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Do Local Tobacco-21 Laws Reduce Smoking among 18 to 20 Year-Olds?

Abstract
Introduction
States and municipalities are increasingly restricting tobacco sales to those under age-21, in an effort to reduce youth and young adult smoking. However, the effectiveness of such policies remains unclear, particularly when implemented locally.

Methods
Analyses use 2011 – 2016 data from the Behavioral Risk Factor Surveillance System’s Selected Metropolitan/Micropolitan Area Risk Trends dataset. Difference-in-differences and triple-difference regressions estimate the relationship between local tobacco-21 policies and smoking among 18 to 20 year-olds living in MMSAs (metropolitan/micropolitan statistical areas).

Results
Current smoking rates fell from 16.5 percent in 2011 to 8.9 percent in 2016 among 18-20 year-olds in these data. Regressions indicate that a tobacco-21 policy covering one’s entire MMSA yields an approximately 3.1 percentage point reduction in 18 to 20 year-olds’ likelihoods of smoking [CI: -0.0548, -0.0063]. Accounting for partial policy exposure — tobacco-21 laws implemented in some but not all jurisdictions within an MMSA — this estimate implies that the average exposed 18 to 20 year-old experienced a 1.2 percentage point drop in their likelihood of being a smoker at interview relative to unexposed respondents of the same age, all else equal.

Conclusions
Local tobacco-21 policies yield a substantive reduction in smoking among 18 to 20 year-olds living in metropolitan and micropolitan statistical areas. This finding provides empirical support for efforts to raise the tobacco purchasing age to 21 as a means to reduce young adult smoking. Moreover, it suggests that state laws preempting local tobacco-21 policies may impede public health.

Implications
While states and municipalities are increasingly restricting tobacco sales to under-21-year-olds, such policies’ effectiveness remains unclear, particularly when implemented locally. Using quasi-experimental methods, this paper provides what may be the first evidence that sub-state tobacco-21 laws reduce smoking among 18 to 20 year-olds. Specifically, considering metropolitan and micropolitan areas from 2011 to 2016, the average 18 to 20 year-old who was exposed to these policies exhibited a 1.2 percentage point drop in their likelihood of being a current established smoker, relative to those who were unexposed. These findings validate local tobacco-21 laws as a means to reduce young adult smoking.

Tobacco‐21 laws reducing youth and young adult smoking

Abstract
Aims
To estimate the impact of tobacco‐21 laws on smoking among young adults who are likely to smoke, and consider potential social multiplier effects.

Design

Quasi‐experimental, observational study using new 2016–17 survey data.

Setting
United States.

Participants/cases
A total of 1869 18–22‐year‐olds who have tried a combustible or electronic cigarette.

Intervention and comparators
Tobacco‐21 laws raise the minimum legal sales age of cigarettes to 21 years. Logistic regressions compared the association between tobacco‐21 laws and smoking among 18–20‐year‐olds with that for 21–22‐year‐olds. The older age group served as a comparison group that was not bound by these restrictions, but could have been affected by correlated factors. Age 16 peer and parental tobacco use were considered as potential moderators.

Measurements
Self‐reported recent smoking (past 30‐day smoking) and current established smoking (recent smoking and life‐time consumption of at least 100 cigarettes).

Findings
Exposure to tobacco‐21 laws yielded a 39% reduction in the odds of both recent smoking [odds ratio (OR) = 0.61; 95% confidence interval (CI) = 0.42, 0.89] and current established smoking (OR = 0.61; 95% CI = 0.39, 0.97) among 18–20‐year‐olds who had ever tried cigarettes. This association exceeded the policy’s relationship with smoking among 21–22‐year‐olds. For current established smoking, the tobacco‐21 reduction was amplified among those whose closest friends at age 16 used cigarettes (OR = 0.50; 95% CI = 0.29, 0.87), consistent with peer effects moderating the policy’s impact on young adult smoking.

Conclusions
Tobacco‐21 laws appear to reduce smoking among 18–20‐year‐olds who have ever tried cigarettes.

New York State Raises Smoking Age From 18 To 21

ALBANY, N.Y. (CBSNewYork/AP) — New York will raise its smoking age from 18 to 21 under legislation signed into law Tuesday by Gov. Cuomo.

The change takes effect in 120 days, on Nov. 13, and will apply to the sales of traditional tobacco products as well as electronic cigarettes and vaping devices.

Gov. Cuomo said too many children and teens pick up smoking despite decades of efforts to snuff out the habit. The governor blamed part of that on marketing he says is aimed directly at young people.

“By raising the smoking age from 18 to 21, we can stop cigarettes and e-cigarettes from getting into the hands of young people in the first place and prevent an entire generation of New Yorkers from forming costly and potentially deadly addictions,” he said in a statement.

The governor’s office added that, according to the Surgeon General, 88 percent of adult smokers start using tobacco before age 18 and 90 percent of the people who buy cigarettes for underage children are between ages 18 and 20.

“Tobacco 21 is a no-brainer,” said Julie Hart, senior government relations director for the American Cancer Society Cancer Action Network of New York.

Sixteen states have approved raising the smoking age to 21, though the changes won’t take effect in some of those states until late 2019 or some time after.

In addition, hundreds of local communities around the nation have made the move to 21. In New York state they include New York City, Long Island, Albany and a dozen other counties.

“Tobacco use is harmful to New Yorkers and leads to cancer, major health problems, and death. Raising the age of purchase to 21 will help ensure fewer children start this deadly habit,” senate majority leader Andrea Stewart-Cousins added.

