Efforts to Combat E-Cigarette Misuse Could Backfire
Recent news about e-cigarette misuse has fueled both public misperception and policy responses that are likely to have unintended consequences. As the US vaping market continues to evolve, policymakers face the tricky challenge of safeguarding the potential for positive public health outcomes from e-cigarettes, which offer a lower-risk alternative to traditional cigarettes, while ensuring reasonable protections against youth use.
In the latter half of 2019, public health officials rushed to issue broad warnings against e-cigarettes in response to a surge in vaping-related hospitalizations and deaths that grabbed national headlines. The broad warnings proved to be unfounded, as the hospitalizations and deaths were determined to be unrelated to anything found in typical e-cigarettes. Instead, the primary cause was vitamin E acetate, a substance in illegal vaping products containing tetrahydrocannabinol (THC), also known as “marijuana vaping.”
More public outcry ensued when e-cigarette use among youth was reported to have dramatically increased in 2019, which is clearly a troubling development. The National Youth Tobacco Survey reported 1 million kids using e-cigarettes daily and more than 5 million youths having used such a product in the last 30 days. (The same survey also found that youth use of traditional cigarettes declined in 2019.) Rising youth use of e-cigarettes and sensational headlines about e-cigarette related hospitalizations and deaths led to a flurry of legislative and regulatory activity.
Congress passed legislation setting a nationwide minimum age of 21 to purchase cigarettes, e-cigarettes, and other tobacco products. This law affected the 32 states that had maintained a minimum age of 18, as the other states and the District of Columbia had already raised the minimum age to 21. The Food and Drug Administration (FDA) issued regulatory guidance effectively banning many flavored e-cigarette products, with the stated motivation of reducing teenagers’ demand for e-cigarettes. Some state and local lawmakers also jumped into the fray last year in response to the vaping-related illnesses. For example, Massachusetts Governor Charlie Baker temporarily banned all e-cigarettes from stores in the state.
Raising the legal age to purchase tobacco to 21 is a sensible reform despite the obvious oddity that this threshold is beyond the age to drive a car or serve in the military. However, eliminating flavored e-cigarette products, outright e-cigarette bans, or another popular local policy, e-cigarette taxes, have a major downside: more cigarette smoking.
Because e-cigarettes are a less harmful alternative to cigarettes, public health advocates and officials must appreciate the impact of e-cigarette restrictions on smokers. A number of recent studies indicate that cigarettes and e-cigarettes are substitutes, which means that policies that discourage e-cigarette use will lead to more smoking.
A study released last July (Abouk et al. 2019) found that state-level e-cigarette taxes cause an increase in pre-pregnancy and prenatal cigarette smoking of about 6 percent. Higher prices for e-cigarettes lead to higher pre-pregnancy smoking rates. A paper from last December (Saffer et al. 2019) found that Minnesota’s large e-cigarette tax caused 32,400 fewer smokers to quit and estimated that 1.8 million fewer smokers would quit smoking if a similar tax were imposed at the federal level. Finally, a new study (Cotti et al. 2020) examined a dataset of 35,000 retailer transactions from 2011 to 2017 and investigated the effect of taxes on e-cigarettes on sales of these products and traditional cigarettes. This research concluded that an e-cigarette tax considered by the House Ways and Means Committee could lead to the sale of six more packs of cigarettes for each sale of a standard e-cigarette nicotine cartridge that it eliminated.
These studies, and other like them, offer an important cautionary lesson for the recent efforts to discourage e-cigarette use. Banning flavors in e-cigarettes will dampen their appeal and thereby increase the appeal of cigarettes. Because flavors have been shown to appeal to users of all ages, the flavor ban is likely to increase smoking within today’s adult population. Prohibitions on e-cigarette sales would have an even larger adverse effect.
The FDA and the Centers for Disease Control should continue to monitor the use of e-cigarettes and traditional tobacco products among youth and adult populations. Although youth use of any nicotine product should be strongly discouraged, strategies that are not carefully and narrowly crafted could increase adult smoking, with deadly consequences.
Alex Brill is a resident fellow at the American Enterprise Institute.