Thomson Carey Conley, Hamilton William L, Siegel Michael B, Biener Lois, Rigotti Nancy A
Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA.
Tob Control. 2007 Apr;16(2):119-26. doi: 10.1136/tc.2006.018002.
To test whether community-level restrictions on youth access to tobacco (including both ordinances and enforcement) are associated with less smoking initiation or less progression to established smoking among adolescents.
Prospective cohort study of a random sample of adolescents in Massachusetts whose smoking status was assessed by telephone interviews at baseline and 2-year follow-up, and linked to a state-wide database of town-level youth-access ordinances and enforcement practices.
A random sample of 2623 adolescents aged 12-17 years who lived in 295 towns in Massachusetts in 2001-2 and were followed in 2003-4.
The relationship between the strength of local youth access restrictions (including both ordinances and level of enforcement) and (1) never-smokers' smoking initiation rates and (2) experimenters' rate of progression to established smoking was tested in a multilevel analysis that accounted for town-level clustering and adjusted for potential individual, household and town-level confounders.
Over 2 years, 21% of 1986 never-smokers initiated smoking and 25% of 518 experimenters became established smokers. The adjusted odds ratio (OR) for smoking initiation was 0.89 (95% CI 0.61 to 1.31) for strong versus weak youth-access policies and 0.93 (95% CI 0.67 to 1.29) for medium versus weak policies. The adjusted OR for progression to established smoking among adolescents who had experimented with smoking was 0.79 (95% CI 0.45 to 1.39) for strong versus weak local smoking restrictions and 0.85 (95% CI 0.50 to 1.45) for medium versus weak restrictions.
This prospective cohort study found no association between community-level youth-access restrictions and adolescents' rate of smoking initiation or progression to established smoking over 2 years.
检验社区层面限制青少年获取烟草（包括法规和执法）是否与青少年吸烟起始率降低或向习惯性吸烟进展减少相关。
对马萨诸塞州青少年的随机样本进行前瞻性队列研究，通过基线和2年随访时的电话访谈评估其吸烟状况，并与全州城镇层面青少年获取烟草法规及执法实践数据库相链接。
2001 - 2002年居住在马萨诸塞州295个城镇、年龄在12 - 17岁的2623名青少年的随机样本，并于2003 - 2004年进行随访。
在考虑城镇层面聚类并对潜在个体、家庭和城镇层面混杂因素进行调整的多水平分析中，检验当地青少年获取烟草限制的强度（包括法规和执法水平）与（1）从不吸烟者的吸烟起始率以及（2）尝试吸烟者向习惯性吸烟进展率之间的关系。
在2年期间，1986名从不吸烟者中有21%开始吸烟，518名尝试吸烟者中有25%成为习惯性吸烟者。对于青少年吸烟起始，与弱青少年获取烟草政策相比，强政策的调整优势比（OR）为0.89（95%可信区间0.61至1.31），中等政策与弱政策相比为0.93（95%可信区间0.67至1.29）。对于尝试吸烟的青少年向习惯性吸烟进展，与弱的当地吸烟限制相比，强限制的调整OR为0.79（95%可信区间0.45至1.39），中等限制与弱限制相比为0.85（95%可信区间0.50至1.45）。
这项前瞻性队列研究发现，社区层面青少年获取烟草限制与青少年2年期间的吸烟起始率或向习惯性吸烟进展率之间无关联。
