Aim 2: Evaluate and compare the impacts of e-cigarette control policies on e-cigarette, tobacco, and cannabis use

The current landscape of federal, state, and local public policies to control youth e-cigarette use and protect non-users from e-cigarette vapors may be placed into five policy categories:

1) restricting the age that individuals can buy or be sold e-cigarettes
2) restricting or prohibiting sales of flavored products
3) limiting stores where e-cigarettes may be used or sold
4) restricting where e-cigarettes may be used (e.g., clean indoor air laws)
5) taxing e-cigarettes

The school interview policies included in analysis for a given school district may include implementing tobacco-free school policy components, substance use curriculum, screening for e-cigarette use, enforcement action against e-cigarette use and disciplinary action.

Through this quantiative aim, our research team will compare the independent impacts of five e-cigarette policy categories at the state and national levels (age limits, flavor restrictions, clean indoor air laws, sales restrictions, and taxation) on e-cigarette, tobacco, and cannabis use. We will also assess the impacts of municipal/school policies at the local level using data from 25 communities in the MetroWest region outside of Boston, MA. Data for these analysis will be drawn from following health risk behavior surveys: Behvaioral Risk Factor Surveillance Survey (BRFSS), Youth Risk Behavior Surveillance Survey (YRBSS), and the Metro West Adolescent Health Survey.

Behvaioral Risk Factor Surveillance Survey (BRFSS)

The BRFSS is an annual survey coordinated by the Centers for Disease Control and Prevention (CDC) designed to yield state- and national-level estimates of health risk factors among adults. The BRFSS consists of core questions used nationally, optional CDC-provided modules that states can choose, and questions added independently by states.

The BRFSS will be our data source for estimates focused on young adults (ages 18-24) and adults (ages ≥25) for all outcomes. The Aim 2 analysis will include over 10 years of data spanning survey years 2014-2025.

Youth Risk Behavior Surveillance Survey (YRBSS)

The YRBSS is a national cross-sectional school-based survey conducted biannually in the spring of odd-numbered years by the CDC as well as state and local health and education agencies. Our analysis will include state-level data from high school students from 2015 through 2025.

Metro West Adolescent Health Survey (MWAHS)

The MWAHS is a biennial public school-based census survey of youth administered in 25 suburban communities west of Boston. The survey is administered in 26 high schools, representing 100% of the school districts served by the MetroWest Health Foundation. The MWAHS uses items from the YRBSS, with additional questions to monitor emerging trends. ENDS use has been measured since 2014. The MWAHS has an exceptional response rate and sample size.

Analyses in all three datasets will consist of a comparative interrupted time-series analysis of the natural experiments arising from the introduction of different policies at different places and times. We will separately evaluate impacts for youth (grades 9-12; ages 14-18y), young adults (18-24y), and adults (≥25y). Youth and young adult analysis will utilize YRBSS and MWAHS data while the adult analysis will utilize BRFSS data.

Analysis will span the years of 2014-2025. Examining data over a long time span will allow us to understand the degree to which policy impacts wax or wane with time, will provide us with adequate follow-up to assess the impact of major policy changes taking place in 2019-2020, and will incorporate the significant societal disruption occurring during the COVID-19 pandemic.

Study team memebrs contributing to the Aim 2 analysis include: Dr. Doug Levy (PI), Dr. David Cheng, Dr. Abra Jeffers, Boram Lee, and Dr. Natalie Riva Smith