As they have become more widely available, e-cigarette use has increased significantly, although it is notable that the rate of current use declined from 2015 to 2016 for both adults and high schoolers. The proliferation of e-cigarettes has fueled concerns about potential health risks and adolescent use. While these concerns should be investigated and studied thoroughly, focusing exclusively on the potential negative aspects could preclude considering the potential harm reduction benefits for the about 38 million current smokers in the country.
It has been difficult to ascertain the effects of e-cigarettes on adult smoking due to the number of factors at play and trends that were in place before e-cigarettes came onto the scene. However, a recent working paper finds that e-cigarettes “create a path toward cessation.” Policymakers should incorporate these new findings when considering new regulations, and should avoid regulations that would close off this path and make it more difficult for people to quit conventional smoking.
Previous studies had analyzed survey data and found an association between e-cigarettes and reduced smoking. Some other randomized controlled trials found some evidence that e-cigarette use increased the probability of successful cessation, but relied on small samples. The new working paper, from Henry Saffer and Michael Grossman of NBER, Daniel Dench of the City University of New York, and Dhaval Dave of Bentley University, attempts to further our understanding of the interaction between e-cigarettes and smoking.
One of the major limitations of studies relying on survey data is that the analysis is unable to determine causation: while e-cigarettes use may be associated with reduced smoking, it does not mean necessarily that it is the cause. The authors attempt to correct for this by using the determinants of e-cigarettes demand, such as the prices for cigarettes and e-cigarettes at the county and month level from Nielsen Retail Scanner data.
The authors find that e-cigarettes increase the probability of a quit attempt, the probability of a quit success, the probability of a quit failure, and the number of quit failures. Even for failed quitters and those who did not attempt to quit, e-cigarette use reduced smoking.
Policies that make it more expensive or more difficult for adults to access e-cigarettes could attenuate these potential benefits for current conventional cigarette smokers.
The authors estimate that a 10 percent federal excise tax would reduce the number of quitters in the country by more than 250,000 per year.
It is quite reasonable for federal policymakers to want more studies of e-cigarettes, and to seek to use that data and analysis in crafting the appropriate regulatory framework. Unfortunately, in some cases this does not seem to be the case, and more broadly the United States has fallen behind other countries when it comes to recognizing the continuum of risk and the potential for harm reduction e-cigarettes could offer.
On the positive side, in July 2017, the U.S. Food and Drug Administration announced a comprehensive plan for tobacco and nicotine regulation that took pains to demonstrate the agency’s awareness that smoking methods represent a “continuum of risk” with combustible cigarettes being the most risky and harmful. The National Academy of Sciences, Engineering and Medicine released a 600-page report analyzing e-cigarettes, with one highlight being their conclusion that “across a range of studies and outcomes, e-cigarettes appear to pose less risk to an individual than combustible tobacco cigarettes.”
Higher awareness has not yet translated into much tangible policy change, at least so far. Within the United States, some jurisdictions are passing legislation that does not seem to recognize and difference in risk between conventional cigarettes and e-cigarettes. New York State enacted a public vaping ban, giving e-cigarettes the same treatment as conventional smoking. Oregon recently increased the minimum age to 21 for both tobacco and “inhalant delivery systems” such as e-cigarettes. Shrinking the wedge between cigarettes and e-cigarettes would reduce the incentive to shift away from combustible cigarettes.
The U.K.’s Department of Health’s Five Year Tobacco Control Ban makes clear the distinction between vaping and smoking. In guidance to employers, Public Health England went on to say that in order to maximize the number of smokers shifting away from combustible cigarettes, “vaping should be made a more convenient, as well as safer, option.”
The long-term effects of e-cigarettes certainly merit further study, and that information should help shape a reasonable regulatory framework that balances concerns about health risks with potential harm reduction. Multiple studies have presented evidence that e-cigarettes can provide a pathway to cessation, and their use increases the probability both of trying to quit and successfully doing so. Overly burdensome taxes on these products or restrictive regulations for adult users could reduce these potential benefits, and ultimately lead to more people smoking conventional cigarettes for longer, with negative health effects.
Charles Hughes is a policy analyst at the Manhattan Institute. Follow him on Twitter @CharlesHHughes.
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