Associations between state tobacco control measures and cigarette purchases by U.S. households, 2015-2021.

Abstract

While effects of key tobacco control policies are well-documented, limited research has explored their varying associations across different policy contexts over time. This is crucial given the diverse and evolving tobacco control contexts across states and over time. We evaluated the association between state-level tobacco control measures and cigarette purchases in the US from 2015 to 2021. We analyzed NielsenIQ Consumer Panel data from 10,187 households that purchased cigarettes in 2015-2021. State-level tobacco control policy scores for smoke-free laws, taxes, prevention/control funding, and cessation services were obtained from the American Lung Association's State of Tobacco Control reports. Censored regression models, reporting adjusted beta estimates and 95 % confidence intervals (CI), estimated the associations between each tobacco control measure and annual household cigarette purchases, adjusting for sociodemographics (household composition, marital status, age, education, race/ethnicity, annual income, and internet connection) and accounting for clustering within households and states. Higher scores for smoke-free laws (adjusted beta = -1.00, 95 % CI = -1.73, -0.27), taxes (adjusted beta = -1.23, 95 % CI = -1.88, -0.58), and prevention/control funding (adjusted beta = -0.22, 95 % CI = -0.38, -0.06) were associated with fewer cigarette purchases over time. In the model considering all four measures together, higher tax score was associated with fewer cigarette purchases over time (adjusted beta = -0.96, 95 % CI = -1.73, -0.87). Smoke-free laws, taxation, and prevention/control funding play critical roles in lowering cigarette purchases, while access to cessation services alone may not drive behavioral change. These findings highlight the need for comprehensive tobacco control efforts and renewed policy action to curb cigarette use.