Effect of state e-cigarette tax policies on the transitions of youth tobacco/nicotine use patterns in the USA: evidence from national longitudinal data.

Introduction: Several US states have implemented regulations, including e-cigarette taxes, primarily to reduce e-cigarette use among youth and young adults. Although several studies have examined e-cigarette tax regulations, studies assessing the impact of e-cigarette taxes on the transitions of tobacco/nicotine use patterns are largely absent from the extant literature.

Methods: We included 9774 participants aged 12-17 years at baseline from waves 1 to 4 of the Population Assessment of Tobacco and Health Study. We estimated transition probabilities between non-current users, e-cigarette-exclusive users and other tobacco/nicotine users. The inverse probability of treatment weighting method was applied to estimate the average treatment effect on the treated (ATT) of e-cigarette tax policies on the transitions between tobacco/nicotine use classes among youth and young adults.

Results: Participants in the states with e-cigarette tax policies had lower probabilities of progressing from non-current use to the other two classes and higher probabilities of opposite transitions than those without. The e-cigarette tax policies significantly decreased the probability of remaining as e-cigarette-exclusive users (ATT=-0.15 (95% CI -0.23, -0.08)) and increased their probability of transitioning to non-current users (0.19 (95% CI 0.09, 0.29)), compared with if they had not been exposed to e-cigarette tax policies. These policies also increased the probability of remaining in non-current users (0.02 (95% CI 0.01, 0.03)) and decreased the probability of progressing to other classes.

Conclusions: Our findings suggest that e-cigarette tax policies may prevent and reduce exclusive e-cigarette use in youths, providing valuable insights for states that have not implemented e-cigarette taxes.