Article Text
PDF
Abstract
Background States have recently enacted tobacco-related age and flavour restrictions in addition to federal T21 laws. Little is known about the independent effects of these policies on young adult tobacco use.
Methods Linking 2011–2022 Behavioural Risk Factor Surveillance System data on 2 696 870, 18–59 years from 50 states and DC with policy data, we conducted probit regression models to evaluate the associations between state and federal T21 laws and state flavour restrictions with cigarettes, electronic nicotine delivery system (ENDS) and smokeless tobacco use. Models were adjusted for sociodemographics, additional tobacco policies, COVID-19-related factors, year and state. We tested two-way and three-way interactions between age, state T21 and federal T21 laws.
Results Although we did not find evidence that state T21 laws were associated with cigarette, smokeless tobacco or ENDS use overall, the federal T21 law was associated with lower use of all three tobacco products by 0.39–0.92 percentage points. State flavour restrictions were associated with lower use of cigarettes by 0.68 (−1.27 to –0.09) and ENDS by 0.56 (−1.11 to –0.00) percentage points, but not with smokeless tobacco. A three-way interaction revealed that state and federal T21 laws together were associated with a lower prevalence of ENDS use among 18–20 years, but there were no differences in cigarette use from both policies combined versus either alone.
Conclusion State and federal T21 laws are broadly effective at reducing adult tobacco use, while state flavour restrictions specifically lower use of cigarettes and ENDS.
- Electronic nicotine delivery devices
- Public policy
- Priority/special populations
Data availability statement
Data may be obtained from a third party and are not publicly available. The Behavioral Risk Factor Surveillance System is publicly available and can be downloaded from the Centers for Disease Control and Prevention website (https://www.cdc.gov/brfss/annual_data/annual_data.htm)
Statistics from Altmetric.com
Data availability statement
Data may be obtained from a third party and are not publicly available. The Behavioral Risk Factor Surveillance System is publicly available and can be downloaded from the Centers for Disease Control and Prevention website (https://www.cdc.gov/brfss/annual_data/annual_data.htm)
Footnotes
Contributors SSH: conceptualisation, methodology, writing-original draft preparation, writing, reviewing and editing. NC: methodology, formal analysis, writing-reviewing and editing. RLC: methodology, writing-reviewing and editing. CFB: methodology, formal analysis, writing-reviewing and editing. SSH: guarantor. All authors approved the final manuscript as submitted.
Funding This work was supported by the National Cancer Institute of the National Institutes of Health and Food and Drug Administration Center for Tobacco Products (R21CA268199; PI: SSH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Food and Drug Administration.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.