Clean indoor air laws, cigarette excise taxes, and smoking: Results from the current population survey-tobacco use supplement, 2003-2011

Exposure to vaping and smoking prohibitions and nicotine and cannabis vaping in a California-based sample of young adults: An ecological momentary assessment study

BACKGROUND

Localities have extended smoke-free policies to prohibit use of combustible and vaping products for nicotine/tobacco and cannabis (THC), but little is known about how this affects vaping behavior. We used Ecological Momentary Assessment to examine perceived exposure to smoking- and vaping-specific prohibitions and nicotine and THC vaping.

METHODS

Young adults (n = 178; age 25; 55 % male; 47 % Hispanic, 21 % Asian, 21 % White) in California who endorsed past-month use of nicotine and/or THC vaping products were recruited from an existing longitudinal study. In 2023, individuals completed up to five brief surveys each day over 21 days to assess vaping behavior and momentary context (e.g., vaping/smoking prohibitions) of vaping and non-use (random prompt) events. Multilevel generalized linear mixed models assessed associations between exposure to prohibitions and likelihood of vaping nicotine or THC (vs. non-use events).

RESULTS

Young adults showed reduced likelihood of vaping nicotine (aOR = 0.60, 95 % CI 0.42 - 0.85; p = 0.004) and THC (aOR = 0.48, 95 % CI 0.33 - 0.69; p < 0.0001) in settings where vaping and smoking were prohibited compared to settings in which vaping and smoking were allowed. Exposure to settings in which only smoking was prohibited (vaping allowed) was associated with increased likelihood of vaping nicotine (aOR = 2.13, 95 % CI 1.34 - 3.39; p = 0.002), but unrelated to vaping THC (aOR = 0.87, 95 % CI 0.53 - 1.44; p = 0.59).

CONCLUSIONS

Efforts to increase young people's awareness of and compliance with vaping prohibitions may help reduce both nicotine and THC vaping in real-world settings.

Associations between state tobacco control measures and cigarette purchases by U.S. households, 2015-2021

OBJECTIVE

While effects of key tobacco control policies are well-documented, limited research has explored their varying associations across different policy contexts over time. This is crucial given the diverse and evolving tobacco control contexts across states and over time. We evaluated the association between state-level tobacco control measures and cigarette purchases in the US from 2015 to 2021.

METHODS

We analyzed NielsenIQ Consumer Panel data from 10,187 households that purchased cigarettes in 2015-2021. State-level tobacco control policy scores for smoke-free laws, taxes, prevention/control funding, and cessation services were obtained from the American Lung Association's State of Tobacco Control reports. Censored regression models, reporting adjusted beta estimates and 95 % confidence intervals (CI), estimated the associations between each tobacco control measure and annual household cigarette purchases, adjusting for sociodemographics (household composition, marital status, age, education, race/ethnicity, annual income, and internet connection) and accounting for clustering within households and states.

RESULTS

Higher scores for smoke-free laws (adjusted beta = -1.00, 95 % CI = -1.73, -0.27), taxes (adjusted beta = -1.23, 95 % CI = -1.88, -0.58), and prevention/control funding (adjusted beta = -0.22, 95 % CI = -0.38, -0.06) were associated with fewer cigarette purchases over time. In the model considering all four measures together, higher tax score was associated with fewer cigarette purchases over time (adjusted beta = -0.96, 95 % CI = -1.73, -0.87).

CONCLUSIONS

Smoke-free laws, taxation, and prevention/control funding play critical roles in lowering cigarette purchases, while access to cessation services alone may not drive behavioral change. These findings highlight the need for comprehensive tobacco control efforts and renewed policy action to curb cigarette use.

Coupons and state tobacco policy context as predictors of tobacco use among those reporting e-cigarette use in the U.S.: Findings from the Population Assessment of Tobacco and Health (PATH) Study waves 5-6 (2018-2021)

Background

Receipt of cigarette and e-cigarette coupons predicts initiation and progression of use and hinders cessation. Less is known about how coupons operate in different tobacco regulatory environments. The current study utilized longitudinal data from the Population Assessment of Tobacco and Health (PATH) Study to address this research gap.

