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Most US states have had laws to restrict the sale of cigarettes to minors for decades.' Because there was widespread violation of these laws by tobacco vendors,' Congress passed the Synar Amendment to the Public Health Service Act in 1993,3 which required that states enact laws banning cigarette sales to minors and that they enforce such laws with compliance checks using undercover "decoys" posing as underage customers 4,s Enforcement of these youth access regulations is a central feature of US tobacco control programs. However, although compliance checks of vendors have been shown to reduce sales to minors, their effectiveness in reducing youth smoking rates is less certain, for example, because they may obtain cigarettes legally purchased by older friends.6.7 Key regulatory features that are reported to reduce both compliance violations and youth cigarette use include a mandatory tobacco retailer licensing fee to provide sustainable funding of undercover decoys to make at least 1 annual visit to each vendor and fines or penalties for violations.7,8 Low rates of vendor compliance checks, which occur annually at only a small fraction of tobacco vendors under existing state and federal enforcement programs,9.10 and inadequate penalties may explain why associations with youth smoking rates have not consistently been observed.? Within states, compliance enforcement may vary markedly on the basis of local ordinances that provide funding to do so. Given the expense involved in enforcement and the lack of expert consensus on its benefits, additional studies are warranted to assess the effectiveness in reducing youth cigarette use. The impact of youth access restriction on the initiation of alternative tobacco products, such as electronic cigarettes (e-cigarettes), hookah, and cigars, has not been studied, although prevalence of ever using these products is high." An additional gap in understanding the effectiveness of youth tobacco access restriction is during the transition to the legal age of purchase. Most adult smokers historically have initiated cigarette use by age 18,11 which is the legal age of purchase in most states. There have been few prospective studies examining the effect of tobacco licensing and youth access restriction on cigarette and alternative tobacco product use during this transition to adult life. Among participants in the Southern California Children's Health Study, we evaluated whether youth living in jurisdictions with a strong tobacco retail licensing (TRL) ordinance had reduced prevalence of cigarette and other tobacco use, compared with participants in jurisdictions with a poor TRL ordinance. In addition, using prospectively collected data, we assessed the association of local ordinances with the initiation of tobacco product use during a cohort follow-up as youth reached 18 years of age, the age at which the sale of tobacco products was legal in California at the time of the study. METHODS Study Population Between January and June of 2014, a total of 209711th- and 12th-grade participants in the Southern California Children's Health Study (mean age: 17.3; SD: 0.6) completed self-administered questionnaires collecting detailed information about cigarette and alternative tobacco product use. Follow-up online questionnaire data were collected on 1SS3 participants (74%of the 2097 at baseline) as they reached 18 years of age, between January 201S and June 2016 (mean age: 18.8; SD: 0.6). Additional characteristics of the study sample have been described previously.13,14 Ethics Statement The study was approved by the University of Southern California Institutional Review Board. Parental written informed consent and child assent were obtained for all Children's Health Study participants <18 years of age. Participants age 18 or older provided written informed consent. Tobacco and Alternative Tobacco Product Use At each survey, participants were asked whether they had ever tried e-cigarettes, cigarettes, cigars, or hookah and the number of days each product was used in the past 30 days." Participants who had "never tried" a product (not "even 1 or 2 puffs") were classified as never users. Those reporting an age at first use of each tobacco product were classified as ever (lifetime prevalent) users of that product at baseline. Rates of initiation were calculated on the basis of a new report of use of a tobacco product at follow-up among participants not reporting use of that product at baseline. Both prevalent users and initiators of each tobacco product were further characterized on the basis of past 30-day use. Evaluation of Local Tobacco Regulatory Licensing to Reduce Youth Access There were 14 political jurisdictions with corresponding tobacco product ordinances across the 12 participating Children's Health Study communities. Four study jurisdictions were assigned an A grade on the basis of the 2014 American Lung Association (ALA) "Reducing Sales of Tobacco Products" to youth scale, which is used to evaluate the strength of the local TRL ordinance across California." An A grade required adequate annual retail license fees, which were paid by all tobacco retailers (including gas stations, convenience stores, larger grocery stores, and pharmacies), Downloaded from wwwnappublications.org/news by guest on May 7, 2019 ASTOR at al