It’s been well-established for a long time that tobacco control policies, particularly comprehensive 100% smokefree laws and taxes, are associated with less smoking among youth. Now Brian Kelly and colleagues recently published “Tobacco Policy & ENDS Policy Influences on Adolescent Vaping across U.S. States” have extended this literature to state e-cigarette laws. They linked the FDA/NIH PATH dataset, which follows thousands of youth (age 12-17) forward in time, to the American Nonsmokers Rights Foundation Tobacco Control Laws database to assess how changes in the tobacco control legal environment changed youth current e-cigarette use.
Consistent with earlier studies, including two we published (study1, study2), they found that living in a state with comprehensive smokefree legislation had the biggest effect on youth vaping. The odds of vaping for individual youth are reduced by about half after smokefree laws take effect (adjusted OR=0.450, 95% CI: 0.278-0.730).
Youth living in states with minimum age of sales laws were about 20% less likely to be current e-cigarette users than in states without such laws (adjusted OR 0.786, 95% CI 0.632-0.978). (The fact that there is a national minimum sale age of 21 means that emphasis in this area should be on implementation and enforcement.)
These findings are adjusted for a wide range of demographic and state-related factors and time.
Interestingly, the significant effects were associated with comprehensive smokefree laws but not comprehensive restrictions on vaping. The lack of significant of vaping restrictions may be due to the fact that they passed after the laws protecting people from cigarette smoke, so the marginal effect of adding e-cigarettes may have been small.
Tax changes did not have statistically significant effects; this may reflect the fact that not many tax increases passed from 2013-2019, the years that were studied. The odds of current e-cigarette use were on average higher for youth residing in states with higher average cigarette excise taxes, suggesting that youth may use e-cigarettes as a less costly alternative in locales with high tobacco prices, highlighting the importance of taxing e-cigarettes comparably to cigarettes.
A limitation of the study is that it is based on state laws, without considering local ordinances. There are many states where there are strong local laws even though there are not state laws, especially in the south. Not accounting for these local laws probably led Kelly and colleagues to underestimate the effects of smokefree laws. (The authors linked the PATH data to state laws because PATH only releases the states where respondents live. It is possible to compensate for this limitation by estimating the probability that respondents in a given state are covered by a local law using population data.)
Despite this limitation, this paper makes an important contribution to the literature on efficacy of tobacco control policies, particularly the importance of passing comprehensive clean indoor air laws that include all sources of tobacco pollution, including e-cigarettes, heated tobacco products and, for that matter, cannabis.
Here is the abstract:
Introduction: While tobacco use has declined among youth, electronic nicotine delivery systems (ENDS) have the potential to disrupt or reverse these trends. Policies for tobacco and ENDS may have an impact on adolescent ENDS use. The effects of state-level policies were examined for both tobacco and ENDS indoor use bans, excise taxes, and age of purchase laws on past month adolescent ENDS use from 2013 to 2019.
Methods: The study uses cohort data from the Population Assessment of Tobacco and Health (PATH) Study and policy data from the Americans for Nonsmokers’ Rights Foundation repository — three policies for ENDS and two policies for tobacco products. Policies included comprehensive indoor vaping/smoking bans, purchase age restrictions, and excise taxes. Hybrid panel models were estimated in 2022 using data merged from the two longitudinal sources on past month vaping. The analytic sample (N=26,008) includes adolescents ages 12-17, totaling 72,684 observations.
Results: The odds of adolescent ENDS use were 21.4% lower when the state had an ENDS purchase age restriction, and 55.0% lower when the state had a comprehensive tobacco smoking ban, compared to years when the state did not.
Conclusions: During a period of significant growth in ENDS use among U.S. youth, ENDS purchase age restrictions and smoking bans reduced adolescents’ odds of past month vaping. Wider implementation of policies may help intervene on youth vaping.
The full citation is: Kelly BC, Vuolo M, Orsini MM, Maggs JL, Staff J. Tobacco Policy & ENDS Policy Influences on Adolescent Vaping across U.S. States. Am J Prev Med. 2023 Jul 21:S0749-3797(23)00311-2. doi: 10.1016/j.amepre.2023.07.010. Epub ahead of print. PMID: 37482258. It is available here.
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