Key result
Youth e-cigarette use increased more in rural (6.7% to 13.4%) than urban areas (9.8% to 11.9%) from 2018 to 2019, but Tobacco 21 policies mitigated these increases (interaction P<0.0001).
Why the study?
Although e-cigarette use has increased dramatically among US youth, it was unknown whether the impact of policies curbing e-cigarette use differs between rural and urban areas.
Does a Tobacco 21 policy mitigate the increase in youth e-cigarette use across rural and urban areas?
Cross-Sectional (n=132,803)
Yes
Does a Tobacco 21 policy mitigate the increase in youth e-cigarette use across rural and urban areas?
p-value: p=<0.0001
Tobacco 21 policies appear to mitigate the rising prevalence of youth e-cigarette use in both rural and urban areas, despite a larger overall increase in rural areas.
May widen rural-urban youth vaping gaps; hypothesis-generating for Tobacco 21 equity effects.
BACKGROUND: The prevalence of current electronic cigarette (e-cigarette) use has increased dramatically among US youth. It is unknown how the impact of policies to curb e-cigarette use might differ across rural and urban areas. METHODS: Data were collected from an annual statewide survey of middle and high school students in Kansas. Multivariable logistic regression was performed to examine the temporal change in current e-cigarette use in 2018 and 2019 across rural and urban areas and across the areas with and without a Tobacco 21 (T21) policy that raises the minimum age of tobacco sales to 21 years. RESULTS: Of 132 803 participants, the prevalence of current e-cigarette use increased from 8.2% in 2018 to 12.6% in 2019. The increase was larger in rural areas (from 6.7% in 2018 to 13.4% in 2019, difference = 6.7%) than in urban areas (9.8%–11.9%, difference = 2.1%), with a significant interaction effect of year × urbanicity/T21 group (P < .0001). In urban areas, e-cigarette use increased significantly for middle school students in T21 areas (3.3%–4.5%; P = .01) and all students in non-T21 areas (8.1%–12.0%; P < .0001). In rural areas, the increase in e-cigarette use was significant in both T21 and non-T21 areas for all students, but the increase was smaller in T21 (7.9%–10.8%, difference = 3.0%) than in non-T21 areas (6.5%–13.7%, difference = 7.1%). CONCLUSIONS: In this study, we reported marked disparities in the increase of youth e-cigarette use, with a larger recent increase in rural than in urban areas. T21 policies appear to mitigate these increases in both rural and urban youth.
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Dai et al. (2021) conducted a cross-sectional in E-cigarette use (n=132,803). Tobacco 21 (T21) policy vs. No Tobacco 21 policy was evaluated on Current e-cigarette use (p=<0.0001). Youth e-cigarette use increased more in rural (6.7% to 13.4%) than urban areas (9.8% to 11.9%) from 2018 to 2019, but Tobacco 21 policies mitigated these increases (interaction P<0.0001).
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