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product use were substantial,even the time of the study,e-cigarettes will be required of all vendors of
<br /> in well-regulated jurisdictions.For were not specifically categorized as these products.31 The recent increase
<br /> example,in jurisdictions with an A a tobacco product.27 Therefore,vape in the legal age of tobacco product
<br /> grade,rates of initiation of cigarette shops were not required by state law purchase to 21 years in California,
<br /> and e-cigarette use during the to obtain a tobacco vendor license if passed after data collection for this
<br /> follow-up period were 13.1%and they were not selling other tobacco study was completed,means that
<br /> 24.7%,respectively(from Table 1); products.If strong TRL regulation the associations of TRL policy with
<br /> these high rates of experimentation was responsible for the lower use during the transition to legal
<br /> indicate a need for interventions to rates of e-cigarette use in A-grade age of purchase may no longer be
<br /> reduce initiation in this susceptible jurisdictions,it is possible that applicable to California.However,the
<br /> age window. similar TRL requirements for vape results may broadly be generalizable
<br /> shops would have resulted in larger to local jurisdictions in states with a
<br /> An alternative explanation for the protective effects of protective effects. legal purchase age of 18 years,with
<br /> better TRL policy is that the The US Food and Drug the exception of a few states that
<br /> have prohibited local jurisdictions
<br /> associations reflected broadly Administration(FDA)has contracts from enacting more stringent local
<br /> unfavorable community attitudes with regulators in most states to from enacting
<br /> The increase n poorly
<br /> toward cigarette use,including restrict youth tobacco access and reguregulated . cigarette Internet
<br /> other tobacco regulations that also conducts its own inspections vendors a relatively new way for
<br /> affected the use of cigarettes and and hires third parties to conduct
<br /> e-cigarettes to minors.If this were compliance checks. 8 minors ,o obtain tobacco products
<br /> However,the illegally the time of data collection,
<br /> the explanation,we might expect frequency of compliance checks is TRL may impact of
<br /> limit the future impa
<br /> to have seen associations with generally low,because of resource li li a regulatory tmpa Future
<br /> the other ALA tobacco grades limitations,and penalties for follow-up of this cohort warranted
<br /> .3
<br /> relating to,for example,smoke-free violation of the law vary widely to determine the persistence warranted
<br /> housing,smoke-free outdoor air, between states.California,for associations with strong youth
<br /> of
<br /> or the overall tobacco grade in a example,which has been a leader TRL and to examine longitudinally
<br /> jurisdiction.However,protective in tobacco control,annually potential mediating factors,
<br /> effects only of the TRL grade were inspected,on average,only 7%of such as social characteristics of
<br /> observed. tobacco retailers in 2016.9,10 If a neighborhoods and communities and
<br /> high rate of compliance checks,
<br /> Lower odds of cigar use initiation accompanied by enforcement,is individuals' changing tobacco social
<br /> associated with better TRL environment over time.There were
<br /> as our results suggest,then strong
<br /> regulation,although not statistically necessary reduce youth smoking also other potential confounders or
<br /> significant,were similar in magnitude local TRL ordinances may be an mediators of TRL effects,such as
<br /> to reductions in odds of the initiation important option to reduce teen differences in school-level tobacco
<br /> of cigarettes and e-cigarettes. prevention programs or number of
<br /> tobacco product use through access
<br /> However,living in a jurisdiction restriction.10,29,30 tobacco outlets by jurisdiction,that
<br /> with stronger regulation was not were not available to study.
<br /> protective for baseline prevalence The study has some limitations.The
<br /> or subsequent initiation of hookah ALA criteria for an A grade covered
<br /> use.Sales of hookah paraphernalia a relatively broad spectrum of TRL CONCLUSIONS
<br /> often occur in specialty shops and policy relevant to youth access,
<br /> hookah bars where cigarettes may including larger fees,compliance The results suggest that a strong
<br /> not have been sold24 and therefore access,and penalties if vendors local TRL ordinance that provides
<br /> may not consistently have been violated the law.Identifying the adequate resources to fund regular
<br /> subjected to the same rigorous possible effects of specific features compliance checks and enforcement
<br /> compliance checks as traditional of the TRL policy was not possible. may result in large reductions in
<br /> cigarette vendors.E-cigarettes are A minimum proportion of vendors the use of cigarettes and may also
<br /> commonly sold at locations that actually undergoing compliance result in reduced e-cigarette use.The
<br /> also sell cigarettes that would have checks was not specified,and it was benefits of these policies may extend
<br /> been subject to TRL regulation,and not possible to assess the effect of into early adult life.The study also
<br /> a state law passed in 2010 made it the proportion of vendors visited. suggests that the success of future
<br /> illegal to sell e-cigarettes to minors.25 In addition,the"deeming rule"that FDA regulation to reduce youth
<br /> However,e-cigarettes are also sold defined e-cigarettes and hookah as cigarette and alternative tobacco
<br /> in specialty"vape"shops,26 and at tobacco products means that TRL product access and use,under rules
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<br /> 6 ASTOR et al
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