Evaluating state-level differences in e-cigarette and cigarette use among adults in the United States between 2012 and 2014: Findings from the National Adult Tobacco Survey.

Introduction:
This article investigates the relationship between state-level tobacco control measures and current use estimates of e-cigarettes and cigarettes among US adults. The study used data from the 2012-2014 National Adult Tobacco Survey (NATS) and the American Lung Association’s State of Tobacco Control (SOTC) report for 2012 and 2013. The authors aimed to assess state-specific prevalence estimates of cigarettes and e-cigarette use and determine their relationship with existing state-level tobacco control measures while accounting for respondents’ socio-demographic characteristics.

Key Points:

* The study categorized states into four groups based on the combined state-specific prevalence of both products: low cigarette/e-cigarette, high cigarette/e-cigarette, high cigarette/low e-cigarette, and low cigarette/high e-cigarette.
* The Tobacco Control Index (TCI) was calculated using the State of Tobacco Control annual reports for 2012 and 2013 to evaluate the implementation of state-level tobacco control measures.
* The authors found that all other US-state categories had significantly lower TCI scores compared to the low cigarette/e-cigarette group.
* State-level current use estimates of e-cigarettes and cigarettes varied substantially, with current e-cigarette use being highest in Oklahoma (10.3%) and lowest in Delaware (2.7%), and current cigarette use being highest in West Virginia (26.1%) and lowest in Vermont (12.6%).
* The study found that the overall score of existing state-level tobacco control measures was negatively associated with state-level current use estimates.
* The authors suggest that improving the enforcement of known-to-work tobacco control measures across all US states and developing evidence-based regulations and interventions specific to e-cigarettes are necessary.
* The study highlights the potential relationship between existing state-level tobacco control measures and e-cigarette use, emphasizing the need for further research to better track state-level differences of their use and the eventual impact of yet-to-be implemented national and state-level e-cigarette control measures.

Main Message:
The study emphasizes the importance of improving the enforcement of existing tobacco control measures and developing evidence-based regulations and interventions specific to e-cigarettes within the existing US tobacco use environment. The study suggests that existing state-level tobacco control measures likely interact with e-cigarette use, and continued monitoring of e-cigarette use is critical to establish baseline use and evaluate future e-cigarette specific federal and state-level tobacco regulatory actions.

El-Shahawy O, Park SH, Duncan DT, et al. Evaluating state-level differences in e-cigarette and cigarette use among adults in the United States between 2012 and 2014: Findings from the National Adult Tobacco Survey. Nicotine & Tobacco Research. 2019;21(1):71-80. doi:10.1093/ntr/nty013