Project Summary
The substance use policy landscape has changed dramatically over the past 15 years. Tobacco use policies have strengthened through increasing taxes and the enactment of smoke-free legislation as well as more recent policies related to minimum legal sales age restrictions and flavor restrictions. In contrast, there has been increasing liberalization of cannabis policies, including the relatively recent legalization of recreational cannabis. Against this backdrop, adolescence substance use patterns have also altered over this time period, particularly with the introduction of e-cigarettes and new cannabis products. However, there had been few evaluations to determine whether substance use policies had been driving these changes. We exploited the natural experiment created through changes in tobacco control policies and cannabis legalization within states and over time to conduct rigorous evaluations of the Youth Risk Behavior Survey (YRBS) on adolescent substance use.
Approach
The is a biennial, state-representative survey of health-related behaviors in high school students from 44 states that started in 1991. Adolescents self-report on past-month use of cigarettes, smokeless tobacco, cigars, e-cigarettes, and cannabis. Tobacco control policies included state cigarette taxes, 100% smoke-free legislation, Tobacco 21 (T21) laws, and flavored tobacco restrictions. Cannabis policies included recreational cannabis legalization, medical cannabis legalization, and cannabis decriminalization. We linked state policy information to each adolescent based on the state and year of survey completion. Using quasi-experimental methods, we examined the impact of tobacco control policies and, separately, cannabis legalization, on adolescent substance use.
Key Findings
We first conducted a series of studies evaluating the effects of state-level cigarette taxes and smoke-free legislation on adolescent tobacco use. We found that cigarette tax increases were associated with reductions in smoking among 14- and 15-year-olds only, while the enactment of smoke-free legislation was associated with overall reductions in adolescent smoking.1 We also found that while chewing tobacco taxes had no effect on smokeless tobacco use and cigar taxes had no effect on cigar use, higher cigarette taxes were associated with an increase in adolescents鈥� use of these cheaper, alternative tobacco products. Finally, using the first wave of the YRBS that introduced questions on e-cigarettes in 2015, we found no associations between e-cigarette use and e-cigarette age restrictions or cigarette taxes, but e-cigarette use was higher in states with smoke-free legislation for combustible tobacco products.
In response to recent policies aimed at restricting tobacco use among adolescents, we obtained funding from the National Cancer Institute & FDA Center for Tobacco Products (PI Hawkins; R21CA268199) to examine the impact of state and federal T21 laws and state flavor restrictions on adolescent tobacco use. We found no associations between flavor restrictions and cigarette, cigar, or e-cigarette use. There also were no associations between T21 laws and cigarette use; however, when categorized based on the laws鈥� policy components, strong T21 laws were associated with lower cigarette use. T21 laws were also associated with higher ENDS use.聽
In studies evaluating the effects of state cannabis policies on youth substance use, we found that recreational cannabis legalization led to a small decline in the frequency of cannabis use among users and a small increase in the likelihood of e-cigarette use, with similar patterns across demographic strata. No effects on adolescents鈥� alcohol or cigarette use emerged. In contrast, medical cannabis legalization and cannabis decriminalization led to small declines in the likelihood of e-cigarette use. In a paper published in JAMA Pediatrics using YRBS data through 2021, we found limited associations between recreational cannabis legalization with adolescent substance use, which is consistent with our previous findings. interviewed Dr. Rebekah Levine Coley about these findings in the article, Does legalizing cannabis increase adolescent use? This expert found mixed results.