Effects of E-Cigarette Prices and Vaping Restrictions on Adolescent E-Cigarette Use: Evidence from Monitoring the Future

Significance: Global sales of e-cigarettes (ECs) exceed $8 billion annually, with US consumption accounting for 43% of that market. Although ECs may influence smoking cessation, they generate public health concerns given that e-cigarettes may pose potential health risks, renormalize cigarette smoking, and may serve as “gateway” to cigarette smoking. Our study explores the associations between cigarette/EC prices, smoking/vaping restrictions, EC use, and cigarette and EC dual use among middle and high-school students in the United States.

Methods: Data came from the Monitoring the Future survey 2014, 2015, and 2016 with a total of 39408 middle- and high-school students. Average cigarette prices, e-cigarette prices in the market level were constructed from Nielsen ScanTrack. Smokefree and vapefree air laws data were provided by the ANRF Database. These data include smokefree/vapefree air laws in workplaces, restaurants, and bars at the state, county, and municipality levels. Integration of these diverse data sources, while accounting for year and respondents’ residential locations, afforded a rich dataset, containing smoking/EC use, demographics, household socioeconomic status, cigarette/EC retail prices, and smoke/vape free air policies. We estimated adjusted logit model of EC use and EC and cigarette dual use.

Results: EC price was negatively associated with EC use and EC and cigarette dual use. Respondents living in a county with a higher population coverage of laws regulating use of ECs in 100% smokefree venues were significantly less likely to use ECs or dual use.

Conclusion: This study provides clear evidence that EC use is price sensitive among adolescent. Laws restricting ECs in the 100% smokefree venues may denormalize the use of tobacco products and ultimately discourage adolescent EC use and dual use.