Skip to main content

Advertisement

SpringerLink
Log in

Effects of e-cigarette minimum legal sales ages on youth tobacco use in the United States

  • Published:
Journal of Risk and Uncertainty Aims and scope Submit manuscript

Abstract

In the United States, individual states established a minimum legal sale age (MLSA) for e-cigarettes between 2010 and 2016 when a federal MLSA came into place. These policies provide a natural experiment from which we can better understand the effect that e-cigarettes have on youth combustible tobacco use. This paper uses National Youth Tobacco Survey data to estimate the effect of the gradual roll-out of e-cigarette MLSAs in the United States on youth e-cigarette use, cigarette use, and cigar use (i.e., cigars, cigarillos, or little cigars). Using an estimator designed to correct for dynamic heterogeneity in treatment effects, e-cigarette MLSAs are estimated to reduce lifetime e-cigarette use by approximately 25% and increase daily cigarette use and daily cigar use by approximately 35%. Therefore, these MLSAs operate as intended in reducing e-cigarette use, although at the expense of more dangerous combustible tobacco use. The Food and Drug Administration should consider the impact of e-cigarette availability in reducing youth combustible tobacco use as an important public health benefit of e-cigarettes in their regulatory activity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data Availability

All data available via request from the author, except for indoor air law data that is licensed from the American Nonsmokers Rights' Foundation.

Notes

  1. See here for press release of the FDA’s first e-cigarette marketing orders, allowing their legal sale: https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-e-cigarette-products-marking-first-authorization-its-kind-agency (Accessed Sept. 26, 2022). Current premarket tobacco product marketing granted orders is provided here: Premarket Tobacco Product Marketing Granted Orders | FDA (Accessed Sept. 26, 2022).

  2. E-cigarette MLSAs may increase the difficulty of purchasing e-cigarettes and awareness of potential risks, both of which could raise the costs vis-à-vis cigarettes. This could generate substitution to cigarette use despite previously existing cigarette MLSAs, as has been shown in several studies (Abouk & Adams 2017; Dave et al., 2019b; Friedman, 2015; Pesko & Currie, 2019; Pesko et al., 2016a).

  3. E-cigarette Intelligence estimates an e-cigarette market size of $5.6 billion in 2021.

  4. In June 2022, Juul was estimated to have 33.1% market share (https://vaporvoice.net/2022/06/02/vuse-continues-to-expand-u-s-market-share-over-juul/) (Accessed September 25, 2022).

  5. One study finds the outbreak of “e-cigarette, or vaping product use associated lung injury” (EVALI) in mid- to late-2019 caused sharp increases in risk perception of e-cigarettes relative to cigarettes (Dave et al., 2020), despite this outbreak being caused by contaminated THC vapes rather than nicotine e-cigarettes. Another study finds that public risk perceptions of e-cigarettes are over-estimated, though not necessarily due to EVALI (Viscusi, 2020).

  6. The NYTS wave was also collected in Fall 1999. I do not use this original wave because it is the only one of the waves to be collected in the fall and because it is very near in time to the spring 2000 wave.

  7. Additionally, following two other studies (Pesko and Currie, 2019; Pesko et al., 2016a), Massachusetts is excluded from all analyses because an unusually large number of e-cigarette MLSAs were implemented at the local level.

  8. N reflects the population without consideration to missing outcomes, which ranges from 1.7% to 2.8% depending on outcome and time horizon (2011–2017 or 2000–2017).

  9. Four states (Alabama, Alaska, New Jersey, and Utah) have used a cigarette MLSA of 19 since 2005. By mid-2017, two states (Hawaii and California) had increased the MLSA to 21.

  10. The analysis was approved by the Georgia State University IRB, Protocol # H18423. Archived versions of the NYTS are used that include geographical information. Please see the online appendix for additional information.

  11. This can often be tested by a formal Goodman-Bacon decomposition (Goodman-Bacon, 2021), but this diagnostic aid cannot be used for imbalanced data.

  12. I do not use state economic and policy controls with the C&S estimator because the -csdid- documentation reports that only the base-period values are used for the estimation if variables are time-varying.

