Abstract
BackgroundElectronic cigarettes, or e-cigarettes, are devices that deliver nicotine-containing aerosol and were used by 2.8% of American adults in 2017. Many people who smoke cigarettes have used e-cigarettes for smoking cessation, and the general consensus among health providers is that while vaping is not harmless, it is less harmful than smoking. To try to reduce youth e-cigarette use, the Commonwealth of Massachusetts imposed a 75% excise tax on nicotine-containing vaping products and banned the sale of all flavored tobacco products, including combustible tobacco, effective June 1, 2020. This tax, like similar taxes in other states, aimed to reduce e-cigarette consumption. However, past research has found that e-cigarettes and cigarettes are economic substitutes, meaning that an increase in e-cigarettes prices may push more people who smoke e-cigarettes to smoke combustible cigarettes.MethodsTo determine the impacts of several events, such as the e-cigarette and vaping-associated lung injury (EVALI) outbreak and implementation of the Massachusetts e-cigarette tax, on e-cigarette and cigarette purchasing, we conducted an interrupted time-series analysis of year-on-year consumer purchasing data to impute changes in e-cigarette and cigarette purchasing in the Greater Boston area and the entire USA after several intervention points. We then surveyed a subset of people who used e-cigarettes to evaluate the plausibility that some e-cigarette consumers would travel out-of-state to purchase e-cigarettes.ResultsThe purchasing data indicated that there was no significant decrease in e-cigarette purchases in the Greater Boston convenience market after tax implementation. However, we found that e-cigarette purchases decreased significantly while cigarette purchases increased after several bans on e-cigarettes and numerous policy statements related to the EVALI outbreak. The survey results suggested that people who smoke e-cigarettes did not decrease their consumption after the implementation of the tax, but instead obtained e-cigarettes outside of Massachusetts.ConclusionThese results suggest that the Massachusetts flavor ban and tax did not reduce e-cigarette consumption in the Greater Boston area, and that messaging questioning the safety of e-cigarettes led to an increase in combustible cigarette use. This suggests the need for health authorities to reconsider how they communicate the relative risks of smoking and vaping.
Highlights
Electronic cigarettes, or e-cigarettes, are devices that deliver nicotine-containing aerosol and were used by 2.8% of American adults in 2017
Prior to the first cut point, e-cigarette purchases in the Greater Boston area and the USA were decreasing relative to the prior year’s sales, with a smaller number of units purchased per capita in the Greater Boston area
To measure the effects of Massachusetts House Bill No 4196, which implemented a 75% excise tax on vapingrelated products and banned flavored tobacco products, we analyzed changes in e-cigarette and combustible cigarette purchasing data after multiple local e-cigarette bans, press release from the American Lung Association (ALA) regarding risks associated with e-cigarette use, and the e-cigarette and vaping-associated lung injury (EVALI) outbreak; the beginning and end of the Massachusetts ban on e-cigarettes; the implementation of COVID-19 mitigation measures; and the implementation of the Massachusetts excise tax
Summary
Electronic cigarettes, or e-cigarettes, are devices that deliver nicotine-containing aerosol and were used by 2.8% of American adults in 2017. To try to reduce youth e-cigarette use, the Commonwealth of Massachusetts imposed a 75% excise tax on nicotine-containing vaping products and banned the sale of all flavored tobacco products, including combustible tobacco, effective June 1, 2020. This tax, like similar taxes in other states, aimed to reduce e-cigarette consumption. The emergence of electronic cigarettes, battery-operated devices that heat and vaporize nicotine-containing solutions for inhalation and are sold in disposable and rechargeable varieties known as e-cigarettes, over the past decade has led to debate among health professionals over the risks and benefits of e-cigarettes, their relationship to tobacco smoking, and the question of how e-cigarettes should be regulated [4]. A CDC (US Centers for Disease Control and Prevention) study of smoking cessation methods used by adults who smoked between 2014 and 2016 found that 35.3% of participants who used multiple methods during their most recent cessation attempt replaced some cigarette intake with e-cigarettes, and 24.7% switched completely from cigarettes to e-cigarettes [10]
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