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In June 2016, five new statewide tobacco-related policies took effect in California. The first (SB 5 X2) made electronic cigarettes and other alternative nicotine delivery systems based on aerosols subject to state tobacco control policies by defining them as tobacco products. The second (SB 7 X2) increased the statewide minimum age of legal access (MLA) from 18 to 21 years (excluding military personnel.) The third and fourth (AB 7 X2 and AB 9 X2) expanded the reach of state clean indoor air laws to hotel lobbies, small businesses, and break rooms, and required all school campuses to be tobacco free. The fifth (AB 11 X2) increased tobacco licensing fees. In November 2016, California voters also passed a $2 tobacco tax, which will take effect in April 2017. These decisions were based in part on studies analyzed by the Institute of Medicine that found that increased MLAs for cigarettes would decrease smoking rates, reduce health care costs, and save lives, and on findings from the US Surgeon General showing that increased tobacco taxes had similar effects. These policy changes were made despite pressure from the tobacco and e-cigarette (“vaping”) industry to treat e-cigarettes as smoking cessation aids and to maintain an MLA of 18 years. Tobacco industry representatives argued that California’s new laws would increase youth smoking, pointing to studies that claimed increasing MLAs for e-cigarettes to 18 years had led to higher smoking rates. They also suggested that regulating e-cigarettes like other tobacco products would reduce the ability of California residents to use these products as method to quit smoking. This proposal will assess the effects of California’s 2016 tobacco control policies, including whether they affect perceptions of tobacco product risks and whether they change health behaviors, including the use of tobacco products and efforts to quit smoking. In the first aim of this research we will determine whether these policy changes are associated with different attitudes about the risks of using tobacco products, including e-cigarettes. In the second aim we will assess whether the new policies change decisions about whether to begin using tobacco products. In the third aim we will consider whether these policies change the amount of tobacco products people use, or the frequency with which they use tobacco products. In the fourth aim we will review whether the new California policies affect smokers’ efforts to quit, including quit attempts in which people seek to replace smoking with vaping. This 2-year study will bring together an interdisciplinary team with expertise in the areas of tobacco control policy, drug use initiation, tobacco related attitudes and use, survey research, population health, economics, and health disparities to conduct before-and-after analysis of California’s tobacco control policy changes. Past studies that suggested increased MLAs for e-cigarettes led to higher smoking rates have relied on state-level data, making it impossible to control for substantial variations in local policies or to know whether individuals were covered by relevant tobacco control policies. This research will rely instead on individual-level datasets released every year that ask Californians about their tobacco use and other health-related behaviors. Because multiple localities in California passed policies that applied clean indoor air laws to e-cigarettes prior to 2016—for example, San Francisco and Los Angeles ordinances that took effect in 2014—the analysis will also control for local policies that took effect before the California statewide laws. It is important to address these questions because the goal of California’s new tobacco control policies was to decrease smoking rates and save lives. Understanding how these policies affect health outcomes will inform policy debates about regulation of tobacco products and identify whether these policies improve the health of Californians. |
