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Mtenga EL, Pesko MF. The effect of vertical identification card laws on teenage tobacco and alcohol use. HEALTH ECONOMICS 2024; 33:2525-2557. [PMID: 39020467 DOI: 10.1002/hec.4881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/22/2024] [Accepted: 06/30/2024] [Indexed: 07/19/2024]
Abstract
We study the impact of vertical identification card laws, which changed the orientation of driver's licenses and state identification cards from horizontal to vertical for those under 21 years, on teenage tobacco and alcohol use. We study this question using four national datasets (pooled national and state Youth Risk Behavior Surveillance System, National Youth Tobacco Survey, Current Population Survey to Tobacco Use Supplements, and Behavioral Risk Factor Surveillance System). We improve previous databases of vertical ID law implementation by using original archival research to identify the exact date of the law change. We estimate models using standard two-way fixed effects and stacked difference-in-differences that avoid bias from dynamic and heterogeneous treatment effects. Using data through 2021, we do not find evidence of reductions in teenage tobacco and alcohol use. While these laws reduce retail-based purchasing, they also increase social sourcing, thus leading to no net impact on use.
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Affiliation(s)
- Erica Louis Mtenga
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - Michael F Pesko
- Department of Economics, University of Missouri, Columbia, Missouri, USA
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2
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Akter S, Rahman MM, Rouyard T, Aktar S, Nsashiyi RS, Nakamura R. A systematic review and network meta-analysis of population-level interventions to tackle smoking behaviour. Nat Hum Behav 2024:10.1038/s41562-024-02002-7. [PMID: 39375543 DOI: 10.1038/s41562-024-02002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/04/2024] [Indexed: 10/09/2024]
Abstract
This preregistered systematic review and meta-analysis (PROSPERO: CRD 42022311392) aimed to synthesize the effectiveness of all available population-level tobacco policies on smoking behaviour. Our search across 5 databases and leading organizational websites resulted in 9,925 records, with 476 studies meeting our inclusion criteria. In our narrative summary and both pairwise and network meta-analyses, we identified anti-smoking campaigns, health warnings and tax increases as the most effective tobacco policies for promoting smoking cessation. Flavour bans and free/discounted nicotine replacement therapy also showed statistically significant positive effects on quit rates. The network meta-analysis results further indicated that smoking bans, anti-tobacco campaigns and tax increases effectively reduced smoking prevalence. In addition, flavour bans significantly reduced e-cigarette consumption. Both the narrative summary and the meta-analyses revealed that smoking bans, tax increases and anti-tobacco campaigns were associated with reductions in tobacco consumption and sales. On the basis of the available evidence, anti-tobacco campaigns, smoking bans, health warnings and tax increases are probably the most effective policies for curbing smoking behaviour.
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Grants
- Health and Labour Sciences Research Grant 20FA1022 Ministry of Health, Labour and Welfare (Ministry of Health, Labour and Welfare, Japan)
- Health and Labour Sciences Research Grant 20FA1022 Ministry of Health, Labour and Welfare (Ministry of Health, Labour and Welfare, Japan)
- Health and Labour Sciences Research Grant 20FA1022 Ministry of Health, Labour and Welfare (Ministry of Health, Labour and Welfare, Japan)
- Health and Labour Sciences Research Grant 20FA1022 Ministry of Health, Labour and Welfare (Ministry of Health, Labour and Welfare, Japan)
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Affiliation(s)
- Shamima Akter
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Md Mizanur Rahman
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Thomas Rouyard
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
- Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
| | - Sarmin Aktar
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | | | - Ryota Nakamura
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan.
- Graduate School of Economics, Hitotsubashi University, Tokyo, Japan.
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Courtemanche C, Liang Y, Maclean JC, Muratori C, Sabia JJ. Do e-cigarette retail licensure laws reduce youth tobacco use? JOURNAL OF HEALTH ECONOMICS 2024; 98:102919. [PMID: 39260047 DOI: 10.1016/j.jhealeco.2024.102919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 09/13/2024]
Abstract
E-cigarette licensure laws (ELLs) require retailers to obtain a state license to sell e-cigarettes over the counter. This study is the first to comprehensively explore the effect of ELL adoption on youth tobacco product use. Using data from the State Youth Risk Behavior Survey (YRBS) and a difference-in-differences approach, we find no evidence that ELL adoption reduces youth ENDS use. The precision of our estimates allows us to rule out, with 95 % confidence, ELL-induced declines in prior-month, frequent, and everyday youth ENDS use of more than 0.7, 0.3, and 0.4 percentage points, respectively. The pattern of null findings persists when we examine ELLs that impose higher penalties for retailer non-compliance, higher renewable licensure fees, and criminal in addition to civil penalties. We conclude that ELLs have only limited success in curbing access to ENDS among youths.
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Affiliation(s)
- Charles Courtemanche
- Department of Economics and Institute for the Study of Free Enterprise, University of Kentucky, IZA & NBER, United States.
| | - Yang Liang
- Department of Economics, Center for Health Economics & Policy Studies, San Diego State University, United States.
| | | | - Caterina Muratori
- Center for Health Economics & Policy Studies, San Diego State University, United States.
| | - Joseph J Sabia
- Center for Health Economics & Policy Studies, San Diego State University & IZA, United States.
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Abouk R, De PK, Pesko MF. Estimating the effects of tobacco-21 on youth tobacco use and sales. JOURNAL OF HEALTH ECONOMICS 2024; 94:102860. [PMID: 38341937 DOI: 10.1016/j.jhealeco.2024.102860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/15/2024] [Accepted: 01/27/2024] [Indexed: 02/13/2024]
Abstract
We examine the effect of raising the minimum legal sale age of tobacco to 21 (i.e., "T21"). We estimate difference-in-differences models using the Monitoring the Future (MTF) survey data and Nielsen Retail Scanner data from 2012 to 2019. Outcomes include cigarette and e-cigarette use and sales. We find sizable reductions in e-cigarette and cigarette use for 12th graders. T21 also reduced cigarette sales by 12.4 % and e-cigarette sales by 69.3 % in counties with the highest percent quartile of individuals under 21 years of age. In terms of mechanisms, we find that T21 increases ID checking and perceived risks of using both products.
