Dataset Information

California's tobacco 21 minimum sales age law and adolescents' tobacco and nicotine use: differential associations among racial and ethnic groups.

ABSTRACT:

Objective

A California, USA, law raised the minimum tobacco sales age to 21 (T21) on 9 June 2016. We investigated whether T21 was associated with reductions adolescents' use of tobacco cigarettes, smokeless tobacco and electronic cigarettes and whether these associations differed across racial and ethnic groups.

Methods

Secondary analyses of data from 2 956 054 7th, 9th and 11th grade students who participated in the California Healthy Kids Survey from 2010-11 to 2017-2018.

Results

Multilevel mixed effects logistic regression analyses showed that T21 was associated with reduced prevalence of lifetime smokeless tobacco and e-cigarette use and past month smokeless tobacco use in the overall student population. T21 was associated with increases in prevalence of past month e-cigarette use. Moderation analyses indicated differences by racial and ethnic groups. Notably, T21 was associated with reductions in lifetime and past 30-day use of all tobacco and nicotine products among Latinx youth. The findings were more mixed for other racial and ethnic groups. Slopes analyses indicated that T21 was associated with accelerated downward trends for 30-day cigarette and smokeless use; moderated trends for lifetime cigarette smoking such that downward slopes became less steep; and reversed downward trends for e-cigarette use. Changes in slopes varied across racial and ethnic groups.

Conclusions

Our findings highlight the importance of understanding the complex associations that T21 and other tobacco control policies have with the use of different tobacco and nicotine products among racial and ethnic groups. Future research should investigate mechanisms underlying these differences to inform tobacco control efforts.

SUBMITTER: Grube JW

PROVIDER: S-EPMC8716668 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Publications

California's tobacco 21 minimum sales age law and adolescents' tobacco and nicotine use: differential associations among racial and ethnic groups.

Grube Joel W JW Lipperman-Kreda Sharon S García-Ramírez Grisel G Paschall Mallie J MJ Abadi Melissa H MH

Tobacco control 20210630 e2

<h4>Objective</h4>A California, USA, law raised the minimum tobacco sales age to 21 (T21) on 9 June 2016. We investigated whether T21 was associated with reductions adolescents' use of tobacco cigarettes, smokeless tobacco and electronic cigarettes and whether these associations differed across racial and ethnic groups.<h4>Methods</h4>Secondary analyses of data from 2 956 054 7th, 9th and 11th grade students who participated in the California Healthy Kids Survey from 2010-11 to 2017-2018.<h4>Res ...[more]

PMID: 34193606

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Project description:IntroductionIn 2016, California enacted a law (T21) prohibiting tobacco product sales to individuals under 21 years of age. Given tobacco use disparities among sexual minority (SM) youth, this study investigated whether California's T21 law was differentially associated with changes in tobacco use for SM and non-SM adolescents.Aims and methodsSecondary analyses of California Healthy Kids Survey data from 2013-2014 to 2018-2019 for 7th, 9th, and 11th graders (N = 2 229 401).ResultsMultilevel mixed-effects logistic regression analyses showed that SM students were more likely than non-SM students to report past-30-day and lifetime cigarette (odds ratio (OR) = 2.47; OR = 2.37), e-cigarette (OR = 1.21; OR = 1.10), smokeless tobacco use (OR = 1.95; OR = 1.56), and use of any tobacco product (OR = 1.94; OR = 1.61). Among SM youth, T21 was associated with significant reductions in lifetime e-cigarette use (OR = 0.66), and lifetime use of any tobacco products (OR = 0.75). These decreases generally were greater than or equivalent to those observed for non-SM youth. For 30-day e-cigarette and any tobacco use, SM youth showed no significant increases, whereas non-SM youth showed significant increases (OR = 1.06; OR = 1.11) following T21. T21 was associated with smaller increases in lifetime cigarette use (OR = 1.34), and larger increases for past-30-day and lifetime smokeless tobacco use (OR = 1.34; OR = 1.28) among SM students, to those observed for non-SM students.ConclusionsCalifornia's T21 policy may help reduce tobacco use disparities among SM students who are more at risk for tobacco use than their non-SM peers.ImplicationsResearch on associations of T21 laws with tobacco use among sexual minority (SM) adolescents is lacking. The potential for unintended consequences of T21 for these adolescents raises concerns about increased health disparities. Importantly, our study generally found California's T21 was associated with reductions in tobacco use among SM students that were equivalent to or greater than those for non-SM students. Future research should investigate whether T21 laws and similar policies have differential effects for other marginalized groups and, if so, identify mechanisms that can be targeted in prevention efforts.

