The Impacts of Vaping Regulations on Perceptions, Access, Prices, and Tobacco Use

Smoking and obesity are the two largest sources of preventable death in the United States. E-cigarettes, which became commercially available in 2006 in the United States and may help smokers quit, could potentially reduce both smoking and obesity. Cigarette smoking has long been viewed as a means to control body weight, and vapers are now reporting that e-cigarettes help to control weight as well. Nicotine from both smoking and vaping could affect obesity by acting as an appetite suppressant, raising resting metabolic rates, and altering tastes. Since e-cigarettes are believed to be significantly less harmful than tobacco cigarettes, the overall public health gains of vaping could be large if they help people reduce smoking and obesity. Our proposed research will be the first to empirically evaluate the potential health benefit of vaping on weight outcomes. Another contribution of our work will be to evaluate the impacts of e-cigarette policies like taxes, minimum legal purchase age laws, and indoor air laws on vaping and smoking. Minimum legal purchase age laws have been enacted in all states between 2011 and 2016. As of October, 2016, e-cigarette taxes have been enacted in 7 states and laws prohibiting vaping in bars, restaurants, and private workplaces have been enacted in 10 states. Many other states are considering adopting e-cigarette indoor air laws and e-cigarette taxes as well. We propose matching this policy variation to large, nationally representative survey data sources with questions on smoking, vaping, and weight, including the National Health Interview Survey, the Youth Risk Behavior Surveillance System, and Monitoring the Future. All of these surveys began including vaping questions in 2014, meaning that midway through our proposed R01 we will have at least five years of data for performing our evaluations. We will estimate the effects of e-cigarette policies on our outcomes using reduced- form difference-in-difference-style models and instrumental variable models to provide plausibly causal estimates that are not influenced by unobserved omitted variables influencing both tobacco use and obesity. Our reduced from models will also investigate the exogeneity of the policy variation using event study designs that assess the parallel trends assumption. Before investigating the impact of taxes on behaviors, it is important to first understand the extent to which e-cigarette taxes influence the prices consumers face. The first step of our project will therefore be to conduct the first such investigation by matching state e-cigarette tax rates to e-cigarette price data from the Nielsen retail data system. We will then estimate the effect of e-cigarette policies on vaping, smoking, and dual-use for both adults and children. We will use difference-in-difference-style models to empirically evaluate the hypothesis that vaping restrictions (taxes, minimum age laws, and public-use bans) reduced vaping, increased smoking, reduced dual use, and reduced overall nicotine use. Next, we will estimate the effect of e-cigarette policies on weight-related outcomes using reduced form difference-in-difference-style models. We will also use instrumental variable models to assess the effect of vaping and smoking on weight directly. We hypothesize that weight and obesity were reduced by both instrumented vaping and smoking and the policies themselves. Findings from this proposal will provide critical information on how to optimally regulate e-cigarettes considering the effects of e-cigarette regulations on overall tobacco use and intermediate outcomes, and given possible and previously unrealized benefits of vaping on weight outcomes. The research team has expertise in the fields of health economics, public health policy, epidemiology, and medicine. The findings generated in the proposed research are timely as both state and federal policymakers are currently determining how best to regulate e-cigarettes with a limited scientific evidence base. In particular, we will provide evidence on how these policies impact tobacco use and on a potential unrealized benefit of vaping—possible weight reduction. These estimates will be important to consider alongside costs of vaping to determine how to optimally regulate e-cigarettes going forward.