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Affiliation(s)
- Rahi Abouk
- William Paterson University, United States.
| | - Prabal K De
- CUNY City College and The Graduate Center, United States
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Reiter A, Hébert-Losier A, Mylocopos G, Filion KB, Windle SB, O'Loughlin JL, Grad R, Eisenberg MJ. Regulatory Strategies for Preventing and Reducing Nicotine Vaping Among Youth: A Systematic Review. Am J Prev Med 2024; 66:169-181. [PMID: 37553038 DOI: 10.1016/j.amepre.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Many jurisdictions have implemented different regulatory strategies to reduce vaping among youth. The objective of this systematic review is to synthesize the evidence of the effectiveness of different regulatory strategies for preventing and reducing nicotine vaping among youth. METHODS Five electronic databases were searched from January 1, 2004 to July 17, 2022 for primary studies examining state/provincial or national regulations targeting vaping among youth (aged 12-21 years) in high-income countries. The primary outcome was vaping prevalence. Included studies were qualitatively synthesized through systematic review. RESULTS The systematic review included 30 studies. There was insufficient evidence to recommend age restrictions (n=16), restrictions on location of use (n=1), and mixed/combined regulations (n=3). Flavor bans (n=4), sales licenses (n=2), and taxation (n=2) were generally shown to be associated with decreased rates of youth vaping. Warning labels (n=2) were associated with a decreased desire to initiate vaping. Included studies had moderate-to-serious risks of bias. DISCUSSION Although several regulatory interventions have been shown to be effective at reducing vaping among youth, evidence is insufficient to recommend a specific type of regulation. Regulatory authorities could implement various regulations targeting the price, accessibility, and desirability (i.e., flavors and packaging) of E-cigarettes.
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Affiliation(s)
- Anna Reiter
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology (CCE), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Andréa Hébert-Losier
- Center for Clinical Epidemiology (CCE), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Genevieve Mylocopos
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology (CCE), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Kristian B Filion
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology (CCE), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Sarah B Windle
- Center for Clinical Epidemiology (CCE), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Jennifer L O'Loughlin
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Roland Grad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology (CCE), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Division of Cardiology, Jewish General Hospital, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
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Hansen B, Sabia JJ, McNichols D, Bryan C. Do tobacco 21 laws work? JOURNAL OF HEALTH ECONOMICS 2023; 92:102818. [PMID: 37950948 DOI: 10.1016/j.jhealeco.2023.102818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 11/13/2023]
Abstract
Tobacco 21 (T-21) laws raise the minimum legal purchasing age for all tobacco products to 21. This study is the first to examine the impact of statewide T21 laws on teenage and young adult cigarette and electronic cigarette (e-cigarette) use. Using survey data from the Behavioral Risk Factor Surveillance System (BRFSS) and a difference-in-differences approach, we find that statewide adoption of a T-21 law is associated with a 2-to-4 percentage-point decline in smoking participation among 18-to-20-year-olds. Supplemental analyses using the State Youth Risk Behavior Surveys (YRBS) show that frequent e-cigarette use among 18-year-olds also fell following the adoption of T21 laws, though this effect was partially because teens turned to informal social sources to obtain e-cigarettes (i.e., borrowing or bumming). Finally, we find that T-21 laws generate spillover effects, including (2) reductions in cigarette use among 16-to-17-year-olds, a group that relies heavily on informal social markets in high school, and (2) reductions in marijuana use and days of alcohol use among some teens.
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Affiliation(s)
- Benjamin Hansen
- Department of Economics, University of Oregon, NBER & IZA, United States.
| | - Joseph J Sabia
- Center for Health Economics & Policy Studies, San Diego State University & IZA, United States
| | - Drew McNichols
- Center for Health Economics & Policy Studies Economics, San Diego State University, United States
| | - Calvin Bryan
- Department of Agricultural & Resource, Colorado State University, United States
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Abouk R, Adams S, Feng B, Maclean JC, Pesko MF. The effect of e-cigarette taxes on prepregnancy and prenatal smoking. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2023; 42:908-940. [PMID: 38313828 PMCID: PMC10836838 DOI: 10.1002/pam.22485] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
E-cigarette taxes are an active area of legislation and have important regulatory implications by proxying e-cigarette accessibility. We examine the effect of e-cigarette taxes on prepregnancy and prenatal smoking using the near-universe of births to mothers conceiving between 2013 and 2019 in the United States. Using fixed effect regressions, we show that e-cigarette taxes increase prepregnancy and prenatal smoking. We also find evidence that e-cigarette taxes reduce prepregnancy and 3rd trimester e-cigarette use. Finally, we show that e-cigarette taxes increase news coverage of e-cigarettes and raise perceptions of risk of e-cigarettes.
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Affiliation(s)
- Rahi Abouk
- Department of Economics, Finance, and Global Business at William Paterson University, Wayne, NJ
| | - Scott Adams
- Department of Economics at University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Bo Feng
- Elevance Health, Indianapolis, IN
| | - Johanna Catherine Maclean
- Schar School of Policy and Government at George Mason University; a Research Associate, National Bureau of Economic Research; and a Research Affiliate, Institute for Labor Economics, Arlington VA
| | - Michael F Pesko
- Department of Economics at Andrew Young School of Policy Studies, Georgia State University and a Research Affiliate, Institute of Labor Economics, Atlanta GA
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Dave D, Liang Y, Pesko MF, Phillips S, Sabia JJ. Have recreational marijuana laws undermined public health progress on adult tobacco use? JOURNAL OF HEALTH ECONOMICS 2023; 90:102756. [PMID: 37163862 DOI: 10.1016/j.jhealeco.2023.102756] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 05/12/2023]
Abstract
Public health experts caution that legalization of recreational marijuana may normalize smoking and undermine the decades-long achievements of tobacco control policy. However, very little is known about the impact of recreational marijuana laws (RMLs) on adult tobacco use. Using newly available data from the Population Assessment of Tobacco and Health (PATH) and dynamic difference-in-differences and discrete-time hazard approaches, we find that RML adoption increases prior-month marijuana use among adults ages 18-and-older by 2-percentage-points, driven by an increase in marijuana initiation among prior non-users. However, this increase in adult marijuana use does not extend to tobacco use. Rather, we find that RML adoption is associated with a lagged reduction in electronic nicotine delivery systems (ENDS) use, consistent with the hypothesis that ENDS and marijuana are substitutes. Moreover, auxiliary analyses from the National Survey on Drug Use and Health (NSDUH) show that RML adoption is associated with a reduction in adult cigarette smoking. We conclude that RMLs may generate tobacco-related health benefits.
