Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Strict tobacco retail licensing (TRL) regulation, including enforcement of laws banning cigarette sales to minors and regular compliance checks, was associated with lower odds of baseline cigarette use and lower odds of cigarette initiation and use over time in adolescents.

2. Odds of e-cigarette use initiation was also lower among adolescents in jurisdictions with strict TRL.

Evidence Rating Level: 2 (Good)

Study Rundown:

In 1993 Congress passed legislation requiring states to enact tobacco retail licensing laws banning cigarette sales to minors, enforced by compliance checks. However, jurisdictions vary in the design of their TRL regulation, including the frequency of compliance checks and severity of penalties. Furthermore, the impact of TRL on initiation of tobacco products and alternative tobacco products is poorly understood. In this prospective cohort study, researchers used survey data from 2014 to 2016 to compare rates of cigarette initiation and use among 11th- and 12th-grade adolescents over 1.5 years in jurisdictions with strict TRL compared to areas with less strict TRL. Compared to adolescents in jurisdictions with relatively relaxed TRL regulation, adolescents in jurisdictions with stricter TRL regulation had lower odds of cigarette use at baseline, and lower odds of cigarette and e-cigarette use initiation at follow-up.

These findings are limited by reliance on survey data and are susceptible to recall bias. Furthermore, researchers used TRL grades that encompassed a broad spectrum of TRL policy, making it impossible to identify the effects of individual features of TRL policy. Nonetheless, the study is strengthened by its large sample, longitudinal follow-up, and independent grading system. For physicians, these findings highlight the importance of advocating for stronger TRL policy as an effective regulatory tool for reducing adolescent tobacco initiation and use.

In-Depth [prospective cohort]:

Researchers used self-administered questionnaire data about cigarette and alternative tobacco product use from 1553 from 11th- and 12th-grade adolescents in the 2014 Southern California Children’s Health Study. Follow-up data were collected as participants reached 18 years of age in 2015 and 2016 via online questionnaire. Data were linked to American Lung Association (ALA) youth access grades in each jurisdiction. Grade A was assigned to jurisdictions with more stringent TRL regulation and grades D and F to jurisdictions with less stringent TRL regulation. The association ALA grade and cigarette and alternative tobacco product use was evaluated using logistic regression models adjusted for sociodemographic factors and other tobacco product use at baseline.

At baseline, participants in the most restrictive jurisdictions (those with an A grade) had lower odds of ever using a cigarette (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.41-0.90) and of past 30-day use (OR: 0.51; 95%CI: 0.29-0.89) than participants in less restrictive (D- to F-grade) jurisdictions. At follow-up, living in A-grade jurisdictions was associated with lower odds of cigarette use initiation (OR: 0.67; 95%CI: 0.45-0.99), e-cigarette use initiation (OR: 0.74; 95%CI: 0.55-0.99), and of initiation with past 30-day use (OR: 0.45; 95%CI: 0.23-0.90).

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