Kevin Lewis

August 13, 2020

E-Cigarette Use to Aid Long-Term Smoking Cessation in the US: Prospective Evidence from the PATH Cohort Study
Ruifeng Chen et al.
American Journal of Epidemiology, forthcoming


E-cigarettes are the preferred smoking-cessation aid in the US, however there is little evidence regarding long-term effectiveness among those who use them. We used the Population Assessment of Tobacco and Health Study to compare long-term abstinence between matched US smokers who tried to quit with and without use of e-cigarettes as a cessation aid. We identified a nationally representative cohort of 2,535 adult US smokers in 2014–15 (baseline assessment), who in 2015–2016 (exposure assessment) reported a past-year quit attempt and the cessation aids used, and reported smoking status in 2016–17 (outcome assessment; self-reported 12+ months continuous abstinence). We used propensity-score methods to match each e-cigarette user with similar non-users. We found that, among US smokers who used e-cigarettes to help quit, 12.9% (95% CI: 9.1%,16.7%) successfully attained long-term abstinence. However, there was no difference compared to matched non-e-cigarette-users (cigarette abstinence difference: 2%; 95% CI: −3%, 7%). Furthermore, fewer e-cigarette users were long-term abstinent from nicotine products (nicotine abstinence difference: −4%; 95% CI: −7%, −1%); about two-thirds of e-cigarette users who successfully quit smoking continued to use e-cigarettes. These results suggest that e-cigarettes may not be an effective cessation aid for adult smokers, and instead may contribute to continuing nicotine dependence.

The political consequences of opioid overdoses
Aaron Kaufman & Eitan Hersh
PLoS ONE, August 2020


The United States suffered a dramatic and well-documented increase in drug-related deaths from 2000 to 2018, primarily driven by prescription and non-prescription opioids, and concentrated in white and working-class areas. A growing body of research focuses on the causes, both medical and social, of this opioid crisis, but little work as yet on its larger ramifications. Using novel public records of accidental opioid deaths linked to behavioral political outcomes, we present causal analyses showing that opioid overdoses have significant political ramifications. Those close to opioid victims vote at lower rates than those less affected by the crisis, even compared to demographically-similar friends and family of other unexpected deaths. Moreover, among those friends and family affected by opioids, Republicans are 25% more likely to defect from the party than the statewide average Republican, while Democrats are no more likely to defect; Independents are moderately more likely to register as Democrats. These results illustrate an important research design for inferring the effects of tragic events and speak to the broad social and political consequences of what is becoming the largest public health crisis in modern United States history.

A Dynamic Model of Rational Addiction with Stockpiling and Learning: An Empirical Examination of E-cigarettes
Jialie Chen & Vithala Rao
Management Science, forthcoming


Current regulations on e-cigarettes are minimal compared with cigarette regulations, despite their growing popularity globally. Advocates of e-cigarettes claim that they aid in ceasing smoking habits. However, leaving e-cigarettes unregulated has raised growing health concerns. Policymakers in several countries, including the United States and those in Europe, are considering and experimenting with policy interventions. To evaluate current policies and implement potential regulations on e-cigarettes, policymakers must understand the impact of e-cigarettes on consumers’ smoking behaviors. To address this issue, we construct a dynamic structural model that incorporates consumers’ purchases and consumption behaviors of both cigarettes and e-cigarettes. The results from our proposed model indicate that consumption of e-cigarettes promotes, rather than counteracts, smoking. This is because the less costly e-cigarettes incentivize consumers to build their addiction to nicotine, which, in return, increases future consumption of both cigarettes and e-cigarettes. This finding calls for regulations on e-cigarettes. We then conduct counterfactual analyses to evaluate two policy regulations on e-cigarettes: (1) e-cigarette taxes and (2) price regulation. Because both of these policies have been discussed extensively in both the United States and many countries in the European Union, results of our policy simulations address these policy debates. We find that both are effective in reducing overall consumption of cigarettes and e-cigarettes. We also examine the role of consumers’ heterogeneity on the simulation results as well as the policy implications. We conclude with future research directions, such as inclusion of social influence and cross-selling marketing.

