Regulation of e-cigarettes may be pushing teens back to significantly more harmful traditional tobacco cigarettes, MSU Sociology research finds

December 21, 2022 - Karessa Weir

MSU Sociology PhD student Sam Safford has published a research paper December 2022 that shows an unintended consequence of strict regulation of electronic cigarettes is an increase in the use of traditional cigarettes which carry significantly higher health risks.

Published in the Journal of Health Economics, “Intended and unintended Effects of E-cigarette Taxes on Youth Tobacco Use,” Safford and co-authors found that taxing e-cigarettes reduces youth consumption but unintentionally increases youth use of traditional tobacco cigarettes.

“We conclude that the unintended effects of ENDS (electronic nicotine delivery systems) taxation may considerably undercut or even outweigh any public health gains,” they wrote, ENDs are also called electronic vapor products with brand names such as Juul.

The study follows a Healthy People 2020 goal by the U.S. Surgeon General to reduce youth smoking rate from 19.5 percent in 2009 to 16.0 percent by 2019. The move was overwhelmingly successful, reducing teen smoking to 6 percent by 2019. However, by 2014, e-cigarette use had overtaken traditional cigarettes as “the most commonly used tobacco product among youth.” While only 6 percent of youth were smoking cigarettes, 33 percent had used e-cigarettes in the last 30 days.

“The current scientific consensus is that ENDS are likely substantially less dangerous than combustible tobacco products which are estimated to kill 480,000 Americans annually,” the authors wrote, adding that the exact relative risks of e-cigarettes are uncertain.

However, policies designed to reduce access to e-cigarettes became popular between 2010-2016 including e-cigarette minimum legal sales ages of 18 or higher in all states. Since 2010, 10 states and two counties have adopted taxes on e-cigarette purchases in an attempt to regulate the use. The authors used two large national surveys to estimate the impact of e-cigarette taxes on youth tobacco use.

Earlier studies found adults increased smoking cigarettes following an increase of taxes on e-cigarettes, as well as a high rate of “dual use” of both e-cigarettes and cigarettes.  

“Policies designed to reduce access to ENDS therefore appear to prioritize the goal of reducing nicotine use - nicotine which has limited adverse effects on health outside of causing addiction - over the goal of harm reduction,” they wrote.”If this indirect effect on youth tobacco use is positive and large, and the direct harms of ENDS use are small, then imposing larger taxes on ENDS products could conceivably worsen public health.”

This study specifically looked at the how youth - ages 14-18 - obtain e-cigarettes as well as how often they used either e-cigarettes, cigarettes or both. About three quarters of adolescents who use e-cigarettes do so occasionally and are not regular users, they wrote. While purchase is illegal under 18 in the U.S., 25 percent of youth users purchase the e-cigarettes in retail stores or on the internet while the rest bought through third parties.

They found a $1 increase in the standardized tax on e-cigarettes reduced youth use by between 6 and 21 percent and the taxes may deter initially trying e-cigarettes and increase the perceived risk of the product among youth.

But at the same time, they found between 23 and 68 percent of adolescent e-cigarette users who quit e-cigarettes switched to traditional cigarettes.

“Given current evidence suggesting smoking is substantially more dangerous than using ENDS, the health costs from greater youth smoking as a result of ENDS taxes may considerably undercut or even outweigh benefits from reduced youth ENDS use,” they wrote.

Safford, who earned a master’s degree from San Diego State University, wrote the paper with their masters’ advisor Dr. Joseph J. Sabia. Other authors include Rahi Abouk (William Paterson University), Charles Courtemanche (University of Kentucky), Dhaval Dave (Bentley University), Bo Feng (American Institutes for Research) Abigail S. Friedman (Yale University), Johanna Catherine Maclean (George Mason University), and Michael F. Pesto (Georgia State University).