E-Cigarettes and Respiratory Disease: A Replication, Extension, and Future Directions

Donald S. Kenkel, Alan D. Mathios, Hua Wang

NBER Working Paper No. 27507
Issued in July 2020
NBER Program(s):Health Economics

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.

You may purchase this paper on-line in .pdf format from ($5) for electronic delivery.

Access to NBER Papers

You are eligible for a free download if you are a subscriber, a corporate associate of the NBER, a journalist, an employee of the U.S. federal government with a ".GOV" domain name, or a resident of nearly any developing country or transition economy.

If you usually get free papers at work/university but do not at home, you can either connect to your work VPN or proxy (if any) or elect to have a link to the paper emailed to your work email address below. The email address must be connected to a subscribing college, university, or other subscribing institution. Gmail and other free email addresses will not have access.


Machine-readable bibliographic record - MARC, RIS, BibTeX

Document Object Identifier (DOI): 10.3386/w27507

NBER Videos

National Bureau of Economic Research, 1050 Massachusetts Ave., Cambridge, MA 02138; 617-868-3900; email:

Contact Us