The effects of e-cigarette and cigarette policies on queer youth

Tony Chuo; Chad Cotti; Charles Courtemanche; Johanna Catherine Maclean; Erik Nesson; Joseph J. Sabia

doi:10.1016/j.jhealeco.2026.103116

The effects of e-cigarette and cigarette policies on queer youth

Tony Chuo
, Chad Cotti
, Charles Courtemanche
, Johanna Catherine Maclean
, Erik Nesson
, Joseph J. Sabia

Economics

Research output: Contribution to journal › Article › peer-review

Abstract

Electronic nicotine delivery systems (ENDS) use among lesbian, gay, bisexual, and questioning (LGBQ) teenagers is nearly 50 percent higher than among their heterosexual counterparts. Yet little is known about how recent efforts to curb nicotine vaping through tobacco control policies impact sexual minorities. The minority stress hypothesis (MSH) suggests that LGBQ teens may use nicotine to mediate unique stressors, which could lead LGBQ teens to be less responsive to state policies designed to curtail use of nicotine products. This study explores this question using data from the 2015-2023 State Youth Behavior Surveys and a generalized difference-in-differences identification strategy. We consider the importance of four common policies in the U.S.: ENDS taxes, cigarette taxes, ENDS minimum legal sales ages, and ENDS flavor bans. We document heterogeneous responses to ENDS taxes and MLSA laws that are consistent with the MSH: ENDS taxes and MLSA laws reduce vaping among heterosexual youth but not among LGBQ youth, despite substantially higher baseline ENDS use in the latter group. We also find that LGBQ teens without mental health stressors respond strongly to ENDS taxes and flavor bans, whereas those with such stressors do not, also consistent with the MSH. Cigarette taxes are largely unrelated to ENDS use among teens.

Original language	English
Article number	103116
Journal	Journal of Health Economics
Volume	107
DOIs	https://doi.org/10.1016/j.jhealeco.2026.103116
State	Published - May 2026

Bibliographical note

Publisher Copyright:
© 2026 Elsevier B.V.

Funding

Dr. Sabia acknowledges research support for this work from the Center for Health Economics & Policy Studies (CHEPS) at San Diego State University (SDSU), which has received grants from the Charles Koch Foundation as well as support from the James Hervey Johnson Educational Trust and SDSU's Division of Research and Innovation (DRI). Dr. Sabia and Dr. Courtemanche acknowledge support for this work through a grant made to the San Diego State University Research Foundation from Global Action to End Smoking (formerly known as the Foundation for a Smoke-Free World), an independent, U.S. nonprofit 501(c)(3) grantmaking organization, accelerating science-based efforts worldwide to end the smoking epidemic. Global Action played no role in designing, implementing, data analysis, or interpretation of the study results, nor did Global Action edit or approve any presentations or publications from the study. The contents, selection, and presentation of facts, as well as any opinions expressed, are the sole responsibility of the authors and should not be regarded as reflecting the positions of Global Action to End Smoking. Global Action's mission is to end combustible tobacco use, which remains the leading preventable cause of death globally. The organization collaborates with academic and research centers and others to accelerate life-saving research and educational projects. Global Action does not seek or accept funding from companies that produce tobacco or non-medicinal nicotine products. The charitable gift agreement (the “Pledge Agreement”) between the organization and its prior funder, PMI Global Services Inc., was terminated in September 2023. Dr. Sabia also acknowledges research support from a subcontract by Georgia State University in 2023 – via a grant received from the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA045016 – to support exploratory work on this project. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Institutes of Health. We thank Christian Pryfogle for outstanding research assistance.

Funders	Funder number
Charles Koch Foundation
Desert Research Institute
PMI Global Services Inc.
Global Action to End Smoking
San Diego State University
SDSU's Division of Research and Innovation
James Hervey Johnson Chairitable Educational Trust
Georgia College & State University
Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse
National Institutes of Health (NIH)	R01DA045016

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

ENDS taxes
LGBQ teens
Minority stress
Sexual minorities
Youth E-cigarette use

ASJC Scopus subject areas

Health Policy
Public Health, Environmental and Occupational Health

Access to Document

10.1016/j.jhealeco.2026.103116

Cite this

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title = "The effects of e-cigarette and cigarette policies on queer youth",

abstract = "Electronic nicotine delivery systems (ENDS) use among lesbian, gay, bisexual, and questioning (LGBQ) teenagers is nearly 50 percent higher than among their heterosexual counterparts. Yet little is known about how recent efforts to curb nicotine vaping through tobacco control policies impact sexual minorities. The minority stress hypothesis (MSH) suggests that LGBQ teens may use nicotine to mediate unique stressors, which could lead LGBQ teens to be less responsive to state policies designed to curtail use of nicotine products. This study explores this question using data from the 2015-2023 State Youth Behavior Surveys and a generalized difference-in-differences identification strategy. We consider the importance of four common policies in the U.S.: ENDS taxes, cigarette taxes, ENDS minimum legal sales ages, and ENDS flavor bans. We document heterogeneous responses to ENDS taxes and MLSA laws that are consistent with the MSH: ENDS taxes and MLSA laws reduce vaping among heterosexual youth but not among LGBQ youth, despite substantially higher baseline ENDS use in the latter group. We also find that LGBQ teens without mental health stressors respond strongly to ENDS taxes and flavor bans, whereas those with such stressors do not, also consistent with the MSH. Cigarette taxes are largely unrelated to ENDS use among teens.",

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author = "Tony Chuo and Chad Cotti and Charles Courtemanche and Maclean, \{Johanna Catherine\} and Erik Nesson and Sabia, \{Joseph J.\}",

note = "Publisher Copyright: {\textcopyright} 2026 Elsevier B.V.",

year = "2026",

month = may,

doi = "10.1016/j.jhealeco.2026.103116",

language = "English",

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The effects of e-cigarette and cigarette policies on queer youth

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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Cite this