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

项目摘要 各国通过实施电子尼古丁输送系统（ENDS）来应对电子尼古丁输送系统的出现。 除了现有的烟草控制政策外，还制定了几种针对ENDS的政策。目前，全 这两种政策对ENDS和青少年烟草使用的影响尚不清楚。这 研究将使用多种互补的统计方法和一个强大的政策数据库， 相关烟草和ENDS具体政策对ENDS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ENDS特定政策数据， 评估这些政策对青少年结束性营养不良模式的影响， 相关烟草使用（开始、流行、持续时间、频率和停止）。我们将通过以下方式实现这一目标： 按州和年份对这一政策数据库进行编码，并将其与2010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措施。在第一对目标中，我们 将使用混合效应模型分析这些数据，同时使用人内和人间效应。分别地， 这两种类型的影响决定了：（a）青少年在接受治疗后是否会改变他们的ENDS和烟草使用， 居住州通过一项特定的政策，以及（B）通过一项政策的州的青少年是否 与那些没有吸烟的州相比， 政策此外，我们将介绍序列分析，它允许更详细的描述， 进入和退出ENDS的过渡和相关的烟草使用，并测试不同国家和地区的轨迹差异。 施政纲要而我们还将检验政策的协同效应，也就是说，任何给定政策的组合 特别有效。在我们的第二对目标中，我们评估了特定国家和地区的政策效果差异。 应答特征。首先，我们将考虑父母的背景是否缓和政策的影响。 最后，我们将根据关键人口统计数据（社会经济地位、性别、 种族/民族和农村/城市地区，这将允许确定相关的健康差异。我们 拟议的研究为检验快速演变的政策环境对ENDS的影响提供了机会 并将以下列方式作出贡献。首先，如果某些政策或政策组合 被确定为有效的，结果将提供证据，更广泛地采用，以遏制目前的ENDS趋势。 第二，确定政策执行的惠益中可能存在的健康差异， 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 消除社会不平等，为青少年提供具有长期影响的全面福利。最后 这项研究为未来的研究奠定了基础，未来的研究将考虑地方政策的变化，个人层面的政策， 驱动的变化和ENDS使用模式。

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.