Hands Off E-Cigarettes. Why More Regulations Make No Sense

This article first appeared on the American Enterprise Institute site.

In a recent JAMA Pediatrics article on the correlation between e-cigarette use and subsequent cigarette smoking among adolescents and young adults, Dartmouth demographer Samir Soneji and his co-authors find that the probability of cigarette smoking at follow-up is significantly higher among all e-cigarette users than among individuals who never used a nicotine product.

Based on this finding, they conclude that “strong e-cigarette regulation” by the federal, state, and local governments are needed to minimize the potential “future population-level burden of tobacco.” This conclusion is unwarranted based on the nature of their results.

The article compares the probability of smoking in the post-period conditional on e-cigarette use without smoking to the probability of smoking in the post-period conditional on neither e-cigarette use nor smoking.

GettyImages-481718114 A model smokes an electronic cigarette during the Beijing International Vapor Distribution Alliance Expo at China International Exhibition Center on July 23, 2015 in Beijing, China. VCG/VCG via Getty

This is not the relevant comparison for the purpose of assessing public health risk. The relevant comparison is between smoking behavior conditional on access to e-cigarettes and smoking behavior conditional on no access to e-cigarettes, as such a comparison incorporates both the potential gateway and deterrent/diversion effects of e-cigarette use.

Such a comparison would take into account any beneficial effects of e-cigarettes on potential smokers who choose to reduce their cigarette smoking or to limit themselves to e-cigarette use altogether, as well as on smokers in the pre-period who switch to e-cigarettes partially or fully, or successfully use e-cigarettes as a cessation aid. It is on this comparison that regulatory choices should be based.

The nascent market for e-cigarettes in the United States can make robust empirical research on the consequences of these products on tobacco use challenging.

The importance of a proper analytical framework is illustrated in a recent National Bureau of Economic Research working paper by economists Mike Pesko of Weill Cornell Medical College and Janet Currie of Princeton.

The economists identify an important unintended consequence of minimum legal sale age laws restricting access to e-cigarettes: smoking among underage pregnant teenagers increased by more than 2 percentage points.

With teen smoking at a new low, policymakers should be celebrating a public health success instead of seeking a new regulatory expansion.

Empirically, it is certainly not clear that more vaping has any causal effect on smoking among youth, as Soneji and his co-authors imply but do not demonstrate.

Moreover, the type of analyses reported in JAMA Pediatrics fails to offer a reliable basis for developing an optimal regulatory framework for e-cigarettes and other modified risk tobacco products.

Alex Brill is a research fellow at the American Enterprise Institute (AEI).

Sally Satel, a practicing psychiatrist and lecturer at the Yale University School of Medicine, is a research fellow at AEI.

Stan Veuger is a resident scholar at AEI.