Higher taxes on e-cigs likely to boost cigarette smoking among young adults

In an attempt to curb the use of increasingly popular electronic nicotine delivery systems, such as e-cigarettes, 30 U.S. states and Washington, D.C. have implemented taxes on these products. But a growing body of evidence suggests that, among adults, these taxes can increase cigarette smoking, a habit whose health effects are likely to be more harmful than vaping nicotine according to the National Academy of Science and Medicine.

What is less clear is how taxes affect the habits of 18- to 25-year-olds, a population often grouped with adults in studies. This group is of particular concern because it's typically during these ages that people transition from experimental nicotine use to daily use, says Abigail Friedman, an associate professor at the Yale School of Public Health.

In a new study published July 19 in the journal Addiction, Friedman and her coauthor Michael Pesko of Georgia State University assessed the effects of cigarette and e-cigarette taxes on smoking and vaping nicotine among this age group.

For the study, the authors compared survey data on young adult smoking and vaping across states that did increase taxes on cigarette and nicotine vaping products versus those that did not. They found that increasing taxes on nicotine vaping products by $1 per milliliter was associated with a 2.5 percentage point decline in this group's rate of daily vaping, but also a 3.7 percentage point increase in rates of recent smoking. Similarly, a $1 increase in cigarette taxes yielded a 2.5 percentage point decrease in recent smoking and an equivalent increase in daily vaping of nicotine products.

Friedman says these findings show that tax policies need nuance.

"Anyone who is going to levy a tax on one tobacco or nicotine product needs to think about the tax rates on all the others," she said. "Because if people are substituting between products and you raise the price of one, some subset is going to switch to a less expensive option, even if they don't like that product as much. From a public health perspective, it is important that that less expensive option is also less harmful."

Evidence that cigarettes are more lethal than nicotine vaping products suggests that a tax that increases smoking would be worse for public health than one that increases nicotine vaping, say the researchers.

The team also found that this younger population was about three times more responsive to vapor product taxes than what has been found in previous studies of 18- to 40-year-olds.

"If you paint this entire 18 to 40 age range with a broad brush, you're going to get very different indications of what the response would be," she said. "And it makes sense that 18- to 25-year-olds would be much more responsive. This is the peak age range where people are transitioning from experimentation with tobacco products towards habitual use. We see far more uptake there than among older adults."

Friedman says research in this area tends to divide the population between children and adults, but future research should consider these "emerging adults," as she refers to them, on their own.

"One thing that this study makes evident is that the split between children and adults is not clean," she said. "As ages 18 to 25 mark a key transitional period for movement from experimentation with tobacco products into regular use, these are important target ages if you're trying to interrupt initiation of habitual smoking and vaping."