E-cigarette taxes as a public health tool: a qualitative examination of public policy implementation

Taxation has long been a cornerstone of tobacco control. E-cigarettes in recent decades have transformed the nicotine product market. Since 2010, 35 states have enacted e-cigarette taxes, in part to prevent youth vaping. However, for a variety of reasons, e-cigarette taxation is more complicated than traditional cigarette taxation. Studying e-cigarette taxation through an implementation science lens offers the opportunity to more deeply understand the implementation conditions which enable taxation to improve public health. This study applies qualitative methods guided by Bullock et al.’s comprehensive policy-focused implementation science framework to analyze interviews with key informants (KIs) implementing e-cigarette taxes. KIs involved in state e-cigarette policy implementation, including tax implementation, were recruited from all 50 states and the District of Columbia. Qualitative data focused on e-cigarette taxation were collected from 25 KIs across 13 states from December 2023 to June 2024. Data from 43 additional interviews conducted with 45 KIs in 23 states about other e-cigarette policy topics (including licensure requirements, minimum legal sales age, restrictions on the sale of flavored products, and clean indoor air rules) were also used in the analysis, as tax-related information emerged during these conversations. KIs described policy structures and enforcement strategies, barriers, and gaps in e-cigarette tax policy implementation. E-cigarette tax enforcement was identified by KIs as being hampered by the absence of regulatory structures that exist for more traditional tobacco products. E-cigarettes occupy a newer and less regulated market; enforcement was challenged by rapid market evolution, an irregular supply chain, online sales, and limited product tracking mechanisms. KIs utilized and recommended actionable policy and implementation changes to improve tax policy (e.g., leveraging federal interstate sales reports and implementing e-cigarette tax stamps). These findings caution that many traditional tobacco tax enforcement methods face implementation barriers when applied to emergent products without established regulatory structures. Both traditional and novel tools may be more effectively employed to achieve public health goals. Applying an implementation science framework in a public policy context offers opportunities to examine implementation fidelity to policy objectives and identify opportunities to strengthen policy delivery.