Joint impact of cigarette taxes and smoke-free laws on youth cigarette smoking and related disparities in the USA

Objective To examine the impact of cigarette taxes on youth smoking in counties with and without workplace and hospitality smoke-free laws.Methods Using a nationally representative sample of 8th, 10th and 12th graders from the 2001-2021 Monitoring the Future study, we investigated the interaction of taxes and smoke-free policies on cigarette smoking participation, initiation and intention, examining differences by sociodemographic factors (sex, race and ethnicity, parental education, college educational expectations). We stratified models by grade, estimating the average marginal effects (AMEs) using modified Poisson regression with a sandwich variance estimator.Results Among 12th graders, higher taxes were associated with lower past 30-day smoking, and the relationship was stronger in populations covered by either hospitality or workplace smoke-free laws compared with 12th graders not covered (workplace: AME=-0.009, 95% CI=-0.016 to -0.001; hospitality: AME=-0.010, 95% CI=-0.017 to -0.003). We also examined three-way interactions between taxes, smoke-free policies, and sociodemographic subgroups. We found interactions for taxes with hospitality smoke-free laws and parental education for daily smoking initiation, such that higher taxes were effective in areas with smoke-free laws among 8th graders regardless of parental education, but in areas without smoke-free laws, only among 8th graders whose parents had a college education or more. We found no other statistically significant interactions.Conclusion We found some evidence that taxes and smoke-free laws may work jointly to reduce cigarette smoking in certain youth populations. Policymakers should consider the complex tobacco control landscape and its effects on subpopulations when introducing laws.