Adolescent use and co-use of tobacco and cannabis in California: The roles of local policy and density of tobacco, vape, and cannabis retailers around schools

Abstract

Adolescent tobacco use (particularly vaping) and co-use of cannabis and tobacco have increased, leading some jurisdictions to implement policies intended to reduce youth access to these products; however, their impacts remain unclear. We examine associations between local policy, density of tobacco, vape, and cannabis retailers around schools, and adolescent use and co-use of tobacco/vape and cannabis. We combined 2018 statewide California (US) data on: (a) jurisdiction-level policies related to tobacco and cannabis retail environments, (b) jurisdiction-level sociodemographic composition, (c) retailer locations (tobacco, vape, and cannabis shops), and (d) survey data on 534,176 middle and high school students (California Healthy Kids Survey). Structural equation models examined how local policies and retailer density near schools are associated with frequency of past 30-day cigarette smoking or vaping, cannabis use, and co-use of tobacco/vape and cannabis, controlling for jurisdiction-, school-, and individual-level confounders. Stricter retail environment policies were associated with lower odds of past-month use of tobacco/vape, cannabis, and co-use of tobacco/vape and cannabis. Stronger tobacco/vape policies were associated with higher tobacco/vape retailer density near schools, while stronger cannabis policies and overall policy strength (tobacco/vape and cannabis combined) were associated with lower cannabis and combined retailer densities (summed tobacco/vape and cannabis), respectively. Tobacco/vape shop density near schools was positively associated with tobacco/vape use odds, as was summed retailer density near schools and co-use of tobacco, cannabis. Considering jurisdiction-level tobacco and cannabis control policies are associated with adolescent use of these substances, policymakers may proactively leverage such policies to curb youth tobacco and cannabis use.

Keywords: Cannabis; Geographic effects; Policy; Retailer density; Tobacco.

Fig. 1

Direct and indirect path coefficients of associations of local policy strength with individual-level tobacco & cannabis use and co-use, through retailer density within ½ mile of schools (N = 534,176). Note: Untransformed β coefficients (from linear regressions) for the indirect “a” pathway represents mean difference in number of retailers within 0.5mi per 1 SD change in policy strength z-score. Odds ratios for direct and indirect “b” pathways represent odds ratios (from ordinal logistic regressions) of reporting higher use in the past 30 days. 95% confidence intervals in parentheses. Asterisks denote pathways that are statistically significant based on bootstrap 95% confidence intervals (500 replicates). Path “a” models control for city-level (% under age 18, % non-White, mean household income) and school-level (school enrollment, % eligible for free/reduced cost lunch) variables, and path “b” models additionally control for individual-level school climate, grade level, depressive symptoms, sex, race/ethnicity, language spoken at home, housing arrangements. Individual-level data come from 2017 to 2018 California Health Kids Survey; Jurisdiction-level data are from American Community Survey (2015–2019 5-year estimates); Policy strength data for tobacco and vape came from American Lung Association 2017 State of Tobacco Control Grades; Cannabis policy strength data came from the California Cannabis Local Laws Database for 2018; Retailer locations were purchased from a commercial data provider.