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The prevalence of vaping among adolescents is increasing worldwide.[13] There is substantial variability in vaping in youth worldwide across countries.[14] Over the years leading up to 2017, vaping among adolescents has grown every year since these devices were first introduced to the market.[15] There appears to be an increase of one-time e-cigarette use among young people worldwide.[16] Most e-cigarette users among youth have never smoked.[17] Many youths who use e-cigarettes also smoke traditional cigarettes.[18] While some studies find associations between the use of e-cigarettes and traditional cigarettes,[19][20][21] studies that estimate this relationship using causal methods from health economics have concluded the opposite.[12][22] 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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