusetts, while having no impact on neighboring states where menthol cigarettes are sold.
Trends in Unit Sales of Cooling Flavoured E-Cigarettes, USA, 2017–2021
By
Fatma Romeh M. Ali, PhD, MA, Elizabeth L. Seaman, PhD, Megan C. Diaz, PhD, Julianah Ajose, MPH, Brian A. King, PhD, MPH ·
07/15/2022
- During 2017-2021, unit sales of cooling flavoured e-cigarettes increased sevenfold; and unit share doubled from 26.4% to 54.9%.
- In 2021, 73% of cooling flavours were menthol flavors (chill menthol, cool menthol) versus 77% with other characterizing flavours (eg, banana ice, ice, tobacco chill, mint freeze).
- Sales of non-menthol cooling disposable e-cigarettes experienced the highest percentage increase.
- In 2021, 96.6% of menthol cooling flavours were prefilled cartridges, while 99.2% of non-menthol cooling flavours were disposable e-cigarettes.
- Sales of non-menthol cooling disposable e-cigarettes experienced the highest percentage increase.
Trends in Annual Sales and Pack Price of Cigarettes in the US, 2015-2021
By
Fatma Romeh M. Ali, PhD, Elizabeth L. Seaman, PhD, Barbara Schillo, PhD ·
06/03/2022
- From 2015 to 2021, the annual number of cigarette packs sold decreased by 27.2%, prices increased by 29.5%, and dollar sales decreased by 6.0%.
- Menthol cigarettes remained stable from 2015 to 2021, accounting for one-third of total sales.
- Surveillance of tobacco sales provides insight into emerging trends and can inform policy planning.
Different Times Call for Different Measures: Using Retail Sales Data to Keep Pace with Evolving Tobacco Product Landscape
By
Elizabeth L. Seaman, PhD, MHS , Fatma Romeh M. Ali, PhD, MA, Barbara A. Schillo, PhD, Donna M. Vallone, PhD, MPH, Brian A. King, PhD, MPH ·
05/19/2022
- Article describes the merits and limitations of retail sales data in tobacco control research.
- Retail sales data is one way to rapidly assess tobacco product consumption, emerging products and trends.
- Retail sales data can inform public health policy, planning and practice.
[Editorial] The Importance of Global Youth E-Cigarette Use Surveillance: Opportunities and Next Steps
By
Elizabeth L.Seaman, PhD, Rachna Chandara, MPH ·
03/23/2022
- Invited Editorial to accompany Prevalence of E-Cigarette Use and Its Associated Factors Among Youths Aged 12 to 16 Years in 68 Countries and Territories: Global Youth Tobacco Survey, 2012‒2019
- E-cigarette use has increased among youth and young adults since the products entered the market.
- The Global Youth Tobacco Survey (GYTS) is a standardized, school-based survey collecting youth tobacco use data in select countries which can be used to estimate youth e-cigarette use.
- There is a need for increased youth e-cigarette surveillance and a shift in tobacco control priorities globally.
Evaluation of Statewide Restrictions on Flavored E-Cigarette Sales in the US From 2014 to 2020
By
Fatma Romeh M. Ali, PhD, MA, Donna Vallone, PhD, MPH, Elizabeth L. Seaman, PhD, et al. ·
02/10/2022
- Statewide flavor restrictions in New York, Rhode Island, Washington reduced total e-cigarette sales by 25% to 31%.
- In Massachusetts, the comprehensive sales prohibition of all e-cigarette products was associated with about 94%in total sales
- Reductions in total e-cigarette sales were driven by the reduction in non–tobacco-flavored e-cigarette sales, which was partially compensated for by an increase in tobacco-flavored e-cigarette sales.
- The increase in sales of tobacco-flavored e-cigarettes was 40% to 49% of the reduction in sales of non–tobacco-flavored e-cigarettes, leading to an overall decrease in total sales.
E-cigarette Unit Sales, by Product and Flavor Type — United States, 2014–2020
By
Fatma Romeh M. Ali, PhD, Megan C. Diaz, PhD, Donna Vallone, PhD, Michael A. Tynan, Jamie Cordova, MPH, Elizabeth L. Seaman, PhD, Katrina F. Trivers, PhD, Barbara A. Schillo, PhD, Brandon Talley, MPH, Brian A. King, PhD ·
09/18/2020
- During 2014-2020, total monthly e-cigarette sales increased by 122.2%.
- The unit share of prefilled cartridge products increased to 89.4% in August 2019, then decreased to 80.2% in May 2020, as share of disposable e-cigarettes increased to 19.8%.
- 47.6% of prefilled cartridge sales were mint flavored in August 2019, however this percentage decreased to 0.3% in May 2020 as menthol flavored sales increased to 61.8%.
- About 83% of disposable e-cigarette sales in May 2020 were non-tobacco flavored (e.g., menthol, mint, fruits, sweet, etc.)