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Affiliation(s)
- Dhaval Dave
- Department of Economics, Bentley University, NBER & IZA, 175 Forest Street, AAC 197, Waltham, MA 20452, USA.
| | - Yang Liang
- College of Arts & Letters, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Michael F Pesko
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University & IZA, 55 Park Place, Room 657, Atlanta, GA 30303, USA
| | - Serena Phillips
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, 55 Park Place, Room 657, Atlanta, GA 30303, USA
| | - Joseph J Sabia
- College of Arts & Letters, San Diego State University & IZA, 5500 Campanile Drive, San Diego, CA 92182, USA
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Huang H, Zhu X, Ullrich F, MacKinney AC, Mueller K. The impact of Medicare shared savings program participation on hospital financial performance: An event-study analysis. Health Serv Res 2023; 58:116-127. [PMID: 36214129 PMCID: PMC9836956 DOI: 10.1111/1475-6773.14085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To evaluate the impact of hospitals' participation in the Medicare Shared Savings Program (MSSP) on their financial performance. DATA SOURCES Centers for Medicare & Medicaid Services Hospital Cost Reports and MSSP Accountable Care Organizations (ACO) Provider-Level Research Identifiable File from 2011 to 2018. STUDY DESIGN We used an event-study design to estimate the temporal effects of MSSP participation on hospital financial outcomes and compared within-hospital changes over time between MSSP and non-MSSP hospitals while controlling for hospital and year fixed effects and organizational and service-area characteristics. The following financial outcomes were evaluated: outpatient revenue, inpatient revenue, net patient revenue, Medicare revenue, operating margin, inpatient revenue share, Medicare revenue share, and allowance and discount rate. DATA COLLECTION/EXTRACTION METHODS Secondary data linked at the hospital level. PRINCIPAL FINDINGS Controlling for trends in non-MSSP hospitals, MSSP participation was associated with differential increases in net patient revenue by $3.28 million (p < 0.001), $3.20 million (p < 0.01), and $4.20 million (p < 0.01) in the second, third, and fourth year and beyond after joining MSSP, respectively. Medicare revenue differentially increased by $1.50 million (p < 0.05), $2.24 million (p < 0.05), and $4.47 million (p < 0.05) in the first, second, and fourth year and beyond. Inpatient revenue share differentially increased by 0.29% (p < 0.05) in the second year and 0.44% (p < 0.05) in the fourth year and beyond. Medicare revenue share differentially increased by 0.17% (p < 0.01), 0.25% (p < 0.01), 0.32% (p < 0.01), and 0.41% (p < 0.01) in consecutive years following MSSP participation. MSSP participation was associated with 0.33% (p < 0.05) and 0.39% (p < 0.05) differential reduction in allowance and discount rate in the second and third years. CONCLUSIONS MSSP participation was associated with differential increases in net patient revenue, Medicare revenue, inpatient revenue share, and Medicare revenue share, and a differential reduction in allowance and discount rate.
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Affiliation(s)
- Huang Huang
- Department of Health Management and PolicyUniversity of Kentucky College of Public HealthLexingtonKentuckyUSA
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Xi Zhu
- Department of Health Policy and ManagementUCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
| | - Fred Ullrich
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - A. Clinton MacKinney
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Keith Mueller
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
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Cooper M, Panchalingam T, Ce S, Shi Y. Behavioral economic relationship between cannabis and cigarettes: Evidence from hypothetical purchase tasks. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103951. [PMID: 36608406 PMCID: PMC11147132 DOI: 10.1016/j.drugpo.2022.103951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/17/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the United States (U.S), cannabis policies have been increasingly liberalized whereas tobacco policies have been increasingly stringent. Given the high prevalence of cannabis and tobacco dual use, there are concerns that a policy regulating one substance may unintendedly influence the other. This study examined the responsiveness of the demand for cannabis joints and cigarettes when price varied. METHODS The study included 338 adult participants (21+) who used both cannabis and tobacco and lived in one of the U.S. states with recreational cannabis legalized by the time of interview in 2019. They completed hypothetical purchase tasks to indicate the quantity desired of cannabis joints and cigarette packs 1) when only one substance was available with escalating prices and 2) when both substances were concurrently available with escalating prices of cannabis joints and a fixed price of cigarette packs. We estimated 1) the own-price elasticity of demand for each substance using nonlinear exponential demand model, and 2) the cross-price elasticity of demand at aggregate level using nonlinear exponential demand model and at individual level using log-linear demand model. RESULTS The estimates for the rate of change of own-price elasticity (α) were 0.0011 (SE = 0.000039, p < 0.001) for cannabis joints and 0.00095 (SE = 0.000037, p < 0.001) for cigarette packs. The aggregate-level estimates of cross-price elasticity (I = 13.032, SE = 0.34, p < 0.001; β = 0.0029, SE = 0.0021, p > 0.05) suggest an independent relationship between the two substances. At individual level, 78.70% of the participants treated the two substances as independent, 17.46% as complements, and 3.85% as substitutes. CONCLUSIONS For most adults who used both cannabis and tobacco in the U.S., cannabis joints and cigarettes had an independent relationship. Policies regulating the price of cannabis may not have large unintended consequences on cigarette use.
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Affiliation(s)
- Michael Cooper
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Thadchaigeni Panchalingam
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Shang Ce
- Department of Internal Medicine, The Ohio State University. 281 W Lane Ave, Columbus, OH 43120, USA
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, USA.
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Selya A, Wissmann R, Shiffman S, Chandra S, Sembower M, Joselow J, Kim S. Sales of Electronic Nicotine Delivery Systems (ENDS) and Cigarette Sales in the USA: A Trend Break Analysis. JOURNAL OF CONSUMER POLICY 2023; 46:79-93. [PMID: 36686374 PMCID: PMC9841499 DOI: 10.1007/s10603-022-09533-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
UNLABELLED Electronic nicotine delivery systems (ENDS) are a potentially lower-risk tobacco product which could help smokers switch completely away from cigarettes. However, the lack of strong evidence to date of a measurable, population-level effect on reducing smoking has generated skepticism about ENDS' potential benefits. This study examines whether increased US ENDS sales have been associated with reduced cigarette sales. Retail data on weekly per-capita cigarette and ENDS purchases in the USA during 2014-2019 were obtained from a national sample of brick-and-mortar retail outlets. Trends in cigarette sales were modeled before (2014-2016) ENDS had a substantial market share, and, after adjusting for macroeconomic factors, projected into the post-period (2017-2019). Actual cigarette sales were lower than projected sales (by up to 16% across the post-period), indicating a substantial "cigarette shortfall" in the post-period. To explore whether general (i.e., inclusive of potentially many mechanisms) substitution by ENDS can explain the cigarette shortfall, its association with per-capita ENDS volume sales was examined. Higher ENDS sales were significantly associated with a greater cigarette shortfall: for every additional per-capita ENDS unit, cigarette sales were 1.4 packs-per-capita lower than expected (B = 1.4, p < .0001). Error correction models which account for spurious correlation yielded similar results. These findings support ENDS serving as a substitute for cigarettes (through potentially many mechanisms including cigarette price), causing cigarette consumption to decline. Since ENDS potentially pose lower risk than cigarettes, this general substitution effect suggests that risk-proportionate tobacco regulation could mitigate the tobacco-related health burden. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10603-022-09533-4.