Illinois is now a “Tobacco 21” state, here’s how the law is different

SPRINGFIELD – Illinois is now the nation’s seventeenth “Tobacco 21” state, and while the law seems straightforward, it contains some unexpected nuances.

The law specifically prohibits the sale of any tobacco, vaping, or liquid nicotine product to anyone younger than 21 in the state of Illinois.

Bloomington Police spokesman John Fermon said his department has been publicizing plans for compliance checks on local businesses to make sure those businesses are abiding by the new law.

“We wanted to make sure that retailers were aware of the change and had time to prepare,” Fermon said.

The legislation also scrapped the “possession” component of Illinois law. Fermon said officers may still stop a young child smoking, but they’re not going to worry about a 19 year old smoking.

“It just eliminates the extra either fine or charge, the status offense charge,” he said. “It makes their job a little bit easier in that they don’t have to document that or worry about it.”

A breakdown of Tobacco 21 law change:

Bans the sale of tobacco products, vaping products, and liquid nicotine products to anyone younger than 21.

Removes illegal “possession” laws for underage people seen with the aforementioned products and scraps a provision that would require a minor and guardian to attend a smoking prevention class.

Sets the legal age of selling e-cigarette products at 16 to match tobacco laws with exceptions for family-owned businesses.

Adds e-cigarettes to products allowable for purchase by minors in orchestrating “stings” or compliance checks by law enforcement, meaning law enforcement would be able to conduct checks on vaping establishments without legality issues of a minor attempting to purchase the banned products.

Sets delivery sales requirement for businesses to 21, up from 18.

Dozens of municipalities across the state had already banned the sale of tobacco to people younger than 21.

Half of tobacco and vape shops don’t ID teens, undercover research finds

(CNN)An undercover operation in California found that half of tobacco and vape shops failed to check IDs for teens purchasing e-cigarettes and other nicotine products, despite a state law raising the legal age for purchasing tobacco products to 21.

Researchers sent 18- and 19-year-old “decoys” into stores without ID, instructing them to tell the truth about their age if asked. The teenagers then attempted to purchase vape products — e-cigarettes or e-liquids with nicotine — and a chaperone watched to see if the store asked for ID and made a sale.
Almost half of tobacco and vape shops illegally sold nicotine-containing products to the teens, according to the research, published Monday in the medical journal JAMA Pediatrics. Liquor stores, supermarkets and pharmacies were significantly more likely to check for ID and less likely to make the illegal sales.
The research team, consisting of scientists from the California Department of Public Health and Stanford University, also found that vape and tobacco shops were more likely to sell teenagers vape products than traditional cigarettes.

It’s unclear why that’s the case, but “one possibility may be that vape products cost more and they might have a higher profit margin for retailers, so the temptation is greater to sell,” said Lisa Henriksen, a co-author of the study and a senior research scientist at the Stanford Prevention Research Center.

‘Raising the age is not enough’

Anti-tobacco advocates say the research raises questions over recent efforts to raise the legal age for purchasing tobacco to 21, most recently championed by Senate Majority Leader Mitch McConnell.
The president of the Campaign for Tobacco-Free Kids, Matthew L. Myers, said the study “underscores the serious shortcomings of claims” from vape manufacturers that “the only solution needed for the youth e-cigarette epidemic is to raise the tobacco age to 21.”

E-cigarette use among teens has skyrocketed in recent years, with nearly 40% of 12th graders now saying they use the devices, according to a report released last year. “Raising the age is not enough and won’t work when tobacco and vape shops aren’t even checking IDs of young purchasers,” said Myers.
Gregory Conley, president of the American Vaping Association, said that “due to California’s recently enacted law raising the age to purchase tobacco and vaping products to 21, it is probable that those under 18 are less likely to successfully purchase than in the past, but retailers are still mistakenly selling products to adults between the ages of 18 and 21.”

In June 2016, California raised its age limit for tobacco products to 21, and more than 98% of retailers were aware of the new age restriction seven months after it went into effect, according to a survey conducted by researchers at the California Department of Public Health.

Conley added that “no youth sales should ever be permitted” and said his group supports mandatory ID scanners at points of sale. The country’s leading vape manufacturer, Juul Labs, has also advocated for “Tobacco 21” laws in digital, print and radio ads.

In a statement last week, after Connecticut raised the purchase age for tobacco and vape products to 21, Juul said the laws “fight one of the largest contributors to this problem: sharing by legal-age peers.” The company also said it has its own secret-shopper program, targeting 2,000 stores a month to ensure age verification.

But Myers, whose group has long advocated for raising the legal age to purchase tobacco, says recent laws that do that — such as those passed in Texas and Illinois — don’t go far enough. “It’s critical to prohibit the flavored products that are enticing and addicting kids,” he said.

‘Preventing teen access’

Juul has considered opening private retail stores that would check customers’ IDs at the door. The move came amid heightened scrutiny of the company, including a lawsuit from North Carolina’s attorney general accusing the manufacturer of marketing products to children.

In September, the FDA announced that a “blitz” on retailers resulted in more than 1,300 warning letters and fines related to sales of Juuls and other e-cigarettes to minors. In November, the agency proposed a plan to limit flavored vape products to age-restricted, adult-only stores, such as vape shops.

“We need to commend the FDA for trying to solve the epidemic of youth vaping by restricting the retail environment for these products,” said Henriksen, who co-authored the new study on IDs.
“What we’re worried about,” she said, “is concentrating sales in stores with the worst record [of age verification and illegal sales] without stepping up enforcement significantly.”