State-level tobacco policies and youth smoking status

This study examines the impact that state-level tobacco policies, including clean indoor air laws and youth-access restrictions, have on cigarette smoking status in school-aged adolescents. A cross-sectional design with a sample of 14,818 children living in the United States in grades 6 through 10 was used. The datasets used for this study were the 2001-2002 U.S. Health Behavior in School-Aged Children Survey and the State Cancer Legislative Database. In bivariate analyses, free cigarette distribution, and the absence of vending machine and packaging restrictions were associated with higher rates of smoking among high school students. Schools, childcare facilities, government worksites, private worksites, and recreational and cultural facilities with no smoking restriction policies were associated with higher rates of smoking among middle and high school students. Logistic regression analyses reveal that high school students in states with no youth-access restrictions on vending machines and free distribution were twice as likely to be daily smokers as never smokers. Both middle and high school students in states with permissive clean indoor air provisions were more likely to be daily smokers than those living in states with stringent provisions. Findings show that stringent youth-access laws and clean indoor air provisions are predictive of cigarette smoking status. This study reveals that state tobacco policies are important health promotion activities in the prevention and deterrence of smoking among youth. Future research should investigate the combined impact that clean indoor laws and youth access restrictions have on youth smoking status.