State regulations linked to reduced e-cigarette use

Recent data suggest that several state regulations on the use, marketing and sale of e-cigarettes may be associated with current use of these products among adults 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.

Notably, 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 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 use of e-cigarettes or conventional cigarettes in restaurants, bars or workplaces.

Recent data suggest that several state regulations on the use, marketing and sale of e-cigarettes may be associated with current use of these products among adults in the U.S.

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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. Additionally, participants were considered to be exposed to state-level e-cigarette regulations in the specific state in which they resided during the time of the survey, but some may have moved or worked between states, which could have led to misclassification of exposure to the state laws. The survey also did not collect detailed information on the years that participants resided in the same states and their knowledge of state laws regarding e-cigarettes.

“Findings from this study suggest that U.S. state regulations regarding e-cigarettes may be associated with reduced e-cigarette use among U.S. adults. Because of the dynamic nature of state law legislation and implementation, future studies are needed to continue monitoring the patterns of state-level variations in e-cigarette use and the outcomes of changing state laws on e-cigarette use,” the researchers wrote. – by Melissa Foster

Disclosures: The authors report no relevant financial disclosures.