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to cover the administration of an college,or completed college or ALA 2014 TRL A grade,and 68.9%
<br />enforcement program and regular more). 1445)students lived in jurisdictions
<br />compliance checks in each store.An with D or F grades.Sex and ethnic
<br />A grade also required(1)an annual Statistical Analysis distributions were similar in A and
<br />renewal of this local license; (2)a D or F jurisdictions,but students in
<br />provision that any violation of local,
<br />Unconditional logistic regression
<br />models were used to evaluate the A jurisdictions were more likely to
<br />state,or federal law is a violation come from less-educated households
<br />of the license;and(3)a graduated
<br />associations of living in a jurisdiction
<br />with Table 1).Unadjusted prevalence
<br />penalty system for violators,
<br />r
<br />ALA grade A versus D or F
<br />and initiation rates for each tobacco
<br />including financial deterrents such
<br />TRL ordinance with baseline ever
<br />product were lower in jurisdictions
<br />as fines or other penalties,including
<br />and past 30 day use of cigarettes,
<br />with A than with D or F grades,
<br />license revocation or suspension.
<br />15 e-cigarettes,hookah,cigars,or use
<br />with the exception of new initiation
<br />of any of these tobacco products in
<br />of hookah with past 30-day use.
<br />The remaining study jurisdictions separate models.Models were also fit
<br />Initiation rates were substantial
<br />were assigned an F grade(8)or a to evaluate associations of ALA grade
<br />among never tobacco product
<br />D grade(1).An F grade indicated with the initiation of each product,
<br />with or without past 30-day use.In users at baseline,in particular for
<br />either(1)no local ordinance p y e-cigarette use.Both prevalence and
<br />mandating a license fee or(2)a fee models used to evaluate the initiation
<br />initiation rates of past 30-day tobacco
<br />insufficient to fund administrative of use of each tobacco product product use generally did not exceed
<br />and compliance checks as well as between baseline and follow-up,the
<br />10%for any product.
<br />none of the 3 other provisions for an sample was restricted to baseline
<br />A grade.The jurisdiction with the D never users of that product.Odds For baseline prevalence of ever and
<br />grade had a licensing fee that was ratios(ORs)and 95%confidence past 30-day use of cigarette and
<br />insufficient to cover administration intervals(CIs)were used to estimate e-cigarette ever use,and to a lesser
<br />and compliance checks,but it had the association of each tobacco degree for prevalence of cigar use,
<br />at least 1 of the other 3 provisions product use with an ALA grade. jurisdictions with A grades had
<br />listed above that were needed for an All models were adjusted for sex, generally lower use rates than D or
<br />A grade.The D and F communities ethnicity,highest parental education, F jurisdictions(Supplemental Fig 3).
<br />were collapsed for data analysis, and baseline age,factors that have However,within both grade groups,
<br />because the insufficient annual fee been associated both with e-cigarette there was considerable variability in
<br />is a central feature of regulation to use and cigarette use in previous prevalence rates across jurisdictions
<br />reduce youth access.
<br />7,15 No study studies.13,14 Each tobacco product—for all tobacco products.Rates in
<br />jurisdiction in this sample had B or C specific model was also adjusted for individual jurisdictions had wide Cls
<br />grades corresponding to TRL policies a baseline history of use of any other (results not shown)because of small
<br />of intermediate quality.
<br />15 tobacco product,because there was sample size.Rates of tobacco product
<br />clustering of the tobacco product initiation at follow-up were also
<br />ALA assigned grades to other outcomes.
<br />13 A missing indicator generally quite variable across the
<br />categories of tobacco policy(smoke- category for covariates and any other jurisdictions within both A and D or F
<br />free housing policy,smoke-free tobacco product use was included grades(Supplemental Fig 4).
<br />outdoor policy,and overall tobacco where appropriate.Additionally,all At baseline,participants living in the
<br />policy).
<br />15 These policies,which are models included a random effect for 4 jurisdictions with A grades had
<br />not specific to youth tobacco product community to account for similarities lower odds of ever using a cigarette
<br />access,were not associated with
<br />among subjects within jurisdictions. (OR 0.61;95%CI 0.41-0.90)and
<br />tobacco product use in this study,and In a sensitivity analysis,models were of past 30-day use(OR 0.51;95%
<br />results are not presented. further adjusted for time between CI 0.29-0.89)than participants in
<br />baseline and follow-up questionnaire 10 D-to F-grade jurisdictions,after
<br />Covariates completion.Statistical analyses were adjusting for so cio demographic
<br />Self-administered questionnaires
<br />based on 2-sided hypotheses tested covariates and other tobacco product
<br />completed by parents of
<br />at a 0.05 level of significance,using use at baseline(Fig 1).
<br />SAS 9.4(SAS Institute,Inc,Cary,NC).
<br />participants were used to assess Living in A-grade jurisdictions
<br />socio demographic characteristics, was associated with lower odds
<br />including sex,ethnicity(Hispanic,
<br />RESULTS
<br />of initiation of cigarette use
<br />non-Hispanic white,other),age at between baseline and the follow-up
<br />baseline,and parental education Of the 2097 participants,31.1% questionnaire(OR 0.67;95%CI
<br />completed high school or less,some (652)lived in a jurisdiction with an 0.45-0.99[Fig 2]).The risks of
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<br />PEDIATRICS Volume 143,number 2,February 2019 3
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