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3.0 found reduced smoking rates in <br />communities with youth access <br />Lifetime use <br />Past 30-day use <br />restrictions,but it was not clear <br />15 that reduced access mediated the <br />reduction in smoking rates.19,23 For <br />example,sustained reductions in <br />2.0 <br />adolescent daily smoking rates wereU <br />a°observed in Minnesota communities <br />that were randomly assigned to <br />s <br />intervention supporting community <br />organizers to develop and promote10 <br />a.°good TLR ordinances,compared <br />with nonintervention communities.20 <br />However,it was not clear whether <br />0.5 the observed reductions in <br />smoking rates were due to youth <br />access restrictions and improved <br />o° vendor compliance or to other <br />Cigarettes E-cigarettes Hookah Cigars Anytobacco regulatory features resulting from <br />FIGURE 1 <br />the intervention,such as bans on <br />Associations of prevalent lifetime and current(last 30-day)use of each tobacco product at baseline vending machines and requirements <br />with residence in ALA Reduced Tobacco Sales grade A jurisdictions, compared with residence for posted signs reporting age of <br />in grade D or F jurisdictions. Models were adjusted for sex, ethnicity, parental education, age at sale policies,or for storing cigarettes <br />baseline, and for any other tobacco product use at baseline (except for any tobacco product use behind the sales counter.17 <br />prevalence,which was compared with never users of any tobacco product) and included a random <br />effect for jurisdiction. <br />Our results are broadly consistent <br />with findings of a comprehensive <br />3.0 <br />review in which authors concluded <br />Initiation that lower smoking rates occur if <br />2.5 <br />Initiationwith past30 day use local TRL requires yearly compliance <br />checks with effective enforcement.? <br />Our study is 1 of the few that <br />o assessed associations of TRL with <br />v both prevalence and initiation <br />rates in a prospective assessment <br />e of the same participants during <br />an adolescent period of known <br />o high incidence of initiation.The <br />1° prospective cohort design of the <br />study also provided the opportunity <br />to examine the impact of TRL on <br />a 5 <br />legal tobacco product use by young <br />adults.The reduced risk of initiation <br />0.0- <br />of cigarette and e-cigarette use <br />at follow-up in jurisdictions with <br />Cigarettes E-cigarettes Hookah Cigars Anytobacco <br />better TRL regulation(with effect <br />FIGURE 2 estimates that were unaffected by <br />Associations of initiation of use of each tobacco product between baseline and follow-up and of adjusting for time since turning 18 at <br />initiation and current (last 30-day) use, with residence in ALA Reduced Tobacco Sales grade A follow-up)suggests that regulation <br />jurisdictions, compared with residence in grade D or F jurisdictions. Each model was restricted <br />may have lowered initiation ratestononusersofproductatbaseline. Models were adjusted for sex, ethnicity, parental education, <br />age at baseline,and for any other tobacco product use at baseline(except for any tobacco product even after participants reached the <br />use initiation,which was compared with never users of any tobacco product at either baseline or age for legal purchase.Although most <br />follow-up)and included a random effect for jurisdiction. adult smokers historically first use <br />cigarettes before age 18,12 in our <br />cohort,rates of initiation of tobacco <br />Downloaded from www.aappublications.org/news by guest on May 7,2019 <br />PEDIATRICS Volume 143,number 2,February 2019 5