Original article
Are Tobacco Control Policies Effective in Reducing Young Adult Smoking?

https://doi.org/10.1016/j.jadohealth.2013.09.015Get rights and content

Abstract

Purpose

We examined the influence of tobacco control program funding, smoke-free air laws, and cigarette prices on young adult smoking outcomes.

Methods

We use a natural experimental design approach that uses the variation in tobacco control policies across states and over time to understand their influence on tobacco outcomes. We combine individual outcome data with annual state-level policy data to conduct multivariable logistic regression models, controlling for an extensive set of sociodemographic factors. The participants are 18- to 25-year-olds from the 2002–2009 National Surveys on Drug Use and Health. The three main outcomes are past-year smoking initiation, and current and established smoking. A current smoker was one who had smoked on at least 1 day in the past 30 days. An established smoker was one who had smoked 1 or more cigarettes in the past 30 days and smoked at least 100 cigarettes in his or her lifetime.

Results

Higher levels of tobacco control program funding and greater smoke-free-air law coverage were both associated with declines in current and established smoking (p < .01). Greater coverage of smoke-free air laws was associated with lower past year initiation with marginal significance (p = .058). Higher cigarette prices were not associated with smoking outcomes. Had smoke-free-air law coverage and cumulative tobacco control funding remained at 2002 levels, current and established smoking would have been 5%–7% higher in 2009.

Conclusions

Smoke-free air laws and state tobacco control programs are effective strategies for curbing young adult smoking.

Section snippets

Methods

NSDUH is a national survey of illicit drug, alcohol, and tobacco use by the U.S. civilian, noninstitutionalized population aged 12 years or older that has been conducted since 1971. The 2002–2009 NSDUH employed a state-based design with an independent, multistage area probability sample within each state and the District of Columbia. The design oversampled youths and young adults, so that each state's sample was approximately equally distributed among three age groups: 12 to 17 years, 18 to 25

Results

The trends in our key outcomes (Table 1) show that the prevalence of current and established smoking was lower in 2009 than in 2002 (p < .01), although past year initiation increased (p < .01). Over this same time, the three key tobacco control policy variables increased considerably. The U.S. average percentage of the state population covered by smoke-free air laws more than quadrupled from 15.4% to 71.1%. Inflation-adjusted per capita cumulative funding for state tobacco control programs and

Discussion

From 2002 to 2009, the prevalence of current and established smoking declined by 12% and almost 18%, respectively. However, over this same time, past year initiation increased by 28% (from 6.7% to 8.6%). Given that current smoking rates declined by nearly one third (from 13.0% to 8.9%) among 12- to 17-year-olds during this time period [5], this suggests that smoking initiation may be delayed for some youth, a finding that is consistent with Lantz [1]. From 2002 to 2009, smoke-free air laws

Acknowledgments

The authors would like to thank David Heller of RTI International for reviewing the statistical analyses.

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    Disclaimer: The findings and the conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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