A Comprehensive Approach to Tobacco Policy in the Age of E-Cigarettes

Project Summary: 

The research team is estimating the impact of combustible cigarette (CC) and electronic cigarette (EC) policies on the selection and use of tobacco products. To further population health, tobacco regulations should serve two aims simultaneously: reducing tobacco use overall and leading those who do use to choose lower risk tobacco products over higher risk ones. The investigators are studying how several different types of tobacco policies currently being implemented at state and local levels impact both EC and CC use. Findings from this work will better equip regulators to make evidence-based policy decisions that account for both the policies’ different effects on CC versus EC use, and these products’ different risk profiles.  


CC use, EC use, and any tobacco use


All regressions use difference-in-differences specifications, identifying the relevant policy’s impacts on each tobacco-use behavior, comparing outcomes in geographic areas that did versus did not implement the policy in question, pre- versus post-policy change. Simulation methods are applied to clarify the expected effects of different policy-combinations.


Current smoking rates fell from 16.5 percent in 2011 to 8.9 percent in 2016 among 18-20 year-olds in these data. Regressions indicate that a tobacco-21 policy covering one’s entire metropolitan/micropolitan statistical areas (MMSA) yields an approximately 3.1 percentage point reduction in 18 to 20 year-olds’ likelihoods of smoking [CI: -0.0548, -0.0063]. Accounting for partial policy exposure — tobacco-21 laws implemented in some but not all jurisdictions within an MMSA — this estimate implies that the average exposed 18 to 20 year-old experienced a 1.2 percentage point drop in their likelihood of being a smoker at interview relative to unexposed respondents of the same age, all else equal.

Local tobacco-21 policies yield a substantive reduction in smoking among 18 to 20 year-olds living in metropolitan and micropolitan statistical areas. This finding provides empirical support for efforts to raise the tobacco purchasing age to 21 as a means to reduce young adult smoking. Moreover, it suggests that state laws preempting local tobacco-21 policies may impede public health.