Methods

Adults who reported past 30-day (P30D) e-cigarette use at Wave 5 (2018-2019) were included (N = 3632). The primary outcome was Wave 6 (2021) P30D any tobacco use. Wave 5 predictors were receipt of e-cigarette coupons, state e-cigarette tax, state tobacco policy context, flavored e-cigarette use, income, and education. Covariates were age, sex, race, state coupon policy, and Wave 5 use of tobacco other than e-cigarettes. Weighted logistic regression models examined effects overall and in samples stratified by state e-cigarette tax and tobacco policy context.

Results

Controlling for covariates, Wave 5 coupon receipt (AOR = 1.57; 95 % CI: 1.07, 2.31) and preference for flavored e-cigarettes (AOR = 1.70; 1.37, 2.10) were positively associated with Wave 6 tobacco use. Stronger state tobacco policy context was negatively associated with tobacco use (AOR = 0.69; 0.55, 0.88). Coupon receipt predicted tobacco use in states with an e-cigarette tax (AOR = 2.39; 1.22, 4.68) and with stronger tobacco policy contexts (AOR = 1.80; 1.07, 3.02), but not in states without an e-cigarette tax (AOR = 1.29; 0.83, 1.99) or with weaker tobacco policy contexts (AOR = 1.33; 0.78, 2.24).

Conclusions

Policies that restrict price-discounting could help discourage e-cigarette use, reinforce e-cigarette taxes and other tobacco control policies, and promote cessation of all tobacco among those reporting e-cigarette use.

Comprehensive vaping bans are associated with lower odds of initiation into electronic nicotine delivery systems use among young people

BACKGROUND AND AIMS

E-cigarette and other electronic nicotine delivery systems (ENDS) use has grown considerably over the past decade, with notable increases among young people. US state policy contexts for ENDS and tobacco may shape initiation into ENDS use among adolescents as they age into early adulthood. We aimed to determine whether state-level comprehensive vaping ban policies reduce the odds of youth initiation into ENDS use, net of additional state-level ENDS and tobacco policies, as well as the youth's cigarette smoking status.

DESIGN

Longitudinal data from the Population Assessment of Tobacco and Health study were merged with a state-year database on tobacco and ENDS policies. Multivariable discrete-time event history models of ENDS initiation were estimated.

SETTING

United States.

PARTICIPANTS

Twenty thousand twelve youth assessed over six waves from 2013 to 2019 (n = 53 974 observations).

MEASUREMENT

We examined comprehensive indoor vaping bans (i.e. 100% vape-free workplaces, restaurants and bars) as a key factor in initiation into ENDS use (i.e. first instance of vaping) from age 13 to 22.

FINDINGS

Among young people, residing in a state with a comprehensive vaping ban was associated with 18% lower odds of ENDS initiation (odds ratio = 0.82; 95% confidence interval =[0.71, 0.94]), even after controlling for other state ENDS and tobacco policies, the youth's cigarette smoking and socio-demographic background and state-level covariates.

CONCLUSIONS

In the United States, state-level vaping bans (i.e. 100% vape-free workplaces, restaurants and bars) are associated with reduced odds of youth initiation into electronic nicotine delivery systems use.

Association of cigarette excise taxes and clean indoor air laws with change in smoking behavior in the United States: a Markov modeling analysis

The rates of cigarette smoking in the United States have declined over the past few decades in parallel with increases in cigarette taxes and introduction of more stringent clean indoor air laws. Few longitudinal studies have examined association of taxes and clean indoor air policies with change in smoking nationally. This study examined the association of state and local cigarette taxes and clean indoor laws with change in smoking status of 18,499 adult participants of the longitudinal 2010-2011 Tobacco Use Supplement of the Current Population Survey over a period of 1 year. Every $1 increase in cigarette excise taxes was associated with 36% higher likelihood of stopping smoking among regular smokers. We found no association between clean indoor air laws and smoking cessation nor between taxes and clean indoor air laws with lower risk of smoking initiation. Cigarette taxes appear to be effective anti-smoking policies. Some state and local governments do not take full advantage of this effective policy measure.