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Affiliation(s)
- A. Selya
- PinneyAssociates, Inc, Pittsburgh, PA USA
| | | | | | - S. Chandra
- PinneyAssociates, Inc, Pittsburgh, PA USA
| | | | | | - S. Kim
- PinneyAssociates, Inc, Pittsburgh, PA USA
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12
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Abouk R, Courtemanche C, Dave D, Feng B, Friedman AS, Maclean JC, Pesko MF, Sabia JJ, Safford S. Intended and unintended effects of e-cigarette taxes on youth tobacco use. JOURNAL OF HEALTH ECONOMICS 2023; 87:102720. [PMID: 36565585 PMCID: PMC9879683 DOI: 10.1016/j.jhealeco.2022.102720] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/23/2022] [Accepted: 12/13/2022] [Indexed: 05/26/2023]
Abstract
Over the past decade, rising youth use of e-cigarettes and other electronic nicotine delivery systems (ENDS) has contributed to aggressive regulation by state and local governments. Between 2010 and mid-2019, ten states and two large counties adopted ENDS taxes. We use two large national surveys (Monitoring the Future and the Youth Risk Behavior Surveillance System) to estimate the impact of ENDS taxes on youth tobacco use. We find that ENDS taxes reduce youth ENDS consumption, with estimated ENDS tax elasticities of -0.06 to -0.21. However, we estimate sizable positive cigarette cross-tax effects, suggesting economic substitution between cigarettes and ENDS for youth. These substitution effects are particularly large for frequent cigarette smoking. We conclude that the unintended effects of ENDS taxation may considerably undercut or even outweigh any public health gains.
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Affiliation(s)
- Rahi Abouk
- Department of Economics, Finance, and Global Business, William Paterson University, Wayne, NJ, United States
| | - Charles Courtemanche
- Department of Economics, Gatton College of Business and Economics, University of Kentucky, Lexington, KY, United States; National Bureau of Economics Research, Cambridge, MA, United States; Institute for Labor Studies, Bonn, Germany
| | - Dhaval Dave
- National Bureau of Economics Research, Cambridge, MA, United States; Institute for Labor Studies, Bonn, Germany; Department of Economics, Bentley University, Waltham, MA, United States
| | - Bo Feng
- American Institutes for Research, Columbia, MD, United States
| | - Abigail S Friedman
- Department of Health Policy & Management, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Johanna Catherine Maclean
- National Bureau of Economics Research, Cambridge, MA, United States; Institute for Labor Studies, Bonn, Germany; Schar School of Policy and Government, George Mason University, Arlington, VA, United States
| | - Michael F Pesko
- Institute for Labor Studies, Bonn, Germany; Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, United States.
| | - Joseph J Sabia
- Institute for Labor Studies, Bonn, Germany; Center for Health Economics & Policy Studies, San Diego State University, San Diego, CA, United States
| | - Samuel Safford
- Center for Health Economics & Policy Studies, San Diego State University, San Diego, CA, United States; Department of Sociology, Michigan State University, East Lansing, MI, United States
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Pesko MF, Cummings KM, Douglas CE, Foulds J, Miller T, Rigotti NA, Warner KE. United States public health officials need to correct e-cigarette health misinformation. Addiction 2022; 118:785-788. [PMID: 36507802 DOI: 10.1111/add.16097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/09/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Michael F Pesko
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Clifford E Douglas
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State University - College of Medicine, Hershey, PA, USA
| | | | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth E Warner
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
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14
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Siegel M, Katchmar A. Effect of flavored E-cigarette bans in the United States: What does the evidence show? Prev Med 2022; 165:107063. [PMID: 35452711 DOI: 10.1016/j.ypmed.2022.107063] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/04/2022] [Accepted: 04/15/2022] [Indexed: 11/17/2022]
Abstract
The United States federal government, along with many state and local governments, have passed restrictions on electronic cigarette ("e-cigarette") sales with the stated purpose of preventing youth use of these products. The justification for these restrictions includes the argument that youth e-cigarette use will re-normalize youth smoking, leading to increased rates of cigarette smoking by teenagers. However, in this paper, we propose an evidence-based version of this model based on several years' worth of longitudinal and econometric research, which suggests that youth e-cigarette use has instead worked to replace a culture of youth smoking. From this analysis, we propose a re-evaluation of current policies surrounding e-cigarette sales so that declines in e-cigarette use will not come at the cost of increasing cigarette use among youth and adults.
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Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, United States of America
| | - Amanda Katchmar
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118, United States of America.
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15
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Cotti C, Courtemanche C, Maclean JC, Nesson E, Pesko MF, Tefft NW. The effects of e-cigarette taxes on e-cigarette prices and tobacco product sales: Evidence from retail panel data. JOURNAL OF HEALTH ECONOMICS 2022; 86:102676. [PMID: 36103752 PMCID: PMC11268994 DOI: 10.1016/j.jhealeco.2022.102676] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
We estimate the effect of e-cigarette tax rates on e-cigarette prices, e-cigarette sales, and sales of other tobacco products using NielsenIQ Retail Scanner data from 2013 to 2019. We find that 90% of e-cigarette taxes are passed on to consumer retail prices. We then estimate reduced form and instrumental variables regressions to examine the effects of e-cigarette and cigarette taxes and prices on sales. We calculate an e-cigarette own-price elasticity of -2.2 and particularly large elasticity of demand for flavored e-cigarettes. Further, we document a cigarette own-price elasticity of -0.4 and positive cross-price elasticities of demand between e-cigarettes and cigarettes, suggesting economic substitution.
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Affiliation(s)
- Chad Cotti
- Department of Economics, College of Business, University of Wisconsin-Oshkosh, Oshkosh, WI 54901, United States
| | - Charles Courtemanche
- Department of Economics, Gatton College of Business and Economics, University of Kentucky, Lexington, KY 40506, United States; NBER, IZA, United States
| | - Joanna Catherine Maclean
- NBER, IZA, United States; Schar School of Policy and Government, George Mason University, Arlington, VA 22201, United States
| | - Erik Nesson
- Department of Economics, Miller College of Business, Ball State University Muncie, IN 47306, United States; National Bureau of Economic Research, United States
| | - Michael F Pesko
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA 30303, United States; Institute for Labor Economics, Germany.
