The Effects of New E-cigarette Internet Sales Bans and E-cigarette Flavor Bans on Tobacco Use by Youth, Young Adults and Adults

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Project Summary Use of all tobacco products by youth and young adults up to age 25 poses a serious public health concern because this group is at risk of long-term health effects and neurological damage from nicotine exposure. Interventions targeted at them to discourage tobacco use can help lower the trajectory of nicotine addiction and use of other addictive substances over the life cycle. Reducing their access to e-cigarettes and altering appealing attributes of e-cigarettes are among the cornerstones of a strategic prevention policy framework. The proposed research will provide the first plausibly causal evidence on the effectiveness of two key policies in affecting tobacco use by youth, young adults and adults. These regulations are: 1) a ban on internet sales of all e-cigarette products; and 2) a comprehensive ban on all added flavors in all e-cigarette products – including those exempt from the current federal ban. Internet sales bans have just been enacted at the federal level although there is no empirical evidence speaking to its causal effect on e-cigarette use. These new bans are intended to target youth and young adults, but they apply to all sales. As a result, spillovers of the policy effects to adults are possible. Because e-cigarettes are potentially beneficial to adult smokers who are trying to quit smoking, it is important to ascertain whether these bans mainly affect youth and young adults or also have any spillover effects on adults and in particular adult smokers. We will assess such potential spillovers of internet sales bans, and comprehensive flavor bans on tobacco use outcomes among adults. Beyond descriptive comparisons, there exists virtually no empirical evidence on how effective these regulations would be in curtailing tobacco use at different age levels. This project will capitalize on natural experiments exploiting variation in the timing of the adoption of bans on online e-cigarette sales and on added flavors in all e-cigarette products, to address this critical knowledge gap and provide the first causal estimates in the literature of these regulations. Analyses will be based on a difference-in-differences framework applied to micro-level data from six large-scale national surveys of youth, and young adults and adults. As part of our main aims, the proposed research will also provide some of the first evidence on how state penalties imposed on retailers for selling e-cigarettes to underage youth and young adults are impacting e-cigarette use by these groups and how they are obtaining their e-cigarettes. Despite the age restrictions, the considerable level of e- cigarette use by youth indicates that the minimum purchase age laws by themselves have had limited effectiveness. Thus, it is important to understand whether stricter penalties can reduce the overall use of e- cigarettes.