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Associations Between State Tobacco Control Policies and Adolescent ENDS Use

Hawkins, Summer Sherburne PhD; Ghiani, Marco PhD; Baum, Christopher F. PhD

Journal of Public Health Management and Practice: November/December 2019 - Volume 25 - Issue 6 - p 529–536
doi: 10.1097/PHH.0000000000000859
Research Reports: Research Full Report

Background: Despite an increase in adolescent use of electronic nicotine delivery systems (ENDS), little is known about the role of tobacco control policies on ENDS use.

Objective: For aim 1, we examined how trends in adolescent use of cigarettes were affected by the introduction of ENDS; for aim 2, we examined the associations between ENDS age restrictions, cigarette taxes, and smoke-free legislation and adolescent use of ENDS and cigarettes.

Design and Setting: Repeated cross-sections of the 1999-2015 Youth Risk Behavior Surveys linked to state-level tobacco control policies.

Participants: 938 486 adolescents aged 14 to 18 years from 45 states.

Main Outcome Measures: For aim 1, we examined adolescent use of cigarettes. For aim 2, we examined adolescent use of ENDS, only ENDS, and cigarettes.

Results: We found there was an overall decreasing trend in adolescent use of cigarettes, but the actual decline was greater than the predicted decline for 17- and 18-year-olds. While we found no associations between ENDS use and ENDS age restrictions or cigarette taxes, ENDS use was 3.8 percentage points higher in those states with smoke-free legislation for combustible tobacco products.

Conclusions: Our findings highlight that ENDS age restrictions may not be adequate to curb ENDS use and additional local- and state-level policies governing ENDS are needed.

School of Social Work (Drs Hawkins and Baum) and Department of Economics (Drs Ghiani and Baum), Boston College, Chestnut Hill, Massachusetts; and Department of Macroeconomics, German Institute for Economic Research (DIW Berlin), Berlin, Germany (Dr Baum).

Correspondence: Summer Sherburne Hawkins, PhD, School of Social Work, Boston College, McGuinn Hall, 140 Commonwealth Ave, Chestnut Hill, MA 02467 (

Conflicts of interest: None

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