Substance Use
Associations between county-level e-cigarette smoke-free air law coverage and e-cigarette use behaviors among US adolescents in the Monitoring the Future Study James Buszkiewicz* James Buszkiewicz Yanmei Xie Catherine A. Vander Woude Steven Cook Bukola Usidame Megan E. Patrick Michael Elliott James F. Thrasher Nancy L. Fleischer
Background: Prior studies have found that e-cigarette smoke-free air laws (SFAL) were associated with lower adolescent e-cigarette use but have not examined whether associations differ by sociodemographic factors.
Methods: We analyzed associations between county-level workplace and hospitality e-cigarette SFAL coverage (100% vs. <100%) and past 30-day e-cigarette use (2014–2022) and first e-cigarette initiation (2015–2022) among US 8th, 10th, and 12th graders using national, cross-sectional Monitoring the Future study data. We used weighted, grade-stratified, modified Poisson regression models adjusted for individual-, county-, and state-level confounding factors. We also examined two-way interactions with sex, race and ethnicity, parental education, and college educational expectations.
Results: E-cigarette SFALs were not associated with adolescent e-cigarette use or initiation in the overall sample but were associated with lower use among some sociodemographic subgroups. Higher (100% versus <100%) workplace e-cigarette SFAL coverage was associated with lower e-cigarette use among 12th-grade males versus females. Higher hospitality e-cigarette SFAL coverage was associated with lower e-cigarette use among 8th and 12th-grade males versus females. Higher hospitality SFAL coverage was associated with lower e-cigarette use among 8th graders and 12th graders of all racial and ethnic groups, except non-Hispanic Black 8th and non-Hispanic White 12th graders. Higher workplace and hospitality SFAL coverage was also associated with lower e-cigarette use among 12th graders whose parents had a high school education or less.
Conclusions: E-cigarette SFALs were not associated with lower adolescent e-cigarette use or initiation in the overall sample. However, given current e-cigarette use disparities, our interaction results suggested that e-cigarette SFAL may widen sex and select racial and ethnic adolescent e-cigarette use disparities while narrowing socioeconomic disparities.