New Study Finds that Reducing Youth Access to E-Cigarettes May Increase Youth Smoking

A new study published online ahead of print in the Journal of Health Economics finds that state laws which reduce youth access to e-cigarettes by banning the sale of these products to minors were associated with higher youth smoking rates compared to states without these bans.

(See: Friedman AS. How does electronic cigarette access affect adolescent smoking? Journal of Health Economics. Published online on October 19, 2015. doi:10.1016/j.jhealeco.2015.10.003.)

The paper reports the results of an econometric analysis of trends in biennial rates of youth cigarette smoking from 2002-2013, comparing trends in states with an electronic cigarette sales ban to minors in effect as of January 1, 2013 to trends in states without such a ban. The analysis controls for each state's cigarette taxes, smoke-free air laws, and secular changes in youth smoking.

The paper finds the following: "This paper examines the causal impact of e-cigarette access on conventional cigarette use by adolescents. Regression analyses consider how state bans on e-cigarette sales to minors influence smoking rates among 12 to 17 year olds. Such bans yield a statistically significant 0.9 percentage point increase in recent smoking in this age group, relative to states without such bans. Results are robust to multiple specifications as well as several falsification and placebo checks. This effect is both consistent with e-cigarette access reducing smoking among minors, and large: banning electronic cigarette sales to minors counteracts 70 percent of the downward pre-trend in teen cigarette smoking in the states that implemented such bans."

The authors conclude that: "Across the board, this paper's analyses find that reducing e-cigarette access increases smoking among 12 to 17 year olds. .. banning e-cigarette access increased teen smoking rates."

The Rest of the Story

The chief limitation of this study is that it did not directly measure youth access to electronic cigarettes, nor did it measure actual rates of e-cigarette use to confirm that access was reduced in states with sales bans to minors. Thus, it is not clear whether this variable actually measures reduced access to and use of e-cigarettes or whether it represents some other factor that is related both to the nature of states that implemented a sales ban and to youth smoking.

However, it is not clear why states that enacted a sales ban would have characteristics making it more likely to see a reduced rate of decline in youth smoking in those states. In fact, baseline smoking rates were lower in the states which enacted an e-cigarette sales ban. According to anti-smoking advocates, the tremendous success of these states in reducing youth access is being undermined by youth e-cigarette use. The results of this study do not seem consistent with such a hypothesis. On the contrary, the results suggest that e-cigarette availability might actually be diverting some youths away from smoking.

It is of course necessary to wait until further research is conducted before drawing the conclusion that e-cigarette access reduces youth smoking. Much needed is a study that actually measures e-cigarette use among youth and compares smoking rates between populations with high and low use.

It is, however, quite plausible that e-cigarette use could reduce smoking rates. Insofar as electronic cigarettes represent a more attractive alternative to tobacco cigarettes, they may actually draw youth away from smoking and towards vaping. In particular, the attractive flavors available with e-cigarettes may be much more appealing than the harsh taste of real cigarettes. And it is difficult to imagine a youth wanting to smoke real cigarettes after getting used to a sweetly flavored e-cigarette. Furthermore, e-cigarettes could serve as an alternative for youth smokers who are looking to quit.

Even if it is true that e-cigarette use reduces youth smoking, I would not advocate promoting e-cigarette use among youth or easing the availability of these products to minors. However, I do think that such evidence would be important in assessing the balance of the risks and benefits of promoting e-cigarettes to adult smokers.