Barriers and Facilitators to Enforcing E-Cigarette Regulations for Online Sales

ABSTRACT Introduction Online sales of e-cigarettes challenge the enforcement of state tobacco control (TC) policies. Using key informant (KI) interviews, we examined barriers and facilitators to implementing TC policies in the context of e-cigarettes sold online. Methods From April 2023 to December 2024, we invited state representatives from all 50 states and the District of Columbia to participate in KI interviews. Guided by Bullock’s (2021) policy implementation framework, we examined licensure, minimum legal sales age (MLSA), flavor bans, and taxation. Data were analyzed using team-based, iterative coding. Results We conducted 74 semi-structured interviews with 90 KIs across 41 states, of which online sales emerged as a key theme in 41 interviews with 60 KIs across 34 states. KIs noted how online sales interacted with existing legal frameworks and enforcement methods, often creating challenges, including jurisdictional ambiguity over out-of-state or international sellers, limited capacity to monitor the emergence of new online sellers, statutory language not designed for digital commerce, supply chain ambiguity, and logistical difficulties in conducting online decoy buys. KIs noted several potential enforcement facilitators, including the Prevent All Cigarette Trafficking Act (e.g., monthly delivery sales reports), consumer complaint systems, internet surveillance, directories of products authorized for sale, and interstate coordination of data sharing. Some states pursued legal action against online retailers using consumer protection laws. Conclusions Online e-cigarette sales present a regulatory challenge for TC implementation, requiring policy adaptation, cross-jurisdictional coordination, enhanced monitoring, and research to guide effective regulation of the digital marketplace.