Effects of Tobacco & ENDS Policies on Patterns of Adolescent ENDS Use

项目摘要 各国对电子尼古丁输送系统的出现作出了回应，具体做法是 除了现有的烟草控制政策外，还有几种特定于烟草控制的政策。目前，全面 目前尚不清楚这两类政策在青少年中使用烟草的效果。这 研究性研究将使用多种互补的统计方法和强大的政策数据库来审查 相关烟草和针对终端的政策对终端使用和相关烟草使用的影响 青少年。我们将合并来自美国不吸烟者协会的烟草政策和特定于END的政策数据 人权基金会(ANRF)评估这些政策对青少年末端和 与烟草使用相关的(开始、流行、持续时间、频率和戒烟)。我们将通过以下方式实现这一目标 按州和年份对该政策数据库进行编码，并将其与#年人口评估的数据相结合 烟草与健康(PATH)和美国人口普查的关键时变指标。在我们的第一对目标中，我们 将使用混合效应模型分析这些数据，既使用人内效应，也使用人与人之间的效应。分别， 这两种类型的影响决定了(A)青少年是否改变了他们的目的和烟草的使用 居住国通过特定政策，以及(B)通过政策的州的青少年 与处于不同状态的人相比，经历显著不同的目的和烟草使用轨迹 政策。此外，我们还将介绍序列分析，它允许更详细地描述 进入和离开末端的过渡和相关的烟草使用，以及对不同轨迹的测试 政策。我们还将测试政策的协同效应；即，任何给定政策的组合 是特别有效的。在我们的第二对目标中，我们评估了政策效果的差异，尤其是 被调查者的特征。首先，我们将考虑父代背景是否会影响政策的效果。 最后，我们将根据关键的人口统计数据对政策效果进行分析：社会经济地位、性别、 种族/族裔和农村/城市地区，这将有助于确定相关的健康差距。我们的 拟议的研究提供了测试快速演变的政策格局对EDS的影响的机会 并将在以下方面作出贡献。首先，如果某些策略或策略组合 这些结果被认为是有效的，将为更广泛地采用以遏制目前的末端趋势提供证据。 第二，确定在政策执行的惠益方面可能存在的健康差距不仅可能 帮助卫生专业人员努力纠正差距，但也要确定可能“绕过”的政策 社会不平等为青少年提供具有长期影响的全面利益。最后，这一点 这项研究为未来的研究奠定了基础，该研究将考虑当地政策的变化，个人层面的政策- 驱动的变化，以及终端使用的模式。

Project Summary States have responded to the emergence of electronic nicotine delivery systems (ENDS) through implementing several types of policies specific to ENDS in addition to existing tobacco control policies. At present, the full efficacy of both types of policies on ENDS and related tobacco use among adolescents is unknown. This research study will use multiple, complementary statistical methods and a robust policy database to examine the impact of relevant tobacco and ENDS-specific policies on ENDS use and related tobacco use among adolescents. We will merge tobacco policy and ENDS-specific policy data from the American Nonsmokers’ Rights Foundation (ANRF) to evaluate the effects of these policies on patterns of adolescent ENDS and related tobacco use (initiation, prevalence, duration, frequency, and cessation). We will accomplish this goal by coding this policy database by state and year and combining it with data from the Population Assessment of Tobacco and Health (PATH) and key time-varying measures from the U.S. Census. In our first pair of aims, we will analyze this data using mixed effects models, using both within- and between-person effects. Respectively, these two types of effects determine (a) whether adolescents change their ENDS and tobacco use after their state of residence passes a particular policy, and (b) whether adolescents in a state that passes a policy experience significantly different trajectories of ENDS and tobacco use relative to those in a state without the policy. In addition, we will introduce sequence analysis, which allows for a more detailed depiction of transitions into and out of ENDS and related tobacco use, and testing of differences in trajectories across policies. We also will test for synergistic effects of policy; that is, whether the combination of any given policies is particularly effective. In our second pair of aims, we assess policy effect differences across particular respondent characteristics. First, we will consider whether parent contexts moderate the effects of policies. Finally, we will conduct analyses of policy effects by key demographics: socioeconomic status, gender, race/ethnicity, and rural/urban locale, which will permit the identification of related health disparities. Our proposed research provides opportunities to test the impact of a rapidly evolving policy landscape on ENDS outcomes and will contribute in the following ways. First, if certain policies or combinations of policies are identified as efficacious, the results would provide evidence for broader adoption to curb current ENDS trends. Second, the identification of possible health disparities in the benefits of policy implementation may not only help health professionals work towards redressing disparities, but also identify policies that may “bypass” social inequalities to provide comprehensive benefits to adolescents with long-term implications. Finally, this study establishes a foundation for future research that will consider local policy variation, individual-level policy- driven changes, and patterns of ENDS use.