Project description:IntroductionBeverly Hills and Manhattan Beach were the first California cities to end tobacco sales. Previous research assessed retailers' perceptions of the laws. This study is the first to evaluate compliance (Study 1), assess whether branded or unbranded tobacco cues remain, and examine cigarette prices/discounts in cross-border stores (Study 2).Aims and methodsEach of the four data collectors requested Marlboro or e-cigarettes (randomly assigned) in all restricted stores (n = 33) until four attempts were exhausted or a violation occurred. Follow-up visits recorded whether former tobacco retailers advertised tobacco or contained unbranded cues. In a random sample of 126 cross-border stores (half within 1 mile of no-sales cities and half 2-4 miles away), data collectors recorded price of Marlboro and presence of cigarette discounts. Mixed models (stores within tracts), tested for differences between near and far stores, adjusting for store type and median household income.ResultsCompliance was 87.5%: three stores sold Marlboro (US $8, $10, and $10) and one sold Puff Bar (US $16). Tobacco-branded items and unbranded tobacco cues remained in one store each. Mean Marlboro price was US $10.61 (SD = 1.92) at stores within 1 mile of no-sales cities, averaging US $0.73 more than at stores farther away (p < .05). However, odds of advertising cigarette discounts did not differ between stores nearby and farther from no-sales cities.ConclusionsNearly all retailers complied with tobacco sales bans within 6-12 months of implementation. In addition, retail tobacco marketing was nearly eliminated in the two cities. There was no evidence of price gouging for Marlboro cigarettes in cross-border stores.ImplicationsEvidence from two early adopters of tobacco sales bans suggests that such local laws can be implemented effectively in California, although results from these high-income cities in a state with a strong tobacco control record limits generalizability. Enforcement involving routine purchase attempts rather than visual inspection of tobacco products is recommended. Although Beverly Hills and Manhattan Beach are each surrounded by communities where tobacco sales persist, there was no evidence of price gouging for cigarettes or greater presence of discounts in cross-border stores. Evaluations of the economic impacts and public health benefits of tobacco sales bans are much needed.

Project description:IntroductionTelehealth can potentially improve the quality of healthcare through increased access to primary care. While telehealth use increased during the COVID-19 pandemic, racial/ethnic disparities in the use of telemedicine persisted during this period. Little is known about the relationship between health coverage and patient race/ethnicity after the onset of the COVID-19 pandemic.ObjectiveThis study examines how differences in patient race/ethnicity and health coverage are associated with the number of in-person vs. telehealth visits among patients with chronic conditions before and after California's stay-at-home order (SAHO) was issued on 19 March 2020.MethodsWe used weekly patient visit data (in-person (N = 63, 491) and telehealth visits (N = 55, 472)) from seven primary care sites of an integrated, multi-specialty medical group in Los Angeles County that served a diverse patient population between January 2020 and December 2020 to examine differences in telehealth visits reported for Latino and non-Latino Asian, Black, and white patients with chronic conditions (type 2 diabetes, pre-diabetes, and hypertension). After adjusting for age and sex, we estimate differences by race/ethnicity and the type of insurance using an interrupted time series with a multivariate logistic regression model to study telehealth use by race/ethnicity and type of health coverage before and after the SAHO. A limitation of our research is the analysis of aggregated patient data, which limited the number of individual-level confounders in the regression analyses.ResultsOur descriptive analysis shows that telehealth visits increased immediately after the SAHO for all race/ethnicity groups. Our adjusted analysis shows that the likelihood of having a telehealth visit was lower among uninsured patients and those with Medicaid or Medicare coverage compared to patients with private insurance. Latino and Asian patients had a lower probability of telehealth use compared with white patients.DiscussionTo address access to chronic care management through telehealth, we suggest targeting efforts on uninsured adults and those with Medicare or Medicaid coverage, who may benefit from increased telehealth use to manage their chronic care.

Dataset Information

California's tobacco 21 minimum sales age law and adolescents' tobacco and nicotine use: differential associations among racial and ethnic groups.

Objective

Methods

Results

Conclusions

Publications

California's tobacco 21 minimum sales age law and adolescents' tobacco and nicotine use: differential associations among racial and ethnic groups.

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