Grant: Prize: IHSPR Article of the Year Award

Background: Banning e-cigarette sales to minors has been a key policy to protect children from e-cigarettes in the US and Canada, but little is known about its impact. Methods: In this study, I used data from Canadian Tobacco, Alcohol and Drugs Survey (CTADS) and Canadian Student Tobacco Alcohol and Drugs Survey (CSTADS) and quasi-experimental methods to assess the impact of banning e-cigarette sales to minors in Canada. Outcomes of interest included recent e-cigarette use among youth, their reported difficulty of access to e-cigarettes, their perception of e-cigarette harm, and their use of social sources of e-cigarettes. Results: Following the bans, e-cigarette use among youth increased in all provinces, but the increase was 79% lower in provinces with a ban than in provinces without. Youth in provinces with a ban were 18% less likely to believe that regular e-cigarette use poses no harm and 16% more likely to self-report greater difficulty in obtaining e-cigarettes. However, youth in provinces with a ban were also 29% more likely to obtain e-cigarettes from social sources. These findings were robust to several sensitivity analyses. Conclusion and Relevance: Banning e-cigarette sales to minors was associated with a significant reduction in the rate of increase in e-cigarette use by youth, but this policy alone could not reverse the overall rise in e-cigarette use. This policy should be supplemented with other measures such as a ban on e-cigarettes with child-friendly flavors to reduce young people's desire to obtain e-cigarettes through social sources.