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16
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Friedman AS, Pesko MF. Young adult responses to taxes on cigarettes and electronic nicotine delivery systems. Addiction 2022; 117:3121-3128. [PMID: 35852452 PMCID: PMC9796020 DOI: 10.1111/add.16002] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 06/27/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Although over half of United States states have passed taxes on electronic nicotine delivery systems (ENDS), recent evidence links ENDS tax rates to increases in smoking, suggesting potentially substantive health costs. Overall health implications will depend on how these taxes affect transitions from experimentation to regular smoking and vaping. Current analyses have not assessed ENDS tax rates' effects in young adulthood (ages 18-25). This study measures the relationship between ENDS and cigarette tax rates and ENDS use and smoking in young adulthood, a key period for initiation of regular tobacco use. DESIGN Observational study of data from the Current Population Survey's 2010-2019 Tobacco Use Supplements. SETTING The United States. PARTICIPANTS/CASES A total of 38 906 18 to 25 year-olds MEASUREMENTS: Multivariable linear regressions estimated two-way fixed effects analyses to assess ENDS and cigarette tax rates' relationships to recent and daily smoking and vaping, adjusting for an array of potential sociodemographic and policy confounders along with state and year fixed effects. FINDINGS A $1 increase in ENDS taxes yielded significant reductions in young adults' daily vaping ( β ̂ = -0.025; 95% CI, -0.037, -0.014) alongside increases in recent smoking ( β ̂ = 0.037; 95% CI, 0.013, 0.061), primarily reflecting greater dual use ( β ̂ =2.078; 95% CI, 0.890, 4.852; P = 0.09). A $1 cigarette tax increase yielded 2.1 and 2.5 percentage point increases in recent and daily vaping, with 95% CIs of (0.004, 0.038) and (0.018, 0.032) respectively. CONCLUSIONS In the United States, higher ENDS tax rates are associated with decreased ENDS use but increased cigarette smoking among 18- to 25-year-olds, with associations reversed for cigarette taxes.
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Affiliation(s)
| | - Michael F. Pesko
- Georgia State UniversityAtlantaGAUSA
- Institute of Labor EconomicsBonnGermany
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17
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Choi K, Omole T, Wills T, Merianos AL. E-cigarette-inclusive smoke-free policies, excise taxes, tobacco 21 and changes in youth e-cigarette use: 2017-2019. Tob Control 2022; 31:758-761. [PMID: 33632806 PMCID: PMC8384946 DOI: 10.1136/tobaccocontrol-2020-056260] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/10/2021] [Accepted: 02/05/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND We examined whether the implementation of electronic cigarette (e-cigarette) policies at the state level (e-cigarette-inclusive smoke-free (ESF) policies, excise taxes on e-cigarettes and raising tobacco legal purchasing age to 21 years (T21)) affected recent upward trends in youth e-cigarette use. METHODS Data were from participants from 34 US states who completed the Youth Risk Behavior Survey (YRBS) state surveys in 2017 and 2019 (n=278 271). States were classified as having or not having ESF policies, any e-cigarette excise tax and T21 policies by 1 January 2019. Participants reported ever, past 30-day and frequent (≥20 days) e-cigarette use; past 30-day combustible cigarette smoking; and age, sex and race/ethnicity. Weighted multivariable logistic regression models assessed whether changes in e-cigarette use over time differed by policy status, adjusting for participants' demographics and combustible cigarette smoking. RESULTS Prevalence of ever and past 30-day youth e-cigarette use in states with ESF policies decreased during 2017-2019, while the prevalence of these measures in states without ESF policies increased. States with T21 policies showed non-significant changes in prevalence of ever and past 30-day youth e-cigarette use, whereas states without T21 policies showed significant increases in ever and past 30-day youth e-cigarette use. States with ESF and T21 policies showed slower increases in youth frequent e-cigarette use. E-cigarette excise taxes were not associated with decreasing prevalence of youth e-cigarette use. CONCLUSIONS State-level ESF and T21 policies could be effective for limiting growth of youth e-cigarette use despite an overall national increase. Higher e-cigarette excise tax rates may be needed to effectively reduce youth e-cigarette use.
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Affiliation(s)
- Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Toluwa Omole
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Thomas Wills
- Cancer Center, University of Hawaii, Honolulu, Hawaii, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, Ohio, USA
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18
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DeCicca P, Kenkel D, Lovenheim MF. The Economics of Tobacco Regulation: A Comprehensive Review. JOURNAL OF ECONOMIC LITERATURE 2022; 60:883-970. [PMID: 37075070 PMCID: PMC10072869 DOI: 10.1257/jel.20201482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Tobacco regulation has been a major component of health policy in the developed world since the UK Royal College of Physicians' and the US Surgeon General's reports in the 1960s. Such regulation, which has intensified in the past two decades, includes cigarette taxation, place-based smoking bans in areas ranging from bars and restaurants to workplaces, and regulations designed to make tobacco products less desirable. More recently, the availability of alternative products, most notably e-cigarettes, has increased dramatically, and these products are just starting to be regulated. Despite an extensive body of research on tobacco regulations, there remains substantial debate regarding their effectiveness, and ultimately, their impact on economic welfare. We provide the first comprehensive review of the state of research in the economics of tobacco regulation in two decades.
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Warner KE, Kiessling KA, Douglas CE, Liber AC. A Proposed Policy Agenda For Electronic Cigarettes In The US: Product, Price, Place, And Promotion. Health Aff (Millwood) 2022; 41:1299-1306. [PMID: 36067433 DOI: 10.1377/hlthaff.2022.00187] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Growth in the market for electronic cigarettes (e-cigarettes) raises complex questions about the devices' public health implications and, hence, challenging policy issues. We propose a policy agenda addressing concerns about preventing youth uptake of e-cigarettes and the desire to realize the potential of e-cigarettes to increase adult cigarette smoking cessation. We organize interventions according to the "four Ps" of marketing: product, price, place, and promotion. Policies include decreasing the addictiveness of combusted tobacco products while ensuring the availability of consumer-acceptable reduced-risk nicotine products, imposing large taxes on combustible products and smaller taxes on e-cigarettes, limiting the sale of all tobacco and (nonmedicinal) nicotine products to adult-only retailers, and developing communications that accurately portray e-cigarettes' risks to youth and benefits for inveterate adult smokers. All members of the public health community should unite to pursue a shared commitment to the principle that both youth and adults deserve a future free of tobacco-related disease.
