Conference Coverage

State e-cigarette laws linked to reduced youth use

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Comment by Dr. Susan Millard, MD, FCCP

Dr. Susan Millard

Dr. Susan Millard

This report highlights how much we need to learn about e-cigarettes and consequences for all at-risk groups, including teens. Plus, we need to learn it FAST!



Several state regulations governing the sales or use of e-cigarettes and related products were associated with lower proportions of youth trying or regularly using vaping products, a new study found.

Restricting sales of electronic vapor products to minors, however, was not linked to a lower risk of vaping among teens.

Dr. Sarah A. Keim of Nationwide Children’s Hospital in Columbus, Ohio

Dr. Sarah A. Keim

“It may be too soon to tell if the state level restrictions are having an impact,” said lead author Sarah A. Keim, PhD, of Nationwide Children’s Hospital in Columbus, Ohio, in an interview. “However, it was reassuring to see these early indicators that they may be having an effect so early on, and so these findings were not surprising.”

Dr. Keim and her associates investigated possible associations between various state laws related to vaping products, all passed before 2015, and youth use of the products. They relied on 2015 data from 35 state-specific surveys of youth regarding use of vaping products and from the Youth Risk Behavior Survey from the Centers for Disease Control and Prevention, a nationally representative, biannual survey of students in grades 9-12. The Tobacco Control Laws Database of the American Nonsmokers’ Rights Foundation provided information on state laws related to electronic vapor products.

Among the 200,513 teens whose responses were included in the study, 44% had ever used any kind of electronic vapor product. Rates were similar between girls and boys for ever having tried one or currently using one, Dr. Keim reported at the Pediatric Academic Societies annual meeting.

Experimentation began young for most: 35% of respondents tried an e-cigarette before age 14 years, and 18% under age 14 currently use vaping products. By age 17, half of all kids had tried an e-cigarette or related product, and a quarter were currently using them.

The researchers looked at associations with each of the following types of laws:

• Statewide prohibition of vaping products on school property or in workplaces, which includes Arizona, New Hampshire, Vermont, and Virginia for schools and North Dakota for workplaces.

• Prohibition of sales to minors under age 18 years, present in 24 states.

• Prohibition or restriction of sales of e-cigarette products from vending machines, present in 17 states.

• Prohibition or restriction of self-service displays of vaping products, present in 11 states.

• Prohibition or restriction of sampling of electronic vapor products, present in Arizona, Delaware, Kentucky, Maryland, New Hampshire, North Carolina, Oklahoma, and South Carolina.

The risk of youth currently using electronic vapor products was 5% lower in states with the school grounds and workplace restrictions, and 13% lower in states that restricted self-service displays. Laws restricting minor sales were unrelated to the risk of current vaping among youth. Restricting vending machine sales of vaping products had no association with the risk of a teen ever trying vaping, but it was linked to a 7% lower risk of current use of the products among teens. All these associations were statistically significant based on confidence interval values.

Interestingly, a statistically significant risk increase in vaping use occurred for teens in states that restricted or outlawed sampling of vaping products. The risk was 8% higher for ever trying a product and 20% higher for current use. But those findings also could indicate the possibility of reverse causation.

“It’s possible that states that were particularly concerned about sampling had the worst problems – were the ones more likely to institute a ban on that practice, and that would generate the counterintuitive finding,” Dr. Keim said in an interview. “With the data currently available, we can’t look at teen use both before and after the restrictions, just afterwards, but with more data for 2017, it would provide a clearer picture of all of the associations we examined.”

Aside from these laws, other interventions have the potential to reduce vaping among teens as well.

“Restrictions on use in various types of public places and on school grounds may be additional helpful approaches, similar to what has been done with cigarettes,” Dr. Keim said. Although their analysis included laws that prohibited use on school grounds, only four states have one of these laws.

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