Previously submitted to: JMIR Public Health and Surveillance (no longer under consideration since Jul 17, 2024)
Date Submitted: Jan 19, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Impact of banning sales of tobacco to minors in China on their access to cigarettes: a school-based longitudinal study.
ABSTRACT
Background:
Recent studies in China examined the availability of tobacco products near schools, and nearly all of these studies focused on highly developed cities. However, there is little evidence about whether policies that ban tobacco sales to minors are actually effective. We used data from the 2019 and 2021 China NYTS and a logistic difference-in-differences (DID) regression analysis to address this gap in knowledge regarding the impact of banning tobacco sales to minors.
Objective:
To evaluate the impact of recent policies banning tobacco sales to minors in China.
Methods:
Cross-sectional surveys with national representativeness were conducted at the same middle and high school in 2019 (n=288192) and 2021 (n=269250) in China. Weighted percentages of students denied purchase of cigarettes due to age were calculated. Because 17-year-olds (intervention group) were more likely to be impacted by restrictions than 18-year-olds (reference group), a difference-in-differences (DID) design was used to compare changes in these two groups from 2019 to 2021. Sensitivity analysis was used to assess the robustness of the results.
Results:
In 2021, 22.2% of secondary school students (age: 15 (13,16)) reported being denied tobacco purchase because of age (19.7% of high school students and 26.4% of middle school students). From 2019 to 2021, 6.5% (95%CI: 4.1%, 8.9%) more students were denied purchase of cigarettes because of age (8.1% more high school students, 3.0% more middle school students). In both surveys, there were no significant differences in being denied cigarettes due to age for 17 and 18-year-olds. From 2019 to 2021, the availability of cigarettes among 17-year-olds and 18-year-olds decreased by 6.17% and 6.14%, respectively. Difference-in-difference estimates showed no association of policy changes and the percentage of adolescents who were denied purchase of cigarettes because of age (OR=0.93, 95%CI: 0.62, 1.41, P=0.74).
Conclusions:
Policies prohibiting the sales of tobacco products to minors did not reduce their availability. Greater enforcement of these policies is necessary.
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