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E-cigarette-inclusive smoke-free policies, excise taxes, tobacco 21 and changes in youth e-cigarette use: 2017–2019
  1. Kelvin Choi1,
  2. Toluwa Omole2,
  3. Thomas Wills3,
  4. Ashley L Merianos4
  1. 1 Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
  2. 2 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  3. 3 Cancer Center, University of Hawaii, Honolulu, Hawaii, USA
  4. 4 School of Human Services, University of Cincinnati, Cincinnati, Ohio, USA
  1. Correspondence to Dr Kelvin Choi, Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA; kelvin.choi{at}


Background We examined whether the implementation of electronic cigarette (e-cigarette) policies at the state level (e-cigarette-inclusive smoke-free (ESF) policies, excise taxes on e-cigarettes and raising tobacco legal purchasing age to 21 years (T21)) affected recent upward trends in youth e-cigarette use.

Methods Data were from participants from 34 US states who completed the Youth Risk Behavior Survey (YRBS) state surveys in 2017 and 2019 (n=278 271). States were classified as having or not having ESF policies, any e-cigarette excise tax and T21 policies by 1 January 2019. Participants reported ever, past 30-day and frequent (≥20 days) e-cigarette use; past 30-day combustible cigarette smoking; and age, sex and race/ethnicity. Weighted multivariable logistic regression models assessed whether changes in e-cigarette use over time differed by policy status, adjusting for participants’ demographics and combustible cigarette smoking.

Results Prevalence of ever and past 30-day youth e-cigarette use in states with ESF policies decreased during 2017–2019, while the prevalence of these measures in states without ESF policies increased. States with T21 policies showed non-significant changes in prevalence of ever and past 30-day youth e-cigarette use, whereas states without T21 policies showed significant increases in ever and past 30-day youth e-cigarette use. States with ESF and T21 policies showed slower increases in youth frequent e-cigarette use. E-cigarette excise taxes were not associated with decreasing prevalence of youth e-cigarette use.

Conclusions State-level ESF and T21 policies could be effective for limiting growth of youth e-cigarette use despite an overall national increase. Higher e-cigarette excise tax rates may be needed to effectively reduce youth e-cigarette use.

  • public policy
  • electronic nicotine delivery devices
  • taxation
  • surveillance and monitoring

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  • Contributors KC and TO conceptualised the research question; KC acquired the data and performed the analyses; all authors interpreted the findings; KC drafted the initial manuscript; all authors reviewed the intellectual content of the manuscript and approved its final version for publication.

  • Funding KC was supported by the National Institute on Minority Health and Health Disparities Division of Intramural Research. ALM was supported by the National Institute of Environmental Health Sciences (Grant Number R21ES032161).

  • Disclaimer Opinions and comments expressed are the authors’ own and do not represent those of the US Government, Department of Health and Human Service, National Institutes of Health or National Institute on Minority Health and Health Disparities.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.