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Affiliation(s)
| | | | | | - Alex C Liber
- Alex C. Liber, Georgetown University, Washington, D.C
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20
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Pesko MF. How Data Security Concerns Can Hinder Natural Experiment Research: Background and Potential Solutions. J Natl Cancer Inst Monogr 2022; 2022:89-94. [PMID: 35788379 PMCID: PMC9255918 DOI: 10.1093/jncimonographs/lgac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/24/2022] [Indexed: 11/12/2022] Open
Abstract
Health economists conducting cancer-related research often use geocoded data to analyze natural experiments generated by policy changes. These natural experiments can provide causal interpretation under certain conditions. Despite public health benefit of this rigorous natural experiment methodology, data providers are often reluctant to provide geocoded data because of confidentiality concerns. This paper provides an example of the value of natural experiments from e-cigarette research and shows how this research was hindered by security concerns. Although the tension between data access and security will not be resolved overnight, this paper offers 3 recommendations: 1) provide public access to aggregated data at area levels (eg, state) where possible; 2) approve projects with enough time to allow for publication in journals with lengthy peer-review times; and 3) improve communication and transparency between data providers and the research community. The Foundations for Evidence Based Policymaking Act of 2018 also presents a unique opportunity for improving the ability of researchers to use geocoded data for natural experiment research without compromising data security.
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Affiliation(s)
- Michael F Pesko
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
- Institute of Labor Economics, Bonn, Germany
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21
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Abstract
This editorial argues for the benefits of raising age-of-sale laws for combustible tobacco only, such as through a Combustible 21 law that would prohibit the sale of combustible tobacco to individuals under 21 years of age but leave open the opportunity to legally purchase e-cigarettes and smokeless tobacco products.
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Affiliation(s)
- Michael F Pesko
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
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22
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Pesko MF, Warman C. Re-exploring the early relationship between teenage cigarette and e-cigarette use using price and tax changes. HEALTH ECONOMICS 2022; 31:137-153. [PMID: 34672061 PMCID: PMC9467387 DOI: 10.1002/hec.4439] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 08/05/2021] [Accepted: 09/14/2021] [Indexed: 05/31/2023]
Abstract
In 2016, the Surgeon General used longitudinal cohort studies to conclude that youth e-cigarette use is strongly associated with cigarette use. We re-evaluate data from the period of time before the writing of the Surgeon General report, using quasi-experimental methods, and reach the opposite conclusion. We study contemporaneous and intertemporal effects of e-cigarette and cigarette price and tax changes. Our price variation comes from 35,000 retailers participating in the Nielsen Retail Scanner data system. We match price and tax variation to survey data on current use of e-cigarettes and cigarettes for over 94,000 students between grades 6 and 12 in the National Youth Tobacco Survey (NYTS) for years 2011-2015. We find evidence that e-cigarettes and cigarettes are same-period economic substitutes. Coefficient estimates (while imprecisely estimated) also suggest potentially large positive effects of past e-cigarette prices on current cigarette use, indicating intertemporal economic substitution. Our findings raise doubts about the conclusion of government-sponsored reports that e-cigarettes and cigarettes are strongly positively associated. We recommend revisiting and possibly amending this conclusion.
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23
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Friedman AS, Oliver JF, Busch SH. Adding vaping restrictions to smoke-free air laws: associations with conventional and electronic cigarette use. Addiction 2021; 116:2198-2206. [PMID: 33565665 DOI: 10.1111/add.15434] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/08/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS In the United States, some states and localities have added vaping restrictions to established smoke-free indoor air laws in order to reduce electronic cigarette use. Yet, if smokers use e-cigarettes to quit, such restrictions could have the unintended effect of attenuating the original smoke-free air policy's effects on smoking. This study estimated changes in current smoking, past-year smoking cessation, and recent vaping following the introduction of smoke- and vape-free air laws. DESIGN Observational study of nationally representative data from the 2014-2018 National Health Interview Survey. SETTING United States. PARTICIPANTS/CASES 87 334 participants, 18-54 years of age. MEASUREMENTS Multivariable linear regressions estimated the association between increased exposure to smoke- and vape-free worksite and restaurant laws and self-reported current smoking and recent vaping among emerging adults (ages 18-25), as well as past-12-month smoking cessation among prime age adults (ages 26-54). All regressions adjusted for respondent sociodemographic and other tobacco control policies, along with state and year fixed effects. FINDINGS Smoke-free worksite laws were associated with significant reductions in the likelihood of current smoking ( β̂ = - 0.050, 95% CI: -0.098, -0.002, P = 0.038) and recent vaping ( β̂ = - 0.040, 95% CI: -0.072, -0.007, P = 0.013), as well as increases in the likelihood of smoking cessation ( β̂ = 0.026, 95% CI: 0.000, 0.052, P = 0.046). Adding vaping restrictions to smoke-free worksite laws did not yield further reductions in recent vaping ( β̂ = 0.008, 95% CI: -0.021, 0.036, P = 0.568) and counteracted over half of the estimated association with current smoking relative to smoke-free policies alone ( β̂ = 0.030, 95% CI: -0.028, 0.088, P = 0.301). CONCLUSIONS From 2014 to 2018, increased adoption of smoke-free worksite laws in the United States was associated with reductions in both current smoking and recent vaping, as well as increases in smoking cessation. Adding vaping restrictions to smoke-free worksite laws, however, was not associated with a reduction in recent vaping among emerging adults and may have attenuated the smoke-free policy's impact on current smoking in this age group.
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Affiliation(s)
- Abigail S Friedman
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Jon F Oliver
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Susan H Busch
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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24
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Cahn Z, Drope J, Douglas CE, Henson R, Berg CJ, Ashley DL, Eriksen MP. Applying the Population Health Standard to the Regulation of Electronic Nicotine Delivery Systems. Nicotine Tob Res 2021; 23:780-789. [PMID: 32960217 PMCID: PMC8095236 DOI: 10.1093/ntr/ntaa190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 09/18/2020] [Indexed: 12/20/2022]
Abstract
Regulatory authorities have devoted increasing attention and resources to a range of issues surrounding the regulation of novel nicotine and tobacco products. This review highlights the inherent complexity of evaluating prospective policies that pertain to products that heat solutions containing nicotine, but not tobacco leaf, sometimes referred to as electronic nicotine delivery systems (ENDS). The US Food and Drug Administration (FDA) is compelled to incorporate a set of public health criteria in their decision making, collectively referred to as the Population Health Standard. Adherence to this standard is necessary to estimate the impact of prospective ENDS policy decisions on net population harm associated with nontherapeutic nicotine products. For policies that are expected to decrease or increase ENDS use, application of the Population Health Standard requires a comprehensive assessment of the status quo impact of ENDS use on population health. Accordingly, this review first assesses the state of the evidence on the direct harms of ENDS and the indirect effects of ENDS use on smoking, particularly rates of initiation and cessation. After that, the example of flavor restrictions is used to demonstrate the further considerations that are involved in applying the Population Health Standard to a prospective ENDS policy. Implications: This narrative review aims to inform regulatory considerations about ENDS through the prism of the Population Health Standard. More specifically, this review (1) describes and explains the importance of this approach; (2) provides guidance on evaluating the state of the evidence linking ENDS to the net population harm associated with nontherapeutic nicotine products; and (3) illustrates how this framework can inform policymaking using the example of flavor restrictions.
