Substance Use
Associations between county-level e-cigarette-inclusive Tobacco 21 law coverage and e-cigarette use behaviors among US adolescents in the Monitoring the Future Study James H. Buszkiewicz* James Buszkiewicz Catherine A. Vander Woude Yanmei Xie Steven Cook Bukola Usidame Megan E. Patrick Michael R. Elliott James F. Thrasher Nancy L. Fleischer
Background: State and local Tobacco 21 (T21) laws vary in their inclusion of e-cigarettes, which may inhibit their ability to reduce adolescent e-cigarette use and related disparities.
Methods: We used national, cross-sectional 2014-2020 Monitoring the Future Study data on US 8th, 10th, and 12th graders. Using grade-stratified, modified Poisson regression models, we examine associations between county-level e-cigarette and any T21 law coverage as a combined, dichotomized measure, E-cigarette T21 laws (100% vs. <100%), and past 30-day e-cigarette use and two-way interactions between these policies and sex, race and ethnicity, parental educational attainment, and college educational expectations.
Results: E-cigarette use was 1.8 percentage points (95% CI = -3.0%, -0.5%) lower among 8th graders, 2.5 percentage points lower (95% CI = -4.5%, -0.5%) among 10th graders, and 2.8 percentage points (95% CI = -5.4%, -0.3%) lower among 12th graders living in counties with 100% versus <100% e-cigarette and any T21 law coverage. We also found differences in these associations by sociodemographic subgroups. Higher (100% versus <100%) coverage was associated with lower e-cigarette use among male 8th, 10th, and 12th graders but not among females. Regarding racial and ethnic differences, we observed the greatest differences in use associated with higher coverage among Hispanic 8th graders and 12th and 10th graders of another race and ethnicity. By socioeconomic status, we found the greatest differences in use associated with higher coverage among 10th graders with at least one parent with a college degree or more and among 12th graders who said they probably will graduate from a four-year college.
Conclusions: E-cigarette T21 laws were associated with lower adolescent e-cigarette use. Our findings suggest that, given current e-cigarette use disparities, T21 laws may widen sex disparities in adolescent e-cigarette use but may narrow some racial, ethnic, and socioeconomic disparities.