Marijuana medicalization and motor vehicle fatalities: A synthetic control group approach
Bradley Bartos, Carol Newark & Richard McCleary
Journal of Experimental Criminology, June 2020, Pages 247–264

Objectives: This paper reports a quasi-experimental evaluation of California’s 1996 medical marijuana law (MML), known as Proposition 215, on statewide motor vehicle fatalities between 1996 and 2015.

Methods: To infer the causal impact of California’s MML enactment on statewide motor vehicle fatalities, we construct a synthetic control group for California (i.e., California had it NOT enacted MMLs) as a weighted sum of annual traffic fatality time series from a donor pool of untreated (no MML) states. The post-MML difference between California and its constructed counterfactual reflects the net effect of MMLs on statewide traffic fatalities. The synthetic control group design avoids the problematic homogeneity assumptions intrinsic to panel regression models, which have been employed in prominent studies of this topic.

Results: California’s 1996 MML appears to have produced a large, sustained decrease in statewide motor vehicle fatalities amounting to an annual reduction between 588 and 900 vehicle fatalities. This finding is consistent across a wide range of model specifications and donor pool restrictions. In-sample placebo test results suggest that the estimated intervention effect is unlikely to be a spurious artifact and the “leave-one-out” sensitivity analysis demonstrates that the effect is not being driven by an individual or ensemble of influential donor pool states.

The Opioid Epidemic Was Not Caused by Economic Distress But by Factors that Could be More Rapidly Addressed
Janet Currie & Hannes Schwandt
NBER Working Paper, July 2020


Without the opioid epidemic, American life expectancy would not have declined in recent years. In turn, the epidemic was sparked by the development and marketing of a new generation of prescription opioids and provider behavior is still helping to drive it. There is little relationship between the opioid crisis and contemporaneous measures of labor market opportunity. Cohorts and areas that experienced poor labor market conditions do show lagged increases in opioid mortality, but the effect is modest relative to the scale of the epidemic. Instead, we argue that there are specific policies and features of the U.S. health care market that led to the current crisis. It will not be possible to quickly reverse depressed economic conditions, but it is possible to implement policies that would reduce the number of new opioid addicts and save the lives of many of those who are already addicted.

What Is Driving the Drug Overdose Epidemic in the United States?
Ryan Thombs et al.
Journal of Health and Social Behavior, forthcoming


The demand-side perspective argues that the drug overdose epidemic is a consequence of changes in the economy that leave behind working-class people who lack a college education. In contrast, the supply-side perspective maintains that the epidemic is primarily due to changes in the licit and illicit drug environment, whereas a third, distinct perspective argues that income inequality is likely a key driver of the epidemic. To evaluate these competing perspectives, we use a two-level random intercept model and U.S. state-level data from 2006 to 2017. Contrary to the demand-side approach, we find that educational attainment is not associated with drug-related mortality. In support of the supply-side approach, we provide evidence indicating that opioid prescription rates are positively associated with drug-related mortality. We also find that income inequality is a key driver of the epidemic, particularly the lack of resources going to the bottom 20% of earners. We conclude by arguing that considerations of income inequality are an important way to link the arguments made by the demand-side and the supply-side perspectives.

The Impact of State Tobacco Control Spending on High School Student Vaping
John Tauras et al.
NBER Working Paper, July 2020


The rapid rise in e-cigarette use rates among high school students in the United States is a significant source of public policy concern for many states. This paper is the first study to examine the impact of state tobacco control spending on the demand for vaping products by high school students. The findings from this study provide strong evidence that funding for state tobacco control programs is associated with reduced vaping among youth and young adults in the US. These findings could help to inform decision making about how states should allocate scarce public resources.

