Tobacco use continues to be a public health hazard in the United States, and, according to the CDC, is the leading cause of preventable disease, death, and disability in the country. While the most common forms of tobacco consumption have decreased steadily due to health campaigns, etc., the ongoing damage remains to be of high concern. In June of 2016, the State of California enacted a policy known as Tobacco 21 which increased the legal purchasing age of tobacco products to 21 in the state. Three years later, a similar piece of legislation, was signed into federal law and enacted across the entire United States. This study aims to track changes in 18–20-year-old tobacco use behavior in the state of California (compared to other states) since the implementation of Tobacco 21, with hopes that it may provide a glimpse into nationwide tobacco use following the restructuring of legal sales.
The study uses data from a nationwide longitudinal survey of adults in the United States called the Behavioral Risk Factor Surveillance System (BRFSS). The system samples approximately 400,000 adults in the United States and three of its territories. In 2019, data from 3,050 18–20-year-old adults in California was compared to data of 12,813 adults in the same age demographic in 8 other states (Iowa, Montana, Nebraska, New Mexico, North Dakota, South Dakota, Washington, and Wisconsin) which had yet to enact a Tobacco 21 policy. Measures used within the BRFSS included demographics and tobacco use frequency. The data was analyzed using logistic regression modelling. An additional sensitivity analysis was conducted using data from 21–23-year-old adults in California to serve as a control variable.
Results of the study found no significant decrease in smoking prevalence in 18–20-year-olds in California but did find a significant decrease in total number of total smoking days in this age demographic compared to the 21-23-year-old demographic in California. Additionally, cigarette sales were found to decrease as well as overall smoking intensity (i.e., number of cigarettes smoked per occasion).
Takeaway: the research concerning smoking prevalence in the United States following Tobacco 21 policies is developing and suggests overall decreases in daily smoking and smoking intensity in target demographics.