Review by: Chelsea Boyd

Officials have referred to youth e-cigarette use as an “epidemic” and have continued to sound alarms that vaping lures a new generation to a lifetime of nicotine use. And while certainly no one wants young people to use any form of tobacco or nicotine-containing product, the data simply doesn’t support the argument that youth e-cigarette use constitutes an epidemic. In light of this, blanket bans on e-cigarettes, which also affect adult smokers, may do more harm than good. To interrogate this question, a study by David Braak et al. compares youth e-cigarette use and their means of acquiring these products between the United States, Canada and England to determine the characteristics of young people who purchase vaping products, and the potential impact of minimum-age-of-purchase laws on youth vaping and smoking prevalence.

In so doing, the authors used survey data from 12,128 young people, aged 16-19, from each of the three countries. Each participant answered questions about his/her historical use of e-cigarettes and combustible cigarettes, the means they use to acquire e-cigarettes and their e-cigarette purchasing history.

Among those young people surveyed who had vaped within the past 30 days, numbers between countries did not vary more than five percentage points. This suggests that young people use e-cigarettes at similar rates in the United States, Canada and England. Moreover, in all three countries combined, only 7.5 percent of young people reported purchasing a vapor product during the past twelve months—and this number included young people of legal age to purchase. Among young people who had used an e-cigarette during the past 12 months, those residing in the United States were more likely to have purchased a vaping product during the same period than their Canadian and English counterparts, however, American young people were also more likely to have been refused sale of a vaping product due to their age.

Looking deeper at the association between purchasing and use of vaping products, the study found that young people who smoked or vaped more frequently were also more likely to have purchased vaping products during the past year. The other strong predictor of having purchased a vaping product was being of legal age to do so. Although the authors note their data supports raising the legal age of purchase and strongly enforcing those restrictions, they also note that about 43 percent of young people who vaped during the previous 30 days reported getting their vaping products exclusively from social sources, with another 13 percent reporting both commercial and social sourcing. Young people of legal age to purchase were somewhat more likely to purchase their vaping products than young people under the legal age of purchase. This demonstrates that of the young people who purchased vaping products in the past 12 months, the majority were above the legal age of purchase. It also suggests that most underage people obtaining these products are procuring them not from stores, but from friends.

Indeed, among young people who vaped during the past 30 days, there was no significant difference between young people above the legal age of purchase and those below the legal age when it came to acquisition of their vaping products. That is to say, regardless of age, country of residence and laws, young people acquire tobacco products from both social and commercial sources. This is further evidence that increasing the minimum age of purchase and implementing strong enforcement measures may deter social sourcing and purchasing. And this can be done without blanket bans on these products that many adults use for smoking cessation purposes.

In December 2019, the U.S. Congress increased the legal age for tobacco product purchase to 21 across the country. Since the data used in this study was collected in 2017 and is cross-sectional in nature, the paper does not capture any behavior changes attributable to this change. Nevertheless, Braak et al.’s findings agree with the mountains of public health data that show raising the legal age of purchase to 21 decreases underage tobacco use. However, these findings also show that there is still work to do to decrease underage access and use of tobacco products.

After all, the legal age of purchase is irrelevant if it is not enforced. And, while this study approximates enforcement rates by asking participants if they were refused sale of a vaping product during the prior 12 months because they were underage, truly assessing enforcement is beyond its scope. Still, based on Braak et al.’s findings, it is evident that all three countries must increase enforcement of their legal age limits to decrease young people’s access to tobacco products.

For example, of the underage young people surveyed who had purchased a vaping product during the previous 12 months, about 70 percent said a store had refused to sell them vaping products because they were not of legal age. Unfortunately, similar to how “past 30 day use” can encompass vaping behavior that ranges from daily use to a one-time experimental puff, it is incorrect to assume that the 70 percent statistic means that the young people surveyed were denied purchase every time they tried to buy vaping products. In any event, even if they were, this statistic shows the need for stronger enforcement of legal-age-of-purchase laws in all three countries. Fortunately, the U.S. youth who completed the survey had significantly higher odds of being refused purchase because of age than their Canadian and English peers.

Ultimately, because of social sourcing, including behaviors such as giving money to someone else to buy vaping products—which 10 to 20 percent of young people reported doing, depending on the country—enforcement and minimum-age-of-purchase laws will not eliminate all youth use of vaping products. However, for the health of adult smokers, it is important that bans do not become the means of controlling youth access. The United States is already ahead of Canada and England in enforcement of minimum age laws, and raising the legal age of purchase to 21 will prevent 18-year-old high school students from legally purchasing tobacco products and then giving them to their underage peers. As with all problem solving, we must assess the success of one change before implementing the next.