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Affiliation(s)
- Zachary Cahn
- Economic and Health Policy Research, American Cancer Society, Inc., Atlanta, GA, USA
| | - Jeffrey Drope
- Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Clifford E Douglas
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rosemarie Henson
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
- George Washington Cancer Center, Washington, DC, USA
| | - David L Ashley
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Michael P Eriksen
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
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25
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Selya AS. Reducing the smoking-related health burden in the USA through diversion to electronic cigarettes: a system dynamics simulation study. Harm Reduct J 2021; 18:36. [PMID: 33743722 PMCID: PMC7981929 DOI: 10.1186/s12954-021-00484-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 03/11/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Electronic cigarettes ("e-cigarettes") have altered tobacco smoking trends, and their impacts are controversial. Given their lower risk relative to combustible tobacco, e-cigarettes have potential for harm reduction. This study presents a simulation-based analysis of an e-cigarette harm reduction policy set in the USA. METHODS A system dynamics simulation model was constructed, with separate aging chains representing people in different stages of use (both of combustible cigarettes and e-cigarettes). These structures interact with a policy module to close the gap between actual (simulated) and goal numbers of individuals who smoke, chosen to reduce the tobacco-attributable death rate (i.e., mostly combustible cigarette-attributable, but conservatively allowing e-cigarette-attributable deaths) to that due to all accidents in the general population. The policy is two-fold, removing existing e-liquid flavor bans and providing an informational campaign promoting e-cigarettes as a lower-risk alternative. Realistic practical implementation challenges are modeled in the policy sector, including time delays, political resistance, and budgetary limitations. Effects of e-cigarettes on tobacco smoking occur through three mechanisms: (1) diversion from ever initiating smoking; (2) reducing progression to established smoking; and (3) increasing smoking cessation. An important unintended effect of possible death from e-cigarettes was conservatively included. RESULTS The base-case model replicated the historical exponential decline in smoking and the exponential increase in e-cigarette use since 2010. Simulations suggest tobacco smoking could be reduced to the goal level approximately 40 years after implementation. Implementation obstacles (time delays, political resistance, and budgetary constraints) could delay and weaken the effect of the policy by up to 62% in the worst case, relative to the ideal-case scenario; however, these discrepancies substantially decreased over time in dampened oscillations as negative feedback loops stabilize the system after the one-time "shock" introduced by policy changes. CONCLUSIONS The simulation suggests that the promotion of e-cigarettes as a harm-reduction policy is a viable strategy, given current evidence that e-cigarettes offset or divert from smoking. Given the strong effects of implementation challenges on policy effectiveness in the short term, accurately modeling such obstacles can usefully inform policy design. Ongoing research is needed, given continuing changes in e-cigarette use prevalence, new policies being enacted for e-cigarettes, and emerging evidence for substitution effects between combustible cigarettes and e-cigarettes.
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Affiliation(s)
- Arielle S Selya
- Behavioral Sciences Group, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD, 57104, USA.
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, 1400 West 22nd St, Sioux Falls, SD, 57105, USA.
- System Dynamics Group, Department of Geography, University of Bergen, Postboks 7802, 5020, Bergen, Norway.
- Pinney Associates, Inc, 201 North Craig St. Suite 320, Pittsburgh, PA, 15213, USA.
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26
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Trucco EM, Fallah-Sohy N, Hartmann SA, Cristello JV. Electronic Cigarette Use Among Youth: Understanding Unique Risks in a Vulnerable Population. CURRENT ADDICTION REPORTS 2020; 7:497-508. [PMID: 33409119 PMCID: PMC7781233 DOI: 10.1007/s40429-020-00340-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW This review discusses prevalence rates of electronic (e-)cigarette use among youth and factors that likely contribute to their growing popularity among this population. Trends shaping the e-cigarette landscape, the appeal of e-cigarettes among youth, perceptions contributing to the initiation of e-cigarettes, available assessments capturing the usage of and attitudes towards e-cigarettes, and e-cigarette policies and regulations are reviewed. RECENT FINDINGS E-cigarette use among this vulnerable group may relate to factors associated with the promotion of social status, individuality, and enjoyment, along with low perceptions of risk and harm. Measures assessing factors unique to e-cigarette use among youth (e.g., individuality) still need to be developed and validated. Effects of existing regulations to limit youth access to e-cigarettes may be limited, and shortcomings of current policy measures are discussed with recommendations. SUMMARY The rise of e-cigarette use among youth culminated through a perfect storm of clever marketing targeting youth appeal, innovations in more effective nicotine delivery systems, capitalizing on increased susceptibility of the adolescent brain, and regulatory gaps. Understanding risk and protective factors specific to this vulnerable group, which can be gleaned in part by psychometrically valid assessments, could inform regulatory strategies and prevention programming efforts. Yet, few validated measures exist that assess attitudes, behaviors, and patterns of e-cigarette use that are specific to youth. Ultimately, it is incumbent upon policymakers to create comprehensive regulations that prioritize harm reduction and can evolve in lockstep with the constantly changing e-cigarette product landscape.
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Affiliation(s)
- Elisa M. Trucco
- Florida International University, Psychology Department, Center for Children and Families 11200 SW 8 Street, AHC-1, Miami, FL 33199
- University of Michigan, Psychiatry Department, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Nilofar Fallah-Sohy
- Florida International University, Psychology Department, Center for Children and Families 11200 SW 8 Street, AHC-1, Miami, FL 33199
| | - Sarah A. Hartmann
- Florida International University, Psychology Department, Center for Children and Families 11200 SW 8 Street, AHC-1, Miami, FL 33199
| | - Julie V. Cristello
- Florida International University, Psychology Department, Center for Children and Families 11200 SW 8 Street, AHC-1, Miami, FL 33199
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27
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Kenkel DS, Peng S, Pesko MF, Wang H. Mostly harmless regulation? Electronic cigarettes, public policy, and consumer welfare. HEALTH ECONOMICS 2020; 29:1364-1377. [PMID: 32779278 PMCID: PMC7876166 DOI: 10.1002/hec.4136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 05/19/2023]
Abstract
Electronic cigarettes are a less harmful alternative to combustible cigarettes. We analyze data on e-cigarette choices in an online experimental market. Our data and mixed logit model capture two sources of consumer optimization errors: overestimates of the relative risks of e-cigarettes and present bias. Our novel data and policy analysis make three contributions. First, our predictions about e-cigarette use under counterfactual policy scenarios provide new information about current regulatory tradeoffs. Second, we provide empirical evidence about the role consumer optimization errors play in tobacco product choices. Third, we contribute to behavioral welfare analysis of policies that address individual optimization errors. Compared with standard cost-benefit analysis, our behavioral welfare economics analysis leads to much larger estimates of the costs of policies that discourage e-cigarette use or the benefits of policies that encourage e-cigarette use.
