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Tobacco Retail Licensing
<br />and Youth Product Use
<br />Roee L.Astor,MPH,a Robert Urman,PhD,a Jessica L.Barrington-Trimis,PhD,a Kiros Berhane,PhD,a
<br />Jane Steinberg,PhD,a Michael Cousineau,PhD,a Adam M.Leventhal,PhD,a Jennifer B.Unger,PhD,a
<br />Tess Cruz,PhD,a Mary Ann Pentz,PhD,a Jonathan M.Samet,MD,MS,e Rob McConnell,MDa
<br />BACKGROUND:Restricting youth access to tobacco is a central feature of US tobacco regulatory
<br />policy,but impact of local tobacco retail licensing(TRL)regulation on cigarette smoking
<br />rates remains uncertain.Effects of TRL on other tobacco product use and use as adolescents
<br />reach the age to legally purchase tobacco products has not been investigated.
<br />METHODS:Prevalences of ever and past 30-day cigarette,electronic cigarette(e-cigarette),
<br />cigar,and hookah use were assessed in a survey of a cohort of 1553 11th-and 12th-grade
<br />adolescents (mean age: 17.3 years);rates of initiation were evaluated 1.5 years later.An
<br />American Lung Association (2014)youth access grade was assigned to each of 14 political
<br />jurisdictions in which participants lived on the basis of the strength of the local TRL
<br />ordinance.
<br />RESULTS:At baseline,participants living in 4 jurisdictions with`A"grades (ie,with most
<br />restrictive ordinances)had lower odds of ever cigarette use (odds ratio [OR] 0.61;95%
<br />confidence interval [CI] 0.41-0.90)and of past 30-day use (OR 0.51; 95%Cl 0.29-0.89)
<br />than participants in 10 D-to F-grade jurisdictions.At follow-up at legal age of purchase,
<br />lower odds of cigarette use initiation(OR 0.67; 95%Cl 0.45-0.99)occurred in jurisdictions
<br />with stronger TRL policy.Lower odds of e-cigarette initiation at follow-up(OR 0.74; 95%
<br />Cl 0.55-0.99)and of initiation with past 30-day use (OR 0.45;95%Cl 0.23-0.90)were also
<br />associated with better regulation.
<br />CONCLUSIONS:Strong local TRL ordinance may lower rates of cigarette and e-cigarette use
<br />among youth and young adults.
<br />l U
<br />WHAT'S KNOWN ON THIS SUBJECT.Restricting youth
<br />access to tobacco has long been a central feature of
<br />Department of Preventive Medicine,Keck School of Medicine,University of Southern California,Los Angeles,
<br />UStobaCCOregLllatorypollCy,buttheimpactoflocalCalifornia;and°Colorado School of Public Health,University of Colorado Anschutz Medical Center,Aurora,
<br />Colorado tobacco retail licensing regulation on electronic
<br />cigarette use rates remains uncertain.
<br />Or McConnell conceptualized and designed the study and reviewed and revised the manuscript;
<br />Mr Astor collected data on tobacco retail licensing in study communities,conducted a literature WHAT THIS STUDY ADDS:Strong local tobacco retail
<br />review,and drafted the manuscript;Or Urman conducted all data analyses;Drs Barrington-Trimis, licensing ordinances may lower rates of cigarette
<br />Berhane,Steinberg,Cousineau,Leventhal,Unger,Cruz,Pentz,and Samet provided advice on the and electronic cigarette use among youth and
<br />analysis and interpretation of results and reviewed and provided guidance on the development of young adults.Success of regulations restricting
<br />the manuscript;and all authors approved the final manuscript as submitted.youth access to cigarettes and alternative tobacco
<br />001:https://doi.org/10.1542/peds.2017-3536 products may depend on ensuring a robust
<br />Accepted for publication Oct 31,2018 enforcement scheme.
<br />Address correspondence to Rob McConnell,MD,Department of Preventive Medicine,Keck School
<br />of Medicine,University of Southern California,2001 N Soto St,230-D,Los Angeles,CA 90089.E-mail:
<br />rmcconne@usc.edu
<br />PEDIATRICS(ISSN Numbers:Print,0031-4005;Online,1098-4275).
<br />Copyright©2019 by the American Academy of Pediatrics
<br />To cite:Astor RL, Urman R, Barrington-Trimis JL, et al.
<br />Tobacco Retail Licensing and Youth Product Use.Pediatrics.
<br />2019;143(2):e20173536
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<br />PEDIATRICS Volume 143,number 2,February 2019:e20173536
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