Article Text

Download PDFPDF
The EVALI outbreak and tobacco sales in the USA, 2014–2020
  1. Alex C Liber1,
  2. Zachary Cahn2,
  3. Megan C Diaz3,
  4. Emily Donovan3,
  5. Donna Vallone3,
  6. Barbara Schillo3
  1. 1 Lombardi Cancer Center, Georgetown University, Washington, DC, USA
  2. 2 Darien, Connecticut, USA
  3. 3 Schroeder Institute, Truth Initiative, Washington, DC, USA
  1. Correspondence to Dr Alex C Liber, Lombardi Cancer Center, Georgetown University, Washington, DC 20057, USA; alex.liber{at}


Background The E-cigarette, or Vaping Product-Use Associated Lung Injury (EVALI) Outbreak of 2019 hospitalised thousands and killed dozens of people in the USA and raised perceptions of the dangers posed to health by electronic cigarettes (e-cigarettes). These illnesses along with continued increases in youth vaping rates lead to the passage of many state and federal laws intended to curtail the sale of flavoured e-cigarettes. Little is known about the impact of these events on US e-cigarette and cigarette retail sales.

Methods Using Nielsen Scantrack sales data from January 2014 to January 2020 for 23 US states, we evaluate the effect of the EVALI outbreak. First-differenced state-panel regressions tracking unit sales of total-level and category-level e-cigarettes and cigarette sales controlling for price, Tobacco 21 policy coverage, product distribution, seasonality, EVALI-attributable deaths, and state-level e-cigarette policies affecting the availability of e-cigarettes (non-tobacco flavoured and total) were employed.

Results Dollar sales of e-cigarettes declined 29% from their pre-EVALI peak by January 2020. Total sales of e-cigarettes declined in response to EVALI deaths and the total e-cigarette sales ban put in place in Massachusetts adopted in its wake. Cigarette sales were largely unchanged by either the direct or indirect policy effects of the EVALI outbreak, except for in Massachusetts, where cigarette sales—particularly those smoked by young people—rose temporarily after a total ban on e-cigarette sales.

Conclusion Sales of e-cigarettes declined in response to the EVALI outbreak and from the most restrictive regulatory policies that were adopted in response, while sales of cigarettes were affected less.

  • surveillance and monitoring
  • electronic nicotine delivery devices
  • public policy
  • taxation

Data availability statement

Data may be obtained from a third party and are not publicly available. The data-sharing agreement with Nielsen does not allow us to share the underlying data with third parties.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data may be obtained from a third party and are not publicly available. The data-sharing agreement with Nielsen does not allow us to share the underlying data with third parties.

View Full Text


  • Twitter @AlexCLiber, @MeganCDiaz

  • Contributors ACL and ZC conceived the research question, led the data analysis and drafted the initial manuscript. MCD and ED performed initial data management and helped craft the analytical strategy. DV and BS provided the data and supervised the project. All authors contributed to editing and revising the final manuscript. ACL is responsible as the guarantor of this manuscript.

  • Disclaimer This article reflects the views of the authors and should not be construed to represent the views or policies of any affiliated institution or entity. The conclusions drawn from the Nielsen data are those of the researcher(s) and do not reflect the views of Nielsen. Nielsen is not responsible for, had no role in and was not involved in analysing and preparing the results reported.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.