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Affiliation(s)
- Donald S Kenkel
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
| | - Sida Peng
- Office of Chief Economist, Microsoft Research, Redmond, WA, USA
| | - Michael F Pesko
- Department of Economics, Georgia State University, Atlanta, GA, USA
| | - Hua Wang
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
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Yurekli AA, Kovacevic P, Sunley E, Ranganathan K. Government intervention in the market for electronic nicotine delivery systems (ENDS). The known, the unknown and challenges. DRUGS AND ALCOHOL TODAY 2020. [DOI: 10.1108/dat-02-2020-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to describe the various government measures that regulate the market for novel tobacco harm reduction products (THRPs), with an emphasis on e-cigarettes [electronic nicotine delivery systems (“ENDS”)], and evaluates the public health impact of excise taxes levied on these products.
Design/methodology/approach
The paper reviews the economic research on the impact ENDS. Using cited evidence, the paper compares the tax treatment of ENDS and cigarettes and provides a simulation of potential lives that can be saved under alternative tax treatment of ENDS.
Findings
ENDS are considerably less harmful than cigarettes. Imposing the same tax burden on them (per unit of “harm”) as on cigarettes leads to poorer health outcomes. Differential tax treatment of ENDS will encourage more cigarette smokers to switch to ENDS and could save millions of lives worldwide.
Research limitations/implications
Country experiences with regulatory measures on ENDS are limited to those with high THRP penetration. The paper’s simulation analysis used evidence from a limited number of studies. Rigorous economic analysis is needed to understand how ENDS could save lives and could prevent expected one billion premature deaths by the end of this century.
Originality/value
The paper uses research evidence in its analysis of the impact that the differential taxation of cigarettes and ENDS would have. It also provides a rough estimate of the number of lives that could be saved if more smokers who are trying to quit can make the switch to ENDS.
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Pesko MF, Courtemanche CJ, Catherine Maclean J. The effects of traditional cigarette and e-cigarette tax rates on adult tobacco product use. JOURNAL OF RISK AND UNCERTAINTY 2020; 60:229-258. [PMID: 33584006 PMCID: PMC7880200 DOI: 10.1007/s11166-020-09330-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We study the effects of traditional cigarette and e-cigarette taxes on use of these products among adults in the United States. Data are drawn from the Behavioral Risk Factor Surveillance System and National Health Interview Survey over the period 2011 to 2018. Using two-way fixed effects models, we find evidence that higher traditional cigarette tax rates reduce adult traditional cigarette use and increase adult e-cigarette use. Similarly, we find that higher e-cigarette tax rates increase traditional cigarette use and reduce e-cigarette use. Cross-tax effects imply that the products are economic substitutes. Our results suggest that a proposed national e-cigarette tax of $1.65 per milliliter of vaping liquid would raise the proportion of adults who smoke cigarettes daily by approximately one percentage point, translating to 2.5 million extra adult daily smokers compared to the counterfactual of not having the tax.
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Affiliation(s)
- Michael F Pesko
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta
| | - Charles J Courtemanche
- Gatton College of Business and Economics, University of Kentucky; Research Associate, National Bureau of Economic Research; Research Affiliate, Institute of Labor Economics (IZA)
| | - Johanna Catherine Maclean
- Department of Economics, Temple University; Research Associate, National Bureau of Economic Research; Research Affiliate, Institute for the Study of Labor, Philadelphia
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Mendelsohn CP, Hall W. Does the gateway theory justify a ban on nicotine vaping in Australia? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102712. [PMID: 32145594 DOI: 10.1016/j.drugpo.2020.102712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/26/2022]
Abstract
Australia bans the sale, possession and use of liquid nicotine for vaping. One of the major arguments used to justify Australia's policy is that the availability of nicotine vaping products will lead a substantial number of young people who would otherwise not have smoked cigarettes to take up regular smoking (the gateway theory). In this article, we provide a critical analysis of the use of the gateway theory to justify Australian policy. We argue first that the evidence that vaping serves as a gateway to smoking is unconvincing. Smoking more often precedes vaping than vice versa, regular vaping by never-smokers is rare and the association is more plausibly explained by a common liability model. Second, we argue that even if the evidence were stronger it would not justify a ban on the sale of nicotine to adult smokers because there are other ways of preventing adolescent vaping that do not require a ban. We describe an alternative regulatory model for Australia that would address legitimate concerns about preventing adolescent uptake while allowing adult smokers to access these products for cessation or as an alternative to smoking cigarettes.
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Affiliation(s)
- Colin P Mendelsohn
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Herston, Qld 4006, Australia.
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Pesko MF, Currie JM. E-cigarette minimum legal sale age laws and traditional cigarette use among rural pregnant teenagers. JOURNAL OF HEALTH ECONOMICS 2019; 66:71-90. [PMID: 31121389 PMCID: PMC7051858 DOI: 10.1016/j.jhealeco.2019.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/27/2019] [Accepted: 05/08/2019] [Indexed: 05/19/2023]
Abstract
Teenagers under 18 could legally purchase e-cigarettes until states passed minimum legal sale age laws. These laws may have curtailed teenagers' use of e-cigarettes for smoking cessation. We investigate the effect of e-cigarette minimum legal sale age laws on prenatal cigarette smoking and birth outcomes for underage rural teenagers using data on all births from 2010 to 2016 from 32 states. We find that the laws increased prenatal smoking by 0.6 percentage points (pp) overall. These effects were concentrated in prepregnancy smokers, with no effect on prepregnancy non-smokers. These results suggest that the laws reduced cigarette smoking cessation during pregnancy rather than causing new cigarette smoking initiation. Our results may indicate an unmet need for assistance with smoking cessation among pregnant teenagers.
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Affiliation(s)
- Michael F Pesko
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, United States
| | - Janet M Currie
- Henry Putnam Professor of Economics and Public Affairs, Director of the Center for Health and Well-Being, Princeton University, Woodrow Wilson School of Public and International Affairs, United States.
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