Vaping Taxes Cut Teen Nicotine Use—But Not for LGBQ Youth, Study Finds

Economic levers have long served as tools for public health intervention, with taxes on tobacco products demonstrating measurable impacts on consumption patterns across populations. Yet new research from Wake Forest University reveals a striking disparity in how e-cigarette taxes affect different groups of American youth, exposing limitations in one-size-fits-all policy approaches and highlighting the complex relationship between substance use, mental health, and social stressors.

The study, published in the Journal of Health Economics, found that while a one-dollar tax increase on vaping products successfully reduced prior-month e-cigarette use among heterosexual high school students by three to four percentage points, the same tax increase had no statistically significant effect on lesbian, gay, bisexual, and questioning (LGBQ) youth. This divergence persisted even though LGBQ teens vape at rates more than 30 percent higher than their straight peers.

The Coping Mechanism Hypothesis

The research team, led by Wake Forest Associate Professor of Economics Erik Nesson, traced this differential response to a fundamental distinction in how and why these populations use nicotine. For many LGBQ youth, vaping serves not merely as recreational substance use but as a coping mechanism for chronic stressors including bullying, social isolation, and the psychological burden of navigating non-conforming identities in often hostile environments.

"We found that for LGBQ youth who did not report bullying or sadness, the taxes reduce vaping to a similar degree as among heterosexual youth," Nesson explained. "However, for LGBQ youth who self-reported struggles, the tax had no statistically significant effect on vaping."

This finding carries profound implications for tobacco control policy. When substance use functions as self-medication for emotional distress, price sensitivity diminishes. The nicotine delivery becomes a tool for managing anxiety, depression, or trauma—making consumption relatively inelastic to cost increases. A teenager using vaping to cope with daily harassment at school experiences the habit differently than one experimenting with flavors or socializing with peers who vape.

Data from the Youth Risk Behavior Survey

The research drew upon CDC's Youth Risk Behavior Survey data spanning 2015 to 2023, a nationally representative dataset that tracks health behaviors among high school students across the United States. During this period, at least 30 states and numerous municipalities implemented excise taxes on electronic nicotine delivery systems (ENDS) as youth vaping reached what the Surgeon General characterized as epidemic proportions.

Despite these policy interventions, 2024 data still showed 3.5 percent of middle school students and 7.8 percent of high school students—more than 1.6 million American youth—reported using e-cigarettes. The persistence of youth vaping at these levels, even as taxes increased and regulatory scrutiny intensified, suggests that purely economic interventions may address only a portion of the underlying drivers of adolescent nicotine use.

The Wake Forest study's focus on sexual orientation as a moderating variable represents a relatively novel approach in tobacco control research. Most previous studies examined demographic factors like income, race, or geographic location without considering how marginalized identity itself might shape both substance use patterns and responses to policy interventions.

Mental Health and Substance Use Intersection

The findings illuminate broader patterns in how mental health and substance use disorders intersect, particularly among populations experiencing chronic stress from discrimination or social exclusion. Research consistently demonstrates elevated rates of substance use disorders among LGBTQ+ individuals compared to the general population, with these disparities often attributed to minority stress—the additive psychological burden of living with stigma, concealment, and anticipated discrimination.

For adolescents, these stressors manifest in specific, measurable ways. The Youth Risk Behavior Survey data showed that LGBQ youth reporting experiences of bullying or persistent sadness demonstrated virtually no response to e-cigarette tax increases, while those without such reported struggles responded similarly to heterosexual peers. This pattern suggests that addressing the mental health and social environment factors driving substance use may prove more effective than economic deterrents for vulnerable populations.

Policy Implications Beyond Taxation

The study's conclusions carry direct relevance for policymakers designing comprehensive tobacco control strategies. While excise taxes remain valuable tools for reducing overall population-level consumption—particularly among price-sensitive groups like middle-class heterosexual youth—they appear insufficient as standalone interventions for populations using substances to manage psychological distress.

"Our results suggest that policymakers need to be aware that increasing the cost of nicotine products may not yield uniform results," Nesson noted. "This is important to consider when trying to develop the right mix of tobacco control policies to curb use among teens."

That "right mix" likely requires complementing economic interventions with mental health services, anti-bullying programs, and targeted support for LGBTQ+ youth. School-based interventions that reduce harassment and isolation may prove more effective at reducing vaping among LGBQ students than price increases that primarily burden already marginalized young people without addressing the underlying distress driving their substance use.

The Limits of Economic Solutions

Public health has historically relied heavily on economic incentives and disincentives, from sin taxes to insurance premium adjustments, to shape behavior. The Wake Forest research serves as a reminder that these tools operate within complex social contexts that can blunt or amplify their effectiveness. A tax that reduces consumption among populations with genuine choice about their behavior may prove merely punitive for those whose substance use stems from limited alternatives for managing suffering.

This dynamic appears particularly relevant for adolescent populations, whose decision-making capacities, social environments, and economic resources differ fundamentally from adults. Teenagers experiencing bullying cannot simply choose to avoid their tormentors as easily as adults might change jobs or neighborhoods. The constraints on their autonomy make economic levers less effective and potentially more inequitable.

Looking Forward

As the Food and Drug Administration continues its prolonged regulatory process for e-cigarette products and states consider additional taxation measures, the Wake Forest findings suggest that effective tobacco control requires nuanced understanding of who uses these products and why. Population-level interventions that work for majority groups may leave vulnerable subpopulations unaffected—or may impose costs on those least able to bear them without achieving the desired behavioral change.

The research also points toward opportunities for more targeted interventions. Schools implementing comprehensive anti-bullying programs, communities creating affirming spaces for LGBTQ+ youth, and healthcare providers screening for mental health concerns among young vapers may address the root causes driving nicotine use among LGBQ teens more effectively than taxation alone.

For the more than 1.6 million American youth still using e-cigarettes, the path away from nicotine dependence likely requires more than making vaping expensive. It requires addressing the isolation, distress, and trauma that lead some young people to seek chemical relief in the first place—work that falls outside the traditional scope of tobacco control policy but squarely within the mission of public health.