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State Preemption and Local Laws Related to Youth Tobacco Access and Impacts on Cigarette Purchases and Expenditures
Rishika Chakraborty1, Yan Wang, Y Tony Yang
1Author Affiliations: Center for Health Policy and Media Engagement, School of Nursing, George Washington University, Washington, District of Columbia (Chakraborty and Yang); Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia (Wang and Berg); George Washington Cancer Center, George Washington University, Washington, District of Columbia (Wang, Yang, and Berg); Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland (Li); Joint Program in Survey Methodology, The College of Behavioral and Social Sciences, University of Maryland, College Park, Maryland (Li and Zhang); Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia (Chen); and Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia (Bernat).
Context:
The association between preemption of local youth tobacco access laws and cigarette purchases remain uncertain, particularly considering existing state/local tobacco laws.
Objective:
To assess state preemption and local laws related to youth access to tobacco in relation to cigarette purchases and expenditures from 2004-2021 and explore differential impacts among sociodemographic subpopulations, particularly communities with more youth.
Design:
Longitudinal.
Setting:
The United States.
Participants:
Two thousand nine hundred forty-two counties.
Methods:
Data on state youth access preemption and state smoke-free, cigarette taxes, and licensing laws (CDC's STATE system); local youth access laws (American Nonsmokers' Rights Foundation); county-level cigarette purchases and expenditures (NielsenIQ Consumer Panel); and sociodemographics (American Community Survey) were obtained. Multilevel linear models examined the associations between state preemption and local laws related to youth access and county-level cigarette purchases and expenditures, controlling for state smoke-free, taxation, and licensing laws, county-level sociodemographics, and state as a fixed effect. Analyses assessed interactions between preemption and sociodemographic subgroups.
Results:
Greater state smoke-free law coverage (Purchases: ß = -102 980, P < .001; Expenditures: ß = -143 617, P < .001) and higher cigarette taxes (Purchases: ß = -530 968, P < .001; Expenditures: ß = -783 441, P < .001) were associated with fewer purchases and lower expenditures; neither preemption nor local laws were associated. However, interactions were found between preemption law status and percentage of residents younger than 18 years (Purchases: ß = 5 477 332, P < .001; Expenditures: ß = 15 400 000, P = .01), such that there were greater purchases and expenditures in counties with more youth residents, but the increases were steeper in counties in states with (vs. without) preemption on youth access.
Conclusions:
While smoke-free laws and cigarette taxes remain strongly associated with fewer cigarette purchasing, state preemption may be linked to disproportionately higher purchasing in counties with larger youth populations. Policies limiting preemption and strengthening local authority, alongside comprehensive state measures, may complement comprehensive state tobacco control measures in communities with larger youth populations.
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