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Banning the Sale of E-Cigarettes Might Be Driving More Minors to Smoking

A new Yale University study has found that in states where minors can’t buy e-cigarettes they are – as a whole – smoking more traditional cigarettes.

Abigail Freidman, assistant professor of public health at Yale, looked at teen smoking data in states that prohibit the sale of e-cigs to minors versus ones that do not. She found that in the states that prohibit sales, more young people ages 12 to 17 take up smoking tobacco cigarettes.

“Conventional cigarette use has been falling somewhat steadily among this age group since the start of the 21st century. This paper shows that bans on e-cigarette sales to minors appear to have slowed this decline by about 70 percent in the states that implemented them,” Friedman said. “In other words, as a result of these bans, more teenagers are using conventional cigarettes than otherwise would have done so.”

E-cigs – also known as vaporizers – are a metal tube that is filled with a liquid that contains nicotine and/or flavoring such as cherry, coffee, vanilla, etc. In many cases, they are made to look similar to regular cigarettes, but also are designed with a look similar to a ballpoint pen. When the user “puffs” on the device, a battery heats the liquid and emits a vapor mist that the user inhales. The experience is much like inhaling from a traditional cigarette, but without the toxic, stinky smoke from burning tobacco.

Currently, 47 U.S. states have banned the sale of electronic cigarettes to minors. Lawmakers and health officials have argued that e-cigs are dangerous and serve as a gateway to traditional cigarettes. Proponents of e-cigarettes say that the devices are vastly safer than regular cigarettes because they do not expose the user to toxic tobacco smoke and nicotine-free options exist.

Friedman’s study, which was published in the October issue of the Journal of Health Economics, on average found that smoking rates in states with bans on selling e-cigs to minors were one percentage point higher than in states with no ban. For the purposes of her study, she compared data from states that had bans in place by Jan. 1, 2013 against those that didn’t at the time.

"Policy makers have been assuming that banning e-cigarette sales to minors will improve public health," Friedman said. "This paper's finding, that these bans increase conventional cigarette smoking among teens, suggest that we may need to rethink that conclusion."

Electronic cigarettes, which entered the U.S. market in 2007, have become increasingly popular among former smokers who want a safer alternative or a way to gradually reduce their nicotine dependence. But according to the Centers for Disease Control and Prevention teens are interested in e-cigarettes, too. The rate of e-cigarette use by middle and high school students tripled between 2013 and 2014, according to center data. 

Friedman said her study aimed to look more deeply into the issue. “To understand the public health implications of this increase in e-cigarette use we need to know how e-cigarettes impact conventional cigarette use,” she said. “This paper provides key evidence on that question.”

Based by her findings and the fact that habitual use of traditional tobacco cigarettes first spikes at age 16, Friedman suggested that e-cigarette bans might be more effective in reducing teenage smoking if they were limited to those under age 16, rather than those under 18. She said such a change in law might provide a way to reduce teen smoking while the long-term effects of e-cigarette use and vaping are determined.

As part of her study, Friedman did note a number of limitations. Her research relied on data from the National Survey on Drug Use and Health, which asked teens if they had smoked a cigarette in the past 30 days, rather than measuring those who smoke on a regular basis. The study also did not look directly at e-cigarette use.