Spatial Spillover Effects of State-Level Policies Banning Electronic Nicotine Delivery Systems

After the outbreak of e-cigarette or vaping use-associated lung injury (EVALI) strongly linked to vitamin E acetate found in some tetrahydrocannabinol-containing vaping products in 2019, several states passed emergency bans on the sale of electronic nicotine delivery systems (ENDS) products. We use a fixed-effect panel regression model with an embedded difference-in-differences design to evaluate the unintended effects of state-level ENDS bans. Besides eliminating ENDS sales, our results indicate that a full ENDS ban is associated with a 94.5 percent increase in volume sales of ENDS refills in neighboring counties compared with the pre-ban average. We find similar but weaker spatial spillover impacts of flavor (non-tobacco) ENDS bans. As these flavor bans did not restrict tobacco-flavored ENDS sales, we observe an overall 55.4 percent decline in sales of ENDS refills but more-than-doubled sales of tobacco-flavored ENDS refills in the states subject to the flavor bans. Relative increases in cigarette sales can be observed when states implemented either full or flavor ENDS bans. This study improves our understanding of the unintended consequences of ENDS bans, as our results suggest significant spillover effects from cross-border purchasing behavior, switching across flavors of ENDS, and substitution between ENDS and cigarettes after states implemented such bans.