Tobacco Policy and ENDS Policy Influences on Adolescent Vaping Across the U.S. States

INTRODUCTION

Although the use of tobacco has declined among youth, ENDS has the potential to disrupt or reverse these trends. Policies for tobacco and ENDS may have an impact on adolescent ENDS use. The impacts of state-level policies were examined for both tobacco and ENDS indoor use bans, excise taxes, and age-of-purchase laws on past-month adolescent ENDS use from 2013 to 2019.

METHODS

This study used cohort data from the Population Assessment of Tobacco and Health study and policy data from the Americans for Nonsmokers' Rights Foundation repository-3 policies for ENDS and 2 policies for tobacco products. Policies included comprehensive indoor vaping/smoking bans, purchase-age restrictions, and excise taxes. Hybrid panel models were estimated in 2022 using data merged from the 2 longitudinal sources on past-month vaping. The analytic sample (observations=26,008) included adolescents aged 12-17 years, yielding a total of 72,684 observations.

RESULTS

The odds of adolescent ENDS use were 21.4% lower when the state had an ENDS purchase-age restriction and 55.0% lower when the state had a comprehensive tobacco smoking ban than in the years when the state did not have the ban.

CONCLUSIONS

During a period of significant growth in ENDS use among U.S. youth, ENDS purchase-age restrictions and smoking bans reduced the odds of past-month vaping among adolescents. Wider implementation of policies may help intervene in youth vaping.

Tobacco control policies and smoking cessation treatment utilization: A moderated mediation analysis

BACKGROUND

Tobacco policies, including clean indoor air laws and cigarette taxes, increase smoking cessation in part by stimulating the use of cessation treatments. We explored whether the associations between tobacco policies and treatment use varies across sociodemographic groups.

METHODS

We used data from 62,165 U.S. adult participants in the 2003 and 2010/11 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) who reported smoking cigarettes during the past-year. We built on prior structural equation models used to quantify the degree to which smoking cessation treatment use (prescription medications, nicotine replacement therapy, counseling/support groups, quitlines, and internet resources) mediated the association between clean indoor air laws, cigarette excise taxes, and recent smoking cessation. In the current study, we added selected moderators to each model to investigate whether associations between tobacco polices and smoking cessation treatment use varied by sex, race/ethnicity, education, income, and health insurance status.

RESULTS

Associations between clean indoor air laws and the use of prescription medication and nicotine replacement therapies varied significantly between racial/ethnic, age, and education groups in 2003. However, none of these moderation effects remained significant in 2010/11. Higher cigarette excise taxes in 2010/2011 were associated with higher odds of using counseling among older adults and higher odds of using prescription medications among younger adults. No other moderator reached statistical significance. Smoking cessation treatments did not mediate the effect of taxes on smoking cessation in 2003 and were not included in these analyses.

CONCLUSIONS

Sociodemographic differences in associations between clean indoor air laws and smoking cessation treatment use have decreased from 2003 to 2010/11. In most cases, policies appear to stimulate smoking cessation treatment use similarly across varied sociodemographic groups.

Statewide vaping product excise tax policy and use of electronic nicotine delivery systems among US young adults, 2014-2019

OBJECTIVES

An increasing number of US states have required a tax on electronic nicotine delivery systems (ENDS) in the past few years. This study evaluated the effect of statewide vaping product excise tax policy on ENDS use among young adults.

METHODS

We used the two recent waves (2014-2019) of the Tobacco Use Supplement to the Current Population Survey. A total of 17 896 US young adults were analysed. Difference-in-differences approach along with weighted multilevel logistic regressions were used to evaluate the association of vaping product excise tax policy adoption with current ENDS use, accounting for the clustering of respondents within the same states.

