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Updated: Sep 9, 2025
Comparing the Effects of Electronic Cigarette Vapor and Cigarette Smoke in a Novel In Vivo Exposure System
Published on: May 24, 2017
The Effects of State-Level Flavored Electronic Cigarette Restrictions on Adult Tobacco Use Using Multilevel Modeling:
John H Kingsbury1,2, Michael J Parks1,2, Heather Kimmel1
1National Institute on Drug Abuse, Division of Epidemiology, Services, and Prevention Research, 6001 Executive Blvd, N. Bethesda, MD 20852, USA.
Introduction:
Flavors play an important role in e-cigarette use among both young people and adults, but evaluations of flavored e-cigarette policies have focused almost exclusively on youth. This longitudinal study examined how flavored e-cigarette policies affect tobacco use over time for different adult age groups using data from the Population Assessment of Tobacco and Health (PATH) Study.
Methods:
Adults aged 21 or above at Wave 5 (2018-2019) comprised the analytic sample. Multilevel models were used to examine changes in past 30-day and established e-cigarette use, and past 30-day tobacco use other than e-cigarettes at Wave 7 (2022-2023) for residents of states that had (vs had not) implemented flavored e-cigarette policies between Waves 5 and 7. Sociodemographic variables and state-level tobacco control policies (eg, e-cigarette tax, clean indoor air) were controlled. Regression models tested effects overall and by age group: 21-24, 25-29, 30-39, 40, or above. Full-sample and replicate weights accounted for the complex sample design and nonresponse.
Results:
Among those exposed to a flavored e-cigarette policy, there was a significant decrease in odds of past 30-day e-cigarette use for those age 21-24 (AOR = 0.59; 95% CI: 0.36, 0.97) and in odds of established e-cigarette use for those age 25-29 (AOR = 0.32; 95% CI: 0.14, 0.76) compared to those who were unexposed, adjusting for covariates. There was no change in use of tobacco products other than e-cigarettes by flavored policy exposure.
Conclusions:
Flavored e-cigarette policies are effective at reducing past 30-day and established e-cigarette use among younger adults (aged 21-29). The impact among older adults (30 or above) is less evident.
Implications:
Using longitudinal data and multilevel models, this study demonstrates how flavored e-cigarette policies influence e-cigarette use (and other tobacco product use) for younger adults (21-29). We find limited evidence of policies influencing older adults (30 or above). This work suggests that flavored e-cigarette policies may play an important role in stopping young people from initiating e-cigarette use, and in stopping older young adults who are 25-29 from progressing to more established e-cigarette use.
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