Association of Electronic Cigarette Regulations With Electronic Cigarette Use Among Adults in the United States

Abstract

IMPORTANCE Millions of Americans use electronic cigarettes (e-cigarettes). A growing number of state and local governments have started to draft and implement laws regarding the sale, marketing, and use of e-cigarettes. The association of US state regulations regarding e-cigarettes with e-cigarette use remains unknown. OBJECTIVE To examine the association of US state regulations regarding e-cigarettes with current e-cigarette use among adults in the United States. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included adults aged 18 years or older from the 2016 and 2017 Behavioral Risk Factor Surveillance System, which is a nationwide, telephone-administered survey that collects state-representative data on health-related risk behaviors, chronic health conditions, and use of preventive services. Data analysis was performed from February 1, 2019, to April 31, 2019. EXPOSURES United States state laws regulating e-cigarette use, including prohibiting e-cigarette use in indoor areas of private workplaces, restaurants, and bars; requiring retailers to purchase a license to sell e-cigarettes; prohibiting self-service displays of e-cigarettes; prohibiting sales of tobacco products, including e-cigarettes, to persons younger than 21 years; and e-cigarette taxes. MAIN OUTCOMES AND MEASURES Current use of e-cigarettes. RESULTS Among 894 997 participants aged 18 years or older (503 688 women [51.3%], 679 443 non-Hispanic white [62.6%], 71 730 non-Hispanic black [16.3%], 69 823 Hispanic [11.4%], and 74 001 non-Hispanic other races [9.8%]), 28 907 (weighted prevalence, 4.4%) were currently using e-cigarettes. The age-standardized weighted prevalence of current e-cigarette use varied across US states and territories, from 1.0% in Puerto Rico to 6.2% in Guam. After adjustment for demographic, socioeconomic, and lifestyle factors, including conventional cigarette use, the odds ratios of current e-cigarette use were 0.90 (95% CI, 0.83-0.98) for state laws prohibiting e-cigarette use in indoor areas of private workplaces, restaurants, and bars; 0.90 (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, including e-cigarettes, to persons younger than 21 years; and 0.89 (95% CI, 0.83-0.96) for state laws applying taxes to e-cigarettes. CONCLUSIONS AND RELEVANCE These findings suggest that several state regulations regarding e-cigarettes may be associated with reduced e-cigarette use among US adults.

Pilot Ecological Momentary Assessment Study of Subjective and Contextual Factors Surrounding E-Cigarette and Combustible Tobacco Product Use among Young Adults

“…Studies of young adults demonstrate that the convenience, discreetness, and similarity of e-cigarettes to cigarettes serve as both motives for use and barriers to quitting vaping [ 20 , 21 , 22 ]. Although smoke-free air laws have been shown to reduce cigarette smoking rates [ 23 ], state laws prohibiting e-cigarette use indoors have not been shown to be associated with reductions in e-cigarette use among young adults [ 24 ], suggesting that other intervention strategies may be needed to reduce e-cigarette use in this population.…”

Electronic cigarette use and subjective cognitive complaints in adults

“…Considering potential health risks associated with e-cigarettes, to combat the epidemic of e-cigarette use, since 2010 several states and local governments started to implement laws restricting the sale, marketing, and use of e-cigarettes [ 44 ], which has been shown to be associated with reduced e-cigarette use among US adults [ 45 ]. More recently, the US Food and Drug Administration (FDA) implemented the flavor enforcement policy on February 6, 2020, which restricts the sale of all flavored, cartridge-based e-cigarettes except tobacco and menthol flavors [ 46 ].…”

Looking Back and Going Forward: Roles of Varenicline and Electronic Cigarettes in Smoking Cessation

“…The highest prevalence of active electronic cigarette users in the US in 2018 was among persons aged 18-24 years [ 3 ]. Among current smokers in one study, 24% reported e-cigarette use [ 36 ]; among current electronic cigarette users, 52% reported current conventional cigarette use while 19% denied prior cigarette use [ 45 ]. Smoking cessation, smoking reduction, and reduction in health risks are the most common reasons for the use of electronic cigarettes [ 36 ].…”