The prevalence of vaping among adolescents is increasing worldwide. There is substantial variability in vaping in youth worldwide across countries. Over the years leading up to 2017, vaping among adolescents has grown every year since these devices were first introduced to the market. There appears to be an increase of one-time e-cigarette use among young people worldwide. Most e-cigarette users among youth have never smoked. Many youths who use e-cigarettes also smoke traditional cigarettes. While some studies find associations between the use of e-cigarettes and traditional cigarettes, studies that estimate this relationship using causal methods from health economics have concluded the opposite. In general, those studies tend to use robust quasi-experimental econometrics methods along with policy variation to predict e-cigarette use rather than relying on individual selection. Using policy variation is critical as it avoids the methodological challenge that many e-cigarette users are high-risk individuals that would have otherwise smoked cigarettes and may now use e-cigarettes first to “test the waters” before transitioning to their a-priori preferred choice of cigarettes. Therefore, using policy variation is an improvement over much of the current e-cigarette research to date that fails to separate the causal effect of e-cigarette use from preferences to gradually increase the riskiness of tobacco product use over time. These studies using policy variation generally conclude that e-cigarettes are displacing smoking, which aligns with cigarette use rates falling while e-cigarette use rates are rising. This contrasts with much of the literature not using policy variation and spuriously concluding that e-cigarettes are gateways to subsequent cigarette use, which does not align with observed patterns of tobacco use.
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