Comprehensive E-Cigarette Policies Are Associated With Lower Use Among U.S. Adolescents and Young Adults

We aimed to examine the individual and combined associations of e-cigarette policies with e-cigarette use among U.S. adolescents and young adults aged 12-20 years.

We used data from Waves 7 (January 2022-April 2023) and 7.5 (April 2023-December 2023, conducted approximately one year after completion of the Wave 7 survey) of the Population Assessment of Tobacco and Health (PATH) study (N=11,418 U.S. adolescents and adults aged 12-20 years) and state-level e-cigarette policy data on flavor bans, e-cigarette-inclusive smoke-free policies, excise tax, product packaging, and retail licensing. We conducted multivariable logistic regression analyses to examine the individual and combined associations between e-cigarette policies and lifetime, past 30-day, and frequent e-cigarette use at Wave 7, and initiation of e-cigarette use at Wave 7.5 among those who reported no lifetime e-cigarette use at Wave 7.

Flavor bans were associated with lower odds of lifetime e-cigarette use (AOR=0.69, 95% CI=0.55, 0.85). E-cigarette-inclusive smoke-free policies had significant associations with lifetime and frequent e-cigarette use (AOR range=0.56-0.78, ps<.05). The individual associations between e-cigarette excise taxes, product packaging, and retail licensing policies and underage e-cigarette use were not statistically significant. The combined e-cigarette policies scale was linked to reduced odds of lifetime e-cigarette use (AOR=0.91, 95% CI=0.87, 0.96).

Comprehensive state-level e-cigarette policies, including but not limited to flavor bans and e-cigarette-inclusive smoke-free policies, may be crucial in mitigating e-cigarette use among adolescents and young adults, thereby providing critical evidence to inform future policy initiatives in the regulatory landscape of e-cigarettes.