Research & Commentary: How Do Electronic Cigarettes Affect Adolescent Smoking

Published March 28, 2016

A study published by a Yale researcher in April 2015 examines the causal impact of access to electronic cigarettes, commonly called “e-cigarettes,” on teen smoking and questions whether state bans raise or reduce teen smoking rates. The study, which was conducted by Abigail S. Friedman at the Department of Health Policy and Management at the Yale School of Public Health, concludes, “[A]nalyses consistently find that electronic cigarette access reduces teen smoking,” rather than increases it, a claim often made by opponents of electronic cigarettes.

The study focused on claims suggesting e-cigarettes increase smoking rates, especially for teens. One of the most widely used criticisms made against e-cigarettes is they create a significant “gateway effect,” meaning many people who would otherwise never smoke tobacco do so because they were introduced to a supposedly similar product, such as electronic cigarettes. Another claim is e-cigarettes reduce the social stigma associated with traditional cigarettes, creating more users. A third attack on e-cigarettes is they lower the cost of addiction, which theoretically leads to higher tobacco smoking rates, a phenomenon called “harm reduction.”

Using state-level data on smoking rates and bans, as well as data from the National Survey on Drug Use and Health and the National Youth Tobacco Survey, the study found state bans on the sale of e-cigarettes to minors create “a statistically significant 1.0 percentage point increase in recent cigarette smoking rates among 12 to 17 year olds.” The study also found the greater the access to electronic cigarettes, the greater the drop in the state’s smoking rate. According to the study, a 1 percentage point increase in people using an e-cigarette at some point in their lives yields a 0.65 to 0.83 percentage point drop in smoking rates among teens aged 14 to 18.

E-cigarettes are a less-harmful alternative to traditional cigarettes; they have significantly fewer chemicals that cause smoking-related diseases, and research shows they reduce tobacco smoking rates. A study focused on nicotine products found of the maximum relative harm (MRH) ratings linked to smoking-related diseases and illnesses, cigarettes’ percentage was 100 percent MRH, while electronic cigarettes were rated with only 4 percent MRH. The study concludes products with nicotine and few other ingredients, such as e-cigarettes, “would bring significant benefits not just to users but also to non-smokers and society as a whole.”  

The study presents the first causal evidence of electronic cigarettes and how they impact teen smoking rates. Other variables, such as nicotine levels, pricing, and health care costs associated with traditional cigarettes and e-cigarettes, could impact the findings once the data become available.

States should take sound science into consideration when deliberating the creation of regulations or taxes on e-cigarette products. States imposing bans, excessive regulations, or high taxes on e-cigarettes could be creating an environment in which consumers choose to use more-harmful traditional cigarettes, rather than less-harmful alternatives.

The following articles examine e-cigarettes and vaping from multiple perspectives.

How Do Electronic Cigarettes Affect Adolescent Smoking?
Understanding electronic cigarettes’ effect on tobacco smoking is a central economic and policy issue. This paper examines the causal impact of e-cigarette availability on conventional cigarette use by adolescents. First, synthetic control analyses consider how state bans on e-cigarette sales to minors influence teen smoking rates. These bans yield a statistically significant 1 percentage point increase in recent smoking rates in this age group, relative to states without such bans. The study also examines survey data on cigarette and e-cigarette use, separating teens by estimated propensity to smoke in the absence of e-cigarettes. Among those with the highest propensity to smoke, e-cigarette use increased the most, while cigarette use declined. A 1 percentage point rise in the percentage of people who use e-cigarettes at least once yields a 0.65 percentage point drop in this subgroup’s current smoking rate. These results indicate e-cigarettes have a harm-reducing effect on adolescent cigarette smoking, at least prior to 2014.

Study: Youth E-Cig Access Regulations Increase Smoking Rates
A Yale University researcher has found a link between bans on e-cigarette use by teens under age 18 and increases in underage cigarette smoking rates. The study, authored by Abigail Friedman, an associate professor of public health at Yale University, contradicts government-sponsored studies suggesting e-cigarettes are a “gateway drug” for tobacco cigarettes among teens.

Research & Commentary: Electronic Cigarettes 
Heartland Institute Senior Policy Analyst Matthew Glans examines electronic cigarettes, tobacco harm reduction, and various proposals to regulate e-cigarette use. E-cigarettes have become one of the most popular nicotine replacement products and a key building block in tobacco harm reduction strategies.

Electronic Cigarette Use Among Adults: United States, 2014
This report from the Centers for Disease Control and Prevention provides the first estimates of e-cigarette use among U.S. adults from a nationally representative household interview survey, which is organized by selected demographic and cigarette smoking characteristics. 

Research & Commentary: New CDC Report Finds Vaping Helps Smokers Quit
A new report released by the Centers for Disease Control and Prevention (CDC) found only 0.4 percent of the people who had never smoked tobacco in a CDC study group are current vapers, which the report defines as using a vaping device either every day or some days. The CDC report, the first of its kind, estimates e-cigarette use among U.S. adults using a nationally representative household survey. The report’s findings claim only 3.4 of adults who have never smoked have tried an e-cigarette; 12.6 percent of Americans have tried an e-cigarette; and fewer than 4 percent of the U.S. population are regular e-cigarette users.

E-Cigarettes Are Making Tobacco Obsolete. So Why Ban Them?
Matt Ridley reports vaping works better than any other method of giving up smoking, examining several studies reaching that conclusion. With the success of vaping products, he asks, why are cities banning them?  

E-Cigarettes Poised to Save Medicaid Billions
In a new report from State Budget Solutions, J. Scott Moody finds e-cigarette use could create significant savings for state governments, especially in their Medicaid programs: “As shown in this study, the potential savings to Medicaid significantly exceeds [sic] the state revenue raised from the cigarette excise tax and tobacco settlement payments by 87%. As such, the rational policy decision is to adopt a non-interventionist stance toward the evolution and adoption of the e-cig until hard evidence proves otherwise.” 

Levels of Selected Carcinogens and Toxicants in Vapor from Electronic Cigarettes
Tobacco Control found e-cigarette vapor contains some toxic substances, but only at levels “9–450 times lower than in cigarette smoke and were, in many cases, comparable with trace amounts found in the reference product.” The study finds replacing tobacco cigarettes with electronic cigarettes could substantially reduce exposure to tobacco-specific toxicants.  

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Government Spending News at, The Heartland Institute’s website at, and PolicyBot, Heartland’s free online research database, at

The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state; or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact John Nothdurft, Heartland’s director of government relations, at [email protected] or 312/377-4000.