RESULTS

There was an increase in current ENDS use prevalence from 2014-2015 (3.4%) to 2018-2019 (5.4%). The presence of a tax on ENDS products was significantly associated with reduced current ENDS use (adjusted OR (AOR)=0.64, 95% CI=0.43 to 0.95). Importantly, respondents living in states with the policy showed significantly lower increase in ENDS use prevalence during the study period (interaction between within-state changes and between-state differences: AOR=0.57, 95% CI=0.35 to 0.91), controlling for other state-level policies and sociodemographic characteristics.

CONCLUSIONS

Our findings suggest that adopting a vaping product excise tax policy may help reduce ENDS use and suppress the increase of ENDS use prevalence among young adults. Considering that there are still a number of US states that have not implemented vaping product excise tax policy, wider adoption of such policy across the nation would likely help mitigate ENDS use prevalence.

Social Learning and Addiction

Social learning theory, as originally proposed by Albert Bandura, followed 2000 years of intellectual inquiry into the determinants of human behavior. Reciprocal determinism is a central component of this theory and proposes that human behavior is determined by functional relationships between (1) personal factors, (2) the external environment, and (3) the behavior itself. Using this model, drug addiction can be viewed as resulting from the functional relationships between an individual's personal characteristics, social environment, and drug-centric behaviors. In other words, addiction can be viewed as a chronically evolving biopsychosocial disorder, encompassing dimensions that are both internal and external to the individual. Effective treatment interventions should thus target all nodes of the model and the functional relationships between them, and they must constantly evolve with the progression of the disorder. An argument is thus constructed that emphasizes the need for an organized structure of metacontingencies, operating within an individual's social environment, that targets the functional relationships between the factors that drive drug use. Optimally, these metacontingencies would operate within socially connected individuals who have the power to control the functional relationships that influence drug use, the vested interest to monitor individual and collective outcomes, the skills to determine what moment-to-moment decisions are needed to influence behavioral change, and the relative permanence necessary to carry through with the implementation of new strategies to produce outcomes that are cumulatively significant.

Cigarette excise taxes, clean indoor air laws, and use of smoking cessation treatments: A mediation analysis

The role of smoking cessation treatments in the link between clean indoor air laws and cigarette taxes with smoking cessation is not known. This study examined whether the use of smoking cessation treatments mediates the association between clean indoor air laws and cigarette excise taxes, on the one hand, and recent smoking cessation, on the other hand. Using data on 62,165 adult participants in the 2003 and 2010-2011 Current Population Survey-Tobacco Use Supplement who reported smoking cigarettes in the past year, we employed structural equation models to quantify the degree to which smoking cessation treatments (prescription medications, nicotine replacement therapy, counseling/support groups, quitlines, and internet-based resources) mediate the association between clean indoor air laws, cigarette excise taxes and recent smoking cessation. Recent smoking cessation was associated with clean indoor air laws in 2003 and with both clean indoor air laws and excise taxes in 2010-2011. Smoking cessation treatments explained between 29% to 39% of the effect of clean indoor air laws and taxes on recent smoking cessation. While clean indoor air laws remained significantly associated with the recent smoking cessation over the first decade of the 2000s, excise taxes gained a more prominent role in later years of that decade. The influence of these policies was partly mediated through the use of smoking cessation treatments, underscoring the importance of policies that make these treatments more widely available.

Indoor PM2.5, tobacco smoking and chronic lung diseases: A narrative review

The lung is one of the most important organs exposed to environmental agents. People spend approximately 90% of their time indoors, and risks to health may thus be greater from exposure to poor air quality indoors than outdoors. Multiple indoor pollutants have been linked to chronic respiratory diseases. Environmental tobacco smoke (ETS) is known as an important source of multiple pollutants, especially in indoor environments. Indoor PM_2.5 (particulate matter with aerodynamic diameter < 2.5 μm) was reported to be the most reliable marker of the presence of tobacco smoke. Recent studies have demonstrated that PM_2.5 is closely correlated with chronic lung diseases. In this paper, we reviewed the relationship of tobacco smoking and indoor PM_2.5 and the mechanism that underpin the link of tobacco smoke, indoor PM_2.5 and chronic lung diseases.