The Effect of E-Cigarette Taxes on Pre-Pregnancy and Prenatal Smoking, and Birth Outcomes

We use the universe of birth records in the United States from 2013 to 2017 to examine the effect of e-cigarette taxes on pre-pregnancy smoking, prenatal smoking, and birth outcomes (birth weight, gestational length, and Apgar 5 score). We apply a differences-in-differences model to study these questions. We have two principle findings. First, e-cigarette tax adoption increases pre-pregnancy and prenatal smoking, implying that e-cigarettes and traditional cigarettes are substitutes among pregnant women. Second, in line with clinical literature suggesting that both e-cigarettes and traditional cigarettes are harmful to developing fetuses, birth outcomes are largely unchanged following adoption of an e-cigarette tax. In sum, our results suggest that e-cigarettes reduce prenatal smoking, but have no observable benefit towards the goal of promoting fetal development.