Date of Award

Spring 2021

Project Type


Program or Major


Degree Name

Doctor of Philosophy

First Advisor

Karen S. Conway

Second Advisor

Reagan Baughman

Third Advisor

Dhaval Dave


My dissertation examines the unintended consequences of tobacco control policies on adolescent health behaviors and outcomes. The first essay examines the effects of cigarette taxes on teenagers’ physical activity. Smoking and physical activity are both strategies for weight management, and exercise may be a way to reduce some of the ill effects of smoking. These different links suggest that cigarette taxes could either increase or decrease physical activity. We explore this relationship using repeated cross-sectional 1991-2017 data from the national and state Youth Risk BehaviorSurveillance System (YRBS), combined with state-level policies and controls. Our smoking participation results confirm past work; cigarette taxes have a negative effect on smoking that has waned in recent years. The estimated effects of cigarette taxes on physical activity echo those of smoking; cigarette taxes decrease physical activity and, like smoking, these effects have waned recently. However, one likely avenue - sports participation - is unaffected. These results suggest that increased cigarette taxes lead to modest declines in teen physical activity, a finding consistent with youth using exercise to compensate for the health effects of smoking.

My second essay continues to focus on the unintended effects of a cigarette tax policy. Specifically, we investigate the effect of taxes on Extreme Weight Control Behaviors (EWCBs) which include using diet pills, purging (vomiting or using laxatives) and fasting to lose weight. EWCBs are prevalent among teenagers, have potentially serious health consequences and are precursors to eating disorders. Yet, EWCBs are largely unexplored in health economics and fewpolicy initiatives address them. The link between smoking and body weight, as well as evidence that teenagers smoke to manage weight, suggests that cigarette taxes are a possible policy lever for understanding EWCBs. A theoretical framework models the choice to engage in EWCBs and identifies expected effects of cigarette taxes. Using the YRBS and controlling for state-level characteristics, we estimate models of smoking and EWCBs. Results suggest that cigarette taxes reduce smoking, including for those trying to lose/maintain weight and especially among girls. Cigarette taxes increase the incidence and number of EWCBs, again especially for girls. Our finding that EWCBs respond to any policy lever thus underscores and informs the need to prioritize EWCBs on public policy agendas to curb such behaviors in adolescents.

In my third essay, I set out to explore the spillover effects of a more recent policy. Specifically, I examine the mental health effects of a ban on electronic cigarette sales to minors. While depression and suicide rates have been on the rise in the United States, so has the use of e-cigarettes, commonly known as vaping. E-cigarettes are considered to be safer than traditional cigarettes, yet there is growing evidence that nicotine and other toxins contained in e-cigarettes may have adverse psychological effects on teenagers. For instance, e-cigarette use has been associated with mental health problems in adolescents such as symptoms of depression and suicidal tendencies. This evidence suggests that vaping could contribute to deteriorating mental health of teenagers. In contrast, the antidepressant and mood modulating properties of nicotine could cause teens with underlying conditions to turn to vaping as a way to self-medicate. Existing studies find evidence of a strong negative correlation between vaping and adolescent mental health; none examine if therelationship is causal. This study exploits exogenous changes in state policies restricting youth access to e-cigarettes and a difference-in-differences methodology to identify changes in e-cigarette use and mental health outcomes of teens. Using data from the 2005-2017 YRBS, results suggest that MLSA laws reduce vaping but worsen the mental well-being of adolescents. The findings are primarily consistent with the self-medication hypothesis. Taken together this research provides considerable evidence of undesirable consequences of tobacco regulations on teen health outcomes that are closely related to tobacco use. Findings from this research warrant the need for tobacco control policies to be accompanied by others designed to combat such negative spillover effects.