According to a new observational study from the University of Iowa published by the journal JAMA Network Open, State laws that regulate e-cigarette sales and usage may lower their use in states where those laws have been implemented.
E-cigarette use and vaping are popular among Americans, despite the ongoing controversy about their public health effects. States first started passing laws to address e-cigarette use in 2010; by 2016, most states, territories, and the District of Columbia had some kind of regulation in place.
In the observational study, a research team led by Wei Bao, assistant professor of epidemiology at the University of Iowa College of Public Health, estimated the potential impact of five laws on e-cigarettes uses by adults in the United States. Some of those five laws are implemented in many states, such as prohibitions of self-service displays of e-cigarettes at retail outlets, which was in force in 26 states. Others, such as age limitations or a tax, were in force in just a few states.
- People were 14% less likely to use e-cigarettes in states where laws prohibited their sale to persons under age 21. This is also the law that is in force in the fewest number of states-; only California, Hawaii, and the District of Columbia have implemented age restrictions. However, a new rule from the U.S. Food and Drug Administration now makes it illegal to sell e-cigarettes to anyone under the age of 21 in the U.S.
- People were 11% less likely to use e-cigarettes in states in which the devices and their refills were taxed, laws that have been implemented in seven states.
- People were 10% less likely to use e-cigarettes in states where they are prohibited for use in indoor areas of private workplaces, restaurants, and bars. Ten states have this law in place.
- People were 10% less likely to use e-cigarettes in states where laws required retailers to be licensed to sell them. This law is in place in 15 states.
Not every law was as successful, though. Regulations prohibiting self-service retail displays of e-cigarettes were not significantly associated with e-cigarette use. This is also the most commonly implemented law regarding e-cigarettes, in place in 26 states.
Marketing and sale of e-cigarettes may be associated with the current use of these products in the U.S.
For the cross-sectional study, the researchers assessed data on adults from 2016 to 2017 from the Behavioral Risk Factor Surveillance System in which participants were asked about their history of smoking and e-cigarette use. Information about state laws regarding e-cigarettes was derived from the CDC State Tobacco and Activities Tracking and Evaluation System.
Of 894,997 participants, 28,907 reported current e-cigarette use, yielding a weighted prevalence of 4.4%. Results revealed variation in age-standardized weighted prevalence across U.S. states and territories, ranging from 1% in Puerto Rico to 6.2% in Guam.
After adjustment for age, sex, race/ethnicity, education, family income, smoking status, alcohol intake, and physical activity, the ORs of current e-cigarette use associated with state-level regulations were:
- 0.9 (95% CI, 0.83-0.98) for state laws prohibiting e-cigarette use in indoor areas of private workplaces, restaurants, and bars;
- 0.9 (95% CI, 0.85-0.95) for state laws requiring retailers to purchase a license to sell e-cigarettes;
- 1.04 (95% CI, 0.99-1.09) for state laws prohibiting self-service displays of e-cigarettes;
- 0.86 (95% CI, 0.74-0.99) for state laws prohibiting sales of tobacco products to those younger than 21 years; and
- 0.89 (95% CI, 0.83-0.96) for state laws with a tax on e-cigarettes.
Of the 894,997 participants, 51.3% were women, 62.6% were white, 16.3% were black, 11.4% were Hispanic and 9.8% reported other races. Men, white participants, current smokers, and alcohol drinkers were more likely to report e-cigarette use.
The study was not without limitations, according to the researchers, including its reliance on self-report and lack of information on the brands and subtypes of e-cigarettes and types of e-cigarette liquid.
The most commonly implemented state laws regarding e-cigarettes were those prohibiting self-service displays of e-cigarettes, those requiring a retail license to sell e-cigarettes and those banning the use of e-cigarettes or conventional cigarettes in restaurants, bars or workplaces.
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