Tobacco 21 policies in California and Hawaii and sales of cigarette packs: a difference-in-differences analysis

Abstract

ObjectiveTo measure the association of raising the minimum legal age of tobacco sales to 21 years (T21) statewide with monthly sales of cigarette packs in California and Hawaii, the first two states to implement T21 statewide.MethodsState monthly cigarette tax revenues from state departments of taxation were analysed for 11 states from January 2014 through December 2018 (n=660). Monthly cigarette packs sold were constructed using cigarette tax revenue and cigarette tax rate in each state. A difference-in-differences regression method was used to estimate the association of statewide T21 policies with monthly cigarette packs sold in California and Hawaii, separately, compared to the western states that did not implement such policies. Both models were controlled for year–month fixed effects, cigarette tax rates, smoke-free air laws, Medicaid coverage of smoking cessation, minimum legal sales ages for e-cigarettes and state marijuana laws, in addition to state demographic characteristics (sex, age, education, race/ethnicity and population size).FindingsImplementation of T21 statewide was associated with a reduction of 9.41 (95% CI=–15.52 to –3.30) million monthly packs sold in California and 0.57 (95% CI=–0.83 to –0.30) million monthly packs sold in Hawaii, compared to regional states. These translate to a reduction of 13.1%–18.2%, respectively, in monthly packs sold relative to mean values before the implementation of T21.ConclusionsRaising the minimum legal age for tobacco sales to 21 years could reduce cigarette sales as part of a comprehensive tobacco control strategy that complements and builds on proven approaches to achieve this goal.

Miscommunication about the US federal Tobacco 21 law: a content analysis of Twitter discussions

“…Some users described having an older sibling or friend purchase the product for them, and others offered to purchase tobacco products for those under 21 for an additional fee. Such claims have been propagated by the tobacco industry as justification for not passing youth access laws10 42; however, decreasing the availability and accessibility of tobacco via Tobacco 21 laws has been found to effectively reduce the use43 44 and sales of tobacco products to those under 21 years of age,45–47 even among popular cigarette brands 48. Moreover, only 2.5% of our sample of tweets about Tobacco 21 included requests for other Twitter users to buy tobacco for someone under 21 and only 1.0% of the tweets claimed that the person would buy tobacco for their under-age peers.…”

A Rapid Evaluation of the US Federal Tobacco 21 (T21) Law and Lessons From Statewide T21 Policies: Findings From Population-Level Surveys

“…For example, among White high school students, we found that state T21 policies reduced the probability of smoking 11 or more cigarettes per day by 87% but reduced the probability of smoking on 1 or more of the past 30 days by only 33%. Many previous studies have linked T21 policies with reduced volume sales of cigarettes ( 5 , 6 , 12 ). A pause or a reduction in tobacco use must be accompanied by an intention to stop smoking for it to qualify as a quit attempt ( 29 ).…”

“…This federal law was motivated by a large body of evidence showing that states and jurisdictions that had passed such policies subsequently witnessed reductions in tobacco consumption ( 1 – 5 ). The first 2 states to implement statewide T21 policies were Hawaii (January 1, 2016) and California (June 9, 2016) ( 6 ). New Jersey, Maine, and Oregon followed next in 2017 ( 7 ).…”

“…Evaluations of state and local T21 policies have been conducted by using sales and population-level data, both showing reduced overall tobacco consumption as an immediate effect ( 3 , 5 ). After California and Hawaii passed statewide T21 policies, monthly cigarette volume sales declined between January 2014 and December 2018 for both California (13.1%) and Hawaii (18.2%), compared with western states that had not implemented the T21 laws ( 6 ). Results from another study in Hawaii showed a significant drop in average monthly cigarette unit sales, together with a significant drop in menthol cigarette market share ( 9 ).…”

Cumulative disadvantage as a framework for understanding rural tobacco use disparities.

“…This law was developed based on statistics showing that 54% of cigarette smokers initiate use before the age of 18 while 85% intiate by the age of 21 (Institute of Medicine, 2015). Limited research suggests that tobacco-21 law does have a positive impact (Ali et al, 2020; Oregon Health Authority, 2019); a national survey found that the odds of recent and current established cigarette smoking was reduced by as much as 39% among 18–20 year olds (Friedman et al, 2019). However, it is unclear whether residents of rural areas specifically are benefiting from tobacco-21 law.…”