Hazardous or not? Cannabis use and early labor market experiences of young men
Jenny Williams & Jan van Ours
Health Economics, forthcoming


We study the relationship between cannabis use and early labor market experiences of young men, focusing on the time it takes them to find their first job, and the wage rate they receive at that job. We find that early cannabis users accept job offers more quickly and at a lower wage rate compared with otherwise similar males who did not use cannabis. These differences are present only for those who use cannabis for longer than a year before starting their job search. We also find that early cannabis users are less likely to return to education and, as a consequence, will have a lower educational attainment. Overall, our findings provide new insights into the direct and indirect relationships between cannabis use and early labor market experiences.

Competitive Effects of Federal and State Opioid Restrictions: Evidence from the Controlled Substance Laws
Sumedha Gupta et al.
NBER Working Paper, July 2020


A large concern in U.S. opioid policy is whether supply side controls are effective at reducing the quantity of opioids prescribed, without harmful substitution. An unstudied way that policy targeted a major opioid through the federal Controlled Substance Act (CSA) was the August 2014 scheduling of tramadol products, the second most popular opioid medication at the time. Twelve states implemented the identical policy prior to federal action, providing a unique opportunity to compare effectiveness of the same opioid policy at state versus federal levels. This is important because many recent opioid policy interventions have only taken the form of state actions, while federal policy has largely been advisory. Seven weeks after tramadol's scheduling, the leading opioid form on the market, hydrocodone combination products, was moved to the more restricted level II (no refills allowed) from level III in the CSA, allowing us to test a new question in the opioid literature: competitive spillover effects from regulations targeting one drug. Using weekly prescription data spanning 2007-2017, this study finds that tightening prescribing restrictions on one opioid leads to decreases in its use, but also causes some increases in prescriptions of close competitors, leading to no statistically detectable short-run reduction in total opioid prescriptions.

The Dynamics of the Smoking Wage Penalty
Michael Darden, Julie Hotchkiss & Melinda Pitts
NBER Working Paper, July 2020


Cigarette smokers earn significantly less than nonsmokers, but the magnitude of the smoking wage gap and the pathways by which it originates are unclear. Proposed mechanisms often focus on spot differences in employee productivity or employer preferences, neglecting the dynamic nature of human capital development and addiction. In this paper, we formulate a dynamic model of young workers as they transition from schooling to the labor market, a period in which the lifetime trajectory of wages is being developed. We estimate the model with data from the National Longitudinal Survey of Youth, 1997 Cohort, and we simulate the model under counterfactual scenarios that isolate the contemporaneous effects of smoking from dynamic differences in human capital accumulation and occupational selection. Results from our preferred model, which accounts for unobserved heterogeneity in the joint determination of smoking, human capital, labor supply, and wages, suggest that continued heavy smoking in young adulthood results in a wage penalty at age 30 of 14.8% and 9.3% for women and men, respectively. These differences are less than half of the raw difference in means in wages at age 30. We show that the contemporaneous effect of heavy smoking net of any life-cycle effects explains roughly 67% of the female smoking wage gap but only 11% of the male smoking wage gap.

E-Cigarettes and Respiratory Disease: A Replication, Extension, and Future Directions
Donald Kenkel, Alan Mathios & Hua Wang
NBER Working Paper, July 2020


Electronic cigarettes show potential to reduce the harms from smoking combustible tobacco, but there is uncertainty about the long-term health consequences. We replicate and extend the study by Bhatta and Glantz (20192), which reports longitudinal statistical associations between e-cigarette use and long-term respiratory disease. We are able to closely replicate their results. When we use a more flexible empirical specification, among respondents who had never smoked combustible tobacco, we find no evidence that current or former e-cigarette use is associated with respiratory disease. The statistical associations between e-cigarette use and respiratory disease are driven by e-cigarette users who are also current or former smokers of combustible tobacco. A striking feature of the data is that almost all e-cigarette users were either current or former smokers of combustible tobacco. We then discuss the potential for future applied econometric research to credibly identify the causal effects of e-cigarette use on health. Challenges include the potential selection biases that stem from the complex set of consumer choices to initiate and quit smoking combustible tobacco, use of e-cigarettes, and dual use of both products. We suggest using a variety of identification strategies to uncover the causal effects that use a variety of econometric methods.


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