Study organization & specific aims

The overarching goal of our research is to evaluate the impacts of e-cigarette control policies. Our study design employs an expansive mixed-methods approach to account for the far-reaching effects of these policies on the local, state, and national levels. Our study is composed of three complementary aims:

Aim 1: Investigate barriers and facilitators to e-cigarette control policy implementation. To achieve this qualitative analysis, our research team will conduct key informant interviews with personnel at state agencies across the United States and with local municipal and school personnel in 25 eastern Massachusetts communities. Interviews with these key policy actors will contribute to our understanding of how these policies are implemented, what makes implementation successful, and what challenges their organizations might face.

Aim 2: Evaluate and compare the impacts of e-cigarette control policies on e-cigarette, tobacco, and cannabis use. The Aim 2 quantitative analysis will compare the independent impacts of e-cigarette control policies at the national, state, municipal, and school levels. The analysis considers various age groups, utilizing data from the Behavioral Risk Factor Surveillance System, Youth Risk Behavior Surveillance System and the MetroWest Adolescent Health Survey, spanning the years 2014-2025.

Aim 3: Project the health impacts of expanding specific e-cigarette control policies and implementation practices using the Simulation of Tobacco and Nicotine Outcomes and Policy (STOP) e-cigarette/tobacco microsimulation model. Data from Aims 1 and 2 will be incorporated into the model to project the impact of e-cigarette policies and specific implementation factors on future e-cigarette and tobacco use, health, and life expectancy.

These three study aims will provide a comprehensive assessment of the impact of e-cigarette control policies over a significant time span across multiple policy levels. Our research findings will be disseminated utilizing direction from national tobacco policy experts to help guide stakeholders towards policies that are maximally feasible and effective in improving population health.

The public health significance of our research

E-cigarettes have upended tobacco market landscape with their explosion in popularity, disrupting patterns of nicotine, combustible tobacco, and cannabis use. The rapid rise in vaping and the products’ appeal among youth has caused public health professionals concern, and has prompted policy responses in attempts to regulate these devices. At the same time, there is increasing evidence that under proper circumstances, e-cigarettes may be an effective smoking cessation aid and harm reduction tool. As a result, e-cigarette regulation is likely to have broad impact, affecting the use of not only e-cigarettes, but also combustible cigarettes and other vaped products (i.e., cannabis), and differentially affecting use and outcomes for youth, young adults, and adults. A comprehensive effort is needed to understand the potentially far-reaching consequences of e-cigarette policy. Our study’s complementary analyses will address the vital need for high quality, up-to-date data on the impact of e-cigarette policies and guide the development and refinement of future effective and feasible e-cigarette policies. We aim to make the results of our research useful to relevant actors in this field by employing a comprehensive dissemination plan targeting stakeholders at the national, state, and local levels with understandable, actionable information that will maximize public health in the context of a complex regulatory and behavioral environment.