Association of Youth E-Cigarette Bans with Increased Smoking Confirmed

There is fresh evidence indicating that attempts to prohibit youth access to e-cigarettes increase youth smoking rates.

Last November, I discussed a Yale research finding that smoking increased significantly among teens aged 12-17 in states that banned e-cigarette sales to minors compared with states with no bans (here).  Now this from researchers at Cornell University: “We document a concerning trend of cigarette smoking among adolescents increasing when [e-cigarettes] become more difficult to purchase.”

Michael Pesko and colleagues at the Cornell medical school compared adolescent smoking in states that implemented e-cigarette purchasing restrictions during the period 2007 to 2013, compared with states that had no restrictions.  Using federal Youth Risk Behavior Surveillance System surveys, they examined smoking rates over the past 30 days: recent (smoked at least 1 day), casual (1-19 days), regular (20+ days) and heavy (all 30 days).  They also accounted for state differences in cigarette taxes and indoor use laws, and they included a fixed effects variable to account for additional unmeasured differences in states’ smoking norms and anti-smoking sentiments.  The study was published in Preventive Medicine (abstract here).

Pesko et al. found “…that [e-cigarette] age purchasing restrictions are associated with a 3.1 percentage point (17.9% of the mean) increase in adolescent cigarette use (p < 0.05) in the period of implementation.  Most of this effect is accounted for within casual cigarette using adolescents… Our results suggest that adolescents are willing to substitute [e-cigarettes] for cigarettes depending on legal purchasing opportunities of [e-cigarettes].”

The researchers’ finding that e-cigs had no effect on use of cigars, smokeless tobacco or marijuana provides confidence about the specificity of the e-cig effect.    

While the Cornell researchers do not claim that the restrictions caused smoking to increase, they note that their results are consistent with those of the Yale study, and they add: “All policymaking bodies should be aware of a potential increase in cigarette use following [e-cigarette] age purchasing restrictions.”  They recommend raising cigarette excise taxes and they endorse the Yale researchers’ support for setting the e-cig sales age lower than the cigarette age in order to take advantage of the substitution effect.

This is Pesko’s second notable paper this year.  Earlier, he published an experimental study (abstract here) concluding that: “Increased taxes, a proposed US Food and Drug Administration warning label for [e-cigarettes] and a more severe warning label may discourage adult smokers from switching to [e-cigarettes].  Reducing the availability of flavours may reduce [e-cigarette] use by young adult smokers.”

It is important to note that none of these studies were funded by the National Institutes of Health.  The NIH predominantly funds researchers who endorse the federal government’s vision of a tobacco-free society.