  13. There is also evidence from the e-cigarette tax literature (Abouk et al., 2021; Pesko et al., 2020) that current use margins respond relatively imprecisely to policy changes, but ever and daily use margins respond more precisely. One explanation could be recall bias. The NYTS defines current use as any use over the past 30 days. Non-daily users make up the majority of users, and these individuals may have greater difficulty in answering this question accurately. In contrast, it should be relatively easier for people to report daily use or ever use of e-cigarettes (defined as having tried an e-cigarette even once or twice). A second explanation is that non-daily users may not purchase their products directly and may be more likely to “bum” products off of others. “Bumming” behavior may respond differently to e-cigarette policies than the behaviors of daily users purchasing their own products. Either explanation could contribute to the estimated pattern of results.

  14. For combustible tobacco use outcomes, the data is collected irregularly in earlier years (2000, 2002, 2004, 2006, and 2009). Our event studies imply that each “wave” is of equal temporal distance, which could introduce noise into pre-period coefficients for combustible tobacco use outcomes. This issue does not affect post-period coefficients, however, as the NYTS is collected each year that MLSAs come into place.

  15. Even though all individuals in our sample are < 18 years of age and therefore subject to existing MLSA laws, two papers show spillover effects on younger ages of Tobacco-21 laws (Abouk et al., 2022b; Bryan et al., 2020).

References

  • Abouk, R., & Adams, S. (2017). Bans on electronic cigarette sales to minors and smoking among high school students. Journal of Health Economics, 54, 17–24.

    Article  Google Scholar 

  • Abouk, R., Adams, S., Feng, B., Maclean, J. C., & Pesko, M. F. (2022a). The effect of e-cigarette taxes on pre-pregnancy and prenatal smoking. NBER. Working Paper Series, No. 26126.

  • Abouk, R., Courtemanche, C. J., Dave, D. M., Feng, B., Friedman, A. S., Maclean, J. C., Safford, S. (2021). Intended and unintended effects of e-cigarette taxes on youth tobacco use. National Bureau of Economic Research. Working Paper Series, No. 29216.

  • Abouk, R., De, P. K., & Pesko, M. F. (2022b). Estimating the effects of Tobacco-21 on youth tobacco use and sales. Social Science Research Network. Working Paper, No. 3737506.

  • Allcott, H., & Rafkin, C. (2022). Optimal regulation of e-cigarettes: Theory and evidence. American Economic Journal: Economic Policy, 14(4), 1–50.

  • Bryan, C., Hansen, B., McNichols, D., & Sabia, J. J. (2020). Do state Tobacco 21 laws work? National Bureau of Economic Research. Working Paper Series, No. 28173.

  • Buckell, J., Marti, J., & Sindelar, J. L. (2019). Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment. Tobacco Control, 28(2), 168–175.

    Article  Google Scholar 

  • Callaway, B., & Sant’Anna, P. H. C. (2021). Difference-in-differences with multiple time periods. Journal of Econometrics, 225(2), 200–230.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2020). State tobacco activities tracking and evaluation (STATE) system. Retrieved October 1, 2022, from https://www.cdc.gov/statesystem/index.html

  • Consumer Advocates for Smoke-Free Alternatives Association. (2022). Historical timeline of vaping & electronic cigarettes. Retrieved October 1, 2022, from https://casaa.org/education/vaping/historical-timeline-of-electronic-cigarettes/

  • Cotti, C., Courtemanche, C., Maclean, J. C., Nesson, E., Pesko, M. F., & Tefft, N. W. (2022). The effects of e-cigarette taxes on e-cigarette prices and tobacco product sales: Evidence from retail panel data. Journal of Health Economics, 86, 102676.

    Article  Google Scholar 

  • Cotti, C., Nesson, E., Pesko, M. F., Phillips, S., & Tefft, N. (2021). Standardising the measurement of e-cigarette taxes in the USA, 2010–2020. Tobacco Control.

  • Courtemanche, C. J., Palmer, M. K., & Pesko, M. F. (2017). Influence of the flavored cigarette ban on adolescent tobacco use. American Journal of Preventive Medicine, 52(5), e139–e146.

