The Economic Relationship between Smokeless Tobacco and Alcohol Use Among US Youth

Aims: Youth in the US use smokeless tobacco (SLT) and alcohol simultaneously to a high degree. Therefore, we investigate whether US youth consider smokeless tobacco (SLT) and alcohol as economic substitutes or complements using tax and non-tax price measures.Methods: Alcohol and SLT use among youth reported in the Centers for Disease Control and Prevention’s (CDC’s) Youth Risk Behavior Survey (YRBS) from 2007-2019 was linked to state-level taxes on moist snuff and beer and state-level beer and SLT minimum pricing laws data. We implemented a logit model to explore the relationship between SLT and alcohol. A multinomial logit model was used to examine the association between user types and pricing policies. Results: The odds of drinking decreased by 5% with each additional dollar increase in SLT taxes, indicating beer is a complement to SLT. In contrast, the odds of drinking were 49% higher with each additional point increase in the SLT minimum pricing laws strength score, indicating beer is a substitute for SLT. The odds of SLT use increased by 1.7 times with each additional dollar increase in beer taxes, indicating that SLT is a substitute for beer. Beer taxes were significantly associated with all user types. However, SLT taxes were only significantly associated with exclusive SLT users and dual users. Conclusions: Beer is both a substitute for and a complement to SLT, but SLT is only a substitute for beer. When designing control measures for the use of one substance, policymakers may also need to consider the simultaneous side effect on the other substance. The effectiveness will be magnified if regulatory policies for both substances are in place