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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 aAnalternativeexplanation
<br />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
<br />the exception of a few states that
<br />have prohibited local jurisdictions
<br />associations reflected broadly Administration(FDA)has contracts
<br />from enacting more stringent local
<br />unfavorable community attitudes with regulators in most states to
<br />from enacting
<br />The increase
<br />n
<br />poorlytowardcigaretteuse,including restrict youth tobacco access and reguregulated . cigarette Internet
<br />other tobacco regulations that also conducts its own inspections
<br />vendors a relatively new way foraffectedtheuseofcigarettesandandhiresthirdpartiestoconduct
<br />e-cigarettes to minors.If this were compliance checks.
<br />8 minors ,o obtain tobacco productsHowever,the
<br />illegally the time of data collection,
<br />the explanation,we might expect frequency of compliance checks is
<br />TRL
<br />may impact oflimitthefutureimpa
<br />to have seen associations with generally low,because of resource
<br />lili
<br />a regulatory tmpa Future
<br />the other ALA tobacco grades limitations,and penalties for
<br />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
<br />warranted
<br />housing,smoke-free outdoor air, between states.California,for
<br />associations with strong youth
<br />of
<br />or the overall tobacco grade in a example,which has been a leader
<br />TRL and to examine longitudinallyjurisdiction.However,protective in tobacco control,annually potential mediating factors,
<br />effects only of the TRL grade were inspected,on average,only 7%of
<br />such as social characteristics of
<br />observed. tobacco retailers in 2016.9,10 If a
<br />neighborhoods and communities and
<br />high rate of compliance checks,
<br />Lower odds of cigar use initiation
<br />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
<br />necessary reduce youth smoking also other potential confounders or
<br />significant,were similar in magnitude
<br />local TRL ordinances may be an
<br />mediators of TRL effects,such as
<br />to reductions in odds of the initiation
<br />important option to reduce teen
<br />differences in school-level tobacco
<br />of cigarettes and e-cigarettes.prevention programs or number of
<br />tobacco product use through accessHowever,living in a jurisdiction
<br />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.
<br />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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