Electronic Cigarette Access And Adolescent Smoking

By Gil Ross — Oct 26, 2015
A new study suggests restricting teen access to e-cigarettes leads to a relative increase in youth smoking.

Screen Shot 2015-10-26 at 2.06.58 PMIn a new study, Dr. Abigail S. Friedman from the Department of Health Policy and Management, Yale School of Public Health, has concluded that bans of electronic cigarettes to minors results in a higher rate of smoking deadly cigarettes.

Dr. Friedman subjected data on smoking rates as related to e-cigarette access to various statistical tests:

This paper examines the causal impact of e-cigarette access on conventional cigarette use by adolescents. Regression analyses consider how state bans on e-cigarette sales to minors influence smoking rates among 12 to 17 year olds. Such bans yield a statistically significant 0.9 percentage point increase in recent smoking in this age group, relative to states without such bans. Results are robust to multiple specifications as well as several falsification and placebo checks.

In other words, barring access among young people to e-cigarettes was associated with a significant uptick in smoking rates, as compared to those states and regions where such access has not been restricted. This flies in the face of the commonly held position that, while e-cigarette access for adults should not be restricted, purchase of the devices should be withheld from minors (a position I also hold.)

The author goes on: "This effect is both consistent with e-cigarette access reducing smoking among minors, and large: banning electronic cigarette sales to minors counteracts 70 percent of the downward pre-trend in teen cigarette smoking in the states that implemented such bans."

The smoking trend among teens is in a major decline but the analysis shows that in those states which have instituted e-cigarette bans for younger people, that trend is significantly lessened.

Two final points: It might be a quibble but Friedman uses the word causal ("This paper examines the causal impact of e-cigarette access on conventional cigarette use by adolescents") in her summary yet one cannot make a cause-and-effect conclusion based on this type of observational study, as opposed to a prospective randomized controlled study.

The second point is less obvious and more related to a policy recommendation: The way to prevent access to e-cigarettes among 12-17-year-olds may be to only allow younger teens who can be documented to already be smokers to purchase e-cigarettes. That can be done as simply as requiring a parental note. This mitigates concern about any potential "gateway" effect to cigarette smoking, since only existing smokers could buy them, for harm reduction or smoking cessation.

One examination of e-cigarette policy won't settle the issue but at least it addresses a potential problem of limiting harm reduction measures for young smokers. It seems obvious that bans are the wrong way to go, the same way that preaching abstinence only and denying contraception to minors would not do much to solve teen pregnancy.

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