    Article  Google Scholar 

  • Cowen and Company Equity Research. (2019). QUICK TAKE - tobacco - flavor ban coming, boon for cigarettes?

  • Dave, D., Dench, D., Grossman, M., Kenkel, D. S., & Saffer, H. (2019a). Does e-cigarette advertising encourage adult smokers to quit? Journal of Health Economics, 68, 102227.

    Article  Google Scholar 

  • Dave, D., Dench, D., Kenkel, D., Mathios, A., & Wang, H. (2020). News that takes your breath away: Risk perceptions during an outbreak of vaping-related lung injuries. Journal of Risk and Uncertainty, 60(3), 281–307.

    Article  Google Scholar 

  • Dave, D., Feng, B., & Pesko, M. F. (2019b). The effects of e-cigarette minimum legal sale age laws on youth substance use. Health Economics, 28(3), 419–436.

    Article  Google Scholar 

  • DeSimone, J., Grossman, D. S., & Ziebarth, N. R. (2022). Regression discontinuity evidence on the effectiveness of the minimum legal e-cigarette purchasing age. Forthcoming, American Journal of Health Economics.

  • Dutra, L. M., Glantz, S. A., Arrazola, R. A., & King, B. A. (2018). Impact of e-cigarette minimum legal sale age laws on current cigarette smoking. Journal of Adolescent Health, 62(5), 532–538.

    Article  Google Scholar 

  • Feng, B., & Pesko, M. F. (2019). Revisiting the effects of tobacco retailer compliance inspections on youth tobacco use. American Journal of Health Economics, 5(4), 509–532.

    Article  Google Scholar 

  • Friedman, A. S. (2015). How does electronic cigarette access affect adolescent smoking? Journal of Health Economics, 44, 300–308.

    Article  Google Scholar 

  • Friedman, A. S., & Pesko, M. F. (2022). Young adult responses to taxes on cigarettes and electronic nicotine delivery systems. Addiction, 117(12), 3121–3128.

    Article  Google Scholar 

  • Gentzke, A. S., Wang, T. W., Cornelius, M., Park-Lee, E., Ren, C., Sawdey, M. D., & Homa, D. M. (2022). Tobacco product use and associated factors among middle and high school students - national youth tobacco survey, United States, 2021. MMWR Surveillance Summaries, 71(5), 1–29.

    Article  Google Scholar 

  • Goodman-Bacon, A. (2021). Difference-in-differences with variation in treatment timing. Journal of Econometrics, 225(2), 254–277.

    Article  Google Scholar 

  • Institute for Global Tobacco Control. (2020). Country laws regulating e-cigarettes: A policy scan.

  • Kaplan, S. (2021). Juul is fighting to keep its e-cigarettes on the U.S. market. The New York Times.

  • Kennedy, R. D., Awopegba, A., De León, E., & Cohen, J. E. (2017). Global approaches to regulating electronic cigarettes. Tobacco Control, 26(4), 440–445.

    Article  Google Scholar 

  • Lillard, D. R. (2020). The economics of nicotine consumption. In K. F. Zimmermann (Ed.) Handbook of labor, human resources and population economics. Springer, Cham.

  • Marti, J., Buckell, J., Maclean, J. C., & Sindelar, J. (2019). To “vape” or smoke? experimental evidence on adult smokers. Economic Inquiry, 57(1), 705–725.

    Article  Google Scholar 

  • National Academies of Sciences, Engineering, and Medicine. (2018). Public health consequences of e-cigarettes.

  • Nguyen, H. V. (2020). Association of Canada’s provincial bans on electronic cigarette sales to minors with electronic cigarette use among youths. JAMA Pediatrics, 174(1), e193912–e193912.

    Article  Google Scholar 

  • Office of Disease Prevention and Health Promotion. (2021). Adolescent cigarette smoking in past 30 days (percent, grades 9–12). Retrieved October 1, 2022, from https://www.healthypeople.gov/2020/data/Chart/5342?category=1&by=Total&fips=-1

  • Pesko, M. F. (2022a). How data security concerns can hinder natural experiment research: Background and potential solutions. JNCI Monographs, 2022(59), 89–94.

