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SMOKE WHAT?

Restricting e-cigarettes could increase the number of young smokers

By Dan Kopf

E-cigarettes in the US are in the crosshairs. The Trump administration is preparing to ban flavored e-cigarettes. Juul, the largest e-cigarette retailer in the US, announced last week that it would no longer advertise directly to consumers in the US, and Walmart recently declared that it will stop selling e-cigarettes. To help get through the firestorm, Juul just brought in a new CEO.

The turmoil around e-cigarettes is due to a rash of vaping-related deaths and illnesses—many of which involve vaping THC or black market products—and the rapidly rising rate of teenagers who report using e-cigarettes. The share of high schoolers who say they vaped nicotine in the last 30 days rose from just 1.5% in 2011 to 27.5% in 2019, according to figures from the Center for Disease Control and Prevention’s National Youth Tobacco Survey (preliminary results for 2019 were reported by the New York Times).

Yet not everybody believes the rise of vaping has been all bad. Health economist Michael Pesko tells Quartz that he doesn’t think it’s a coincidence that the use of combustible cigarettes (the non-electronic kind) fell among teens at the same time that e-cigarette use has risen. Since 2011, when e-cigarettes took off, the National Youth Tobacco Survey shows that combustible cigarette use among high schoolers has fallen from 15.8% to 5.8% in 2019.

Pesko’s research finds that higher taxes on e-cigarettes and restrictions on their use make people more likely to smoke regular ones (pdf), and that this is true for both adults and teenagers. In the language of economics, that means the two products are “substitutes”—the more expensive or difficult one product is to get, the more people will use the other.

If true, this means e-cigarette restrictions, like the ban on flavored e-cigarettes currently being implemented in Michigan, could make some kids turn to the combustible kind.

There is no doubt that e-cigarette vaping is a bad habit. Scientists find that it hurts people’s lungs and may increase the risk of having a seizure, among other possible consequences. Little is known about the long term effects of vaping, but it’s almost certain that none of them are good. It will also take a lot of money out of your wallet.

Yet nearly all researchers agree that vaping nicotine is better than smoking cigarettes. Which raises the question: If the e-cigarette craze is preventing enough kids from smoking, could the risk be worth it? It’s a tough calculus that requires knowledge of the exact harms of each product, and just how many fewer kids are smoking as a result of their vaping habit. Unfortunately, neither of these is known with much precision.

The downturn in combustible cigarette smoking isn’t necessarily a result of vaping’s rise. One reason to doubt a causal relationship: Teen smoking was already in decline before e-cigarettes were widely used. According to data from the Youth Risk Behavior Survey (pdf), 34.8% of high school students had smoked a cigarette in the last 30 days in 1999, compared to just 18.1% in 2011. (This survey finds that the teen smoking rate in 2011 was slightly lower than the 21.8% found by the National Youth Tobacco Survey.)

But Pesko points out that most of this decline happened from 1999 to 2003, which was just after the “Master Settlement Agreement” imposed major restrictions on cigarette advertising and forced cigarette companies to pay huge settlements to US states. In order to pay for these settlements, cigarette companies raised the price of cigarettes by about 30% in 1999, and about 8-10% in the years after. Price increases have been more modest since then.

Pesko thinks the decline in the 2000s was also impacted by stronger regulation, which slowed in the 2010s. His analysis of data from American Non-Smokers Rights Foundation shows that the share of the US population living in places with smoke-free restaurants skyrocketed from about 15% in 2000 to over 70% in 2010, but has only seen modest growth since (workplaces and bars followed similar trends). With prices and regulation not growing as fast, Pesko sees e-cigarettes as one important explanation for the continued decline.

Pesko makes a case that the fall in regular cigarette use among teens in the 2010s would have been less acute without vaping. If he’s right about the products being substitutes for each other, then increased regulation on e-cigarettes will mean more kids smoking the combustible kind.