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TABLE 1 Prevalence of Sociodemographic Characteristics,Lifetime,and Current(Last 30-Day)Use of sufficient to fund compliance checks Each Tobacco Product at Baseline and Rates of Product Initiation at Follow-up Among Youth and enforcement of regulations Residing in a Jurisdiction With ALA Reduced Tobacco Sales,Grade A or D or F prohibiting tobacco sales to minors Grade A Grade D or F and penalties for violating the law, N(%a) N(%a) features of TRL that have been Sex reported to be necessary to reduce Male 324(49.7) 735(50.9) sales to and use by youth.?Compared Female 328(50.3) 710(49.1) with living in a jurisdiction with poor Ethnicity TRL policy,youth in a jurisdiction Hispanic white 349(53.5) 736(50.9) satisfying these criteria were less Non-Hispanic white 230(35.3) 504(34.9) likely to smoke in high school.In a Other 73(11.2) 205(14.2) Parent education prospective follow-up of the cohort, Less than or equal to high school 245(41.3) 460(34.3) the odds of initiation of e-cigarette Some college 219(36.9) 502(37.4) use,with or without past 30-day College or more 129(21.8) 379(28.3) use,and of initiation of cigarette use Prevalent ever tobacco product use at baseline were also lower in well regulated Cigarette 89(13.7) 302(21.0) E-cigarette 123(19.0) 379(26.4) jurisdictions.Stronger associations Hookah 158(24.3) 411 (28.6) among participants still living in their Cigars 69(10.6) 204(14.2) jurisdiction of origin at follow-up Any tobacco product 214(32.9) 564(39.2) evaluation,with consistent exposure Prevalent past 30-d tobacco product use at baseline to the same regulatory environment Cigarette 24(3.7) 95(6.6) E-cigarette 56(8.6) 145(10.1) throughout,also suggest that the Hookah 62(9.5) 162(11.3) benefits of good TRL policy extended Cigars 21 (3.2) 55(3.8) both beyond cigarette use to Any tobacco product 107(16.5) 267(18.6) e-cigarette use and into early adult Initiation oftobacco product use(between baseline and follow life at age 18 when the sale of Up)e Cigarette 52(13.1) 156(18.0) products was legal at the time of the E-cigarette 92(24.7) 235(29.7) study.The protective associations Hookah 55(15.9) 146(18.9) were large,with risk lower by one- Cigars 49(12.0) 158(17.1) third to a half in the strong compared Any tobacco product 85(27.7) 198(30) Initiation with past 30-d tobacco product use at follow-upe with weak TRL jurisdictions Cigarette 17(4.3) 52(6.0) (depending on the outcome). E-cigarette 17(4.7) 69(8.9) Hookah 16(4.7) 32(4.2) There has been uncertainty Cigars 12(2.9) 36(3.9) Any tobacco product 24(7.9) 78(12.1) regarding the effects of youth access restrictions on cigarette use.6,7,16 a The denominator(652 in grade A;1445 in grade D or F)varies because of missing values in covariates. h Restricted to nonusers of each product(or of any tobacco product)at baseline. Some authors Of prospective Studley in which age-specific prevalence of initiation of e-cigarettes(OR 0.74; compared with D-or F-grade tobacco use was assessed before 95%CI 0.55-0.99)and of initiation associations with cigarette and and after regulatory intervention with past 30-day use(OR 0.45;95%CI e-cigarette initiation at follow-up(and to restrict youth access found 0.23-0.90)were also lower in A-grade ofinitiation of e-cigarettes with past reductions in cigarette use,17-20 but than D-or F-grade jurisdictions.In 30-day use)than in the entire sample others found no benefit.21,22 Authors results not shown sensitivity analyses adjusting for time ( )•The protective of 1 review of studies that reported association of A rade residence with changes in smoking associated with since turning 18 at follow-up,there g youth access restrictions found no was no change in the protective effect initiation of cigar use was similar in magnitude to the association with relationship of vendor compliance estimate of living in awell-regulated or of changes in vendor compliance, A- jurisdiction results not cigarette and e-cigarette use but was ( grade) ( not statistically significant. with smoking prevalence in a shown).Participants still living in meta-analysis of available studieS,6 their jurisdiction of origin at follow-up perhaps because the restriction of evaluation would have had consistent DISCUSSION commercial access resulted in a shift exposure to the same regulatory to social sources of cigarettes such environment.In this sample,there Central features of the ALA TRL as older friends or siblings.Authors were stronger protective A-grade grade include a licensing fee of other observational studies have Downloaded from www.aappublications.org/news by guest on May 7,2019 4 ASTOR et al