    Article  Google Scholar 

  • Pesko, M. F. (2022b). Combustible tobacco age-of-sale laws: An opportunity? Addiction, 117(3), 514–516.

    Article  Google Scholar 

  • Pesko, M. F., Courtemanche, C. J., & Maclean, J. C. (2020). The effects of traditional cigarette and e-cigarette tax rates on adult tobacco product use. Journal of Risk and Uncertainty, 60(3), 229–258.

    Article  Google Scholar 

  • Pesko, M. F., & Currie, J. M. (2019). E-cigarette minimum legal sale age laws and traditional cigarette use among rural pregnant teenagers. Journal of Health Economics, 66, 71–90.

    Article  Google Scholar 

  • Pesko, M. F., Hughes, J. M., & Faisal, F. S. (2016a). The influence of electronic cigarette age purchasing restrictions on adolescent tobacco and marijuana use. Preventive Medicine, 87, 207–212.

    Article  Google Scholar 

  • Pesko, M. F., Kenkel, D. S., Wang, H., & Hughes, J. M. (2016b). The effect of potential electronic nicotine delivery system regulations on nicotine product selection. Addiction, 111(4), 734–744.

    Article  Google Scholar 

  • Pesko, M. F., & Robarts, A. M. T. (2017). Adolescent tobacco use in urban versus rural areas of the United States: The influence of tobacco control policy environments. Journal of Adolescent Health, 61(1), 70–76.

    Article  Google Scholar 

  • Pesko, M. F., & Warman, C. (2022). Re-exploring the early relationship between teenage cigarette and e-cigarette use using price and tax changes. Health Economics, 31(1), 137–153.

    Article  Google Scholar 

  • Prochaska, J. J., Vogel, E. A., & Benowitz, N. (2022). Nicotine delivery and cigarette equivalents from vaping a JUULpod. Tobacco Control, 31(e1), e88–e93.

    Article  Google Scholar 

  • Saffer, H., Dench, D., Grossman, M., & Dave, D. (2020). E-cigarettes and adult smoking: Evidence from Minnesota. Journal of Risk and Uncertainty, 60(3), 207–228.

    Article  Google Scholar 

  • Sharpless, N. (2019). How FDA is regulating e-cigarettes. Retrieved October 1, 2022, from https://www.fda.gov/news-events/fda-voices/how-fda-regulating-e-cigarettes#:~:text=Restricting%20Youth%20Access%20to%20ENDS,to%20purchase%20a%20tobacco%20product

  • Truth Initiative. (2022). Flavored tobacco policy restrictions. Retrieved October 1, 2022, from https://truthinitiative.org/sites/default/files/media/files/2022/05/Q1_2022_FINAL.pdf

  • Tuchman, A. E. (2019). Advertising and demand for addictive goods: The effects of e-cigarette advertising. Marketing Science, 38(6), 994–1022.

    Google Scholar 

  • U.S. Department of Health and Human Services. (2016). E-cigarette use among youth and young adults: A report of the surgeon general.

  • Viscusi, W. K. (2016). Risk beliefs and preferences for e-cigarettes. American Journal of Health Economics, 2(2), 213–240.

    Article  Google Scholar 

  • Viscusi, W. K. (2020). Electronic cigarette risk beliefs and usage after the vaping illness outbreak. Journal of Risk and Uncertainty, 60(3), 259–279.

    Article  Google Scholar 

Download references

Acknowledgements

Thank you to Hai Nguyen for helpful comments.

Funding

Dr. Pesko was supported by R01DA045016 from the National Institute on Drug Abuse of the National Institutes of Health and by a grant from the Institute for the Study of Free Enterprise at the University of Kentucky.

Author information

Authors and Affiliations

  1. Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA

    Michael F. Pesko

Authors
  1. Michael F. Pesko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael F. Pesko.

Ethics declarations

Conflict of Interest

No conflicts of interest to report.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 46.2 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pesko, M.F. Effects of e-cigarette minimum legal sales ages on youth tobacco use in the United States. J Risk Uncertain 66, 261–277 (2023). https://doi.org/10.1007/s11166-022-09402-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11166-022-09402-y

Keywords

JEL

Search

Navigation