Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115. Email:
Sefako Makgatho Health Sciences University, Pretoria, South Africa.
Prev Chronic Dis. 2022 Jun 2;19:E29. doi: 10.5888/pcd19.210430.
On December 20, 2019, the minimum age for purchasing tobacco in the US was raised nationally to 21 years. We evaluated this law (Tobacco 21 [T21]) 1 year after implementation. We also compared states with versus without T21 policies during 2019 to explore potential equity impacts of T21 policies.
We examined shifts in tobacco access among 6th through 12th graders using the National Youth Tobacco Survey. To explore equity of state T21 policies among youths and young adults, the associations with tobacco use were explored separately for race and ethnicity by using data from the 2019 Behavioral Risk Factor Surveillance System (for persons aged 18 to 20 years) and the 2019 Youth Risk Behavior Survey (for high school students).
The overall percentage of 6th to 12th graders perceiving that it was easy to buy tobacco products from a store decreased from 2019 (67.2%) to 2020 (58.9%). However, only 17.0% of students who attempted buying cigarettes in 2020 were unsuccessful because of their age. In the 2019 BRFSS, those aged 18 to 20 years living in a state with T21 policies had a lower likelihood of being a current cigarette smoker (adjusted prevalence ratio [APR], 0.58) or smoking cigarettes daily (APR, 0.41). Similar significant associations were seen when analyses were restricted to only non-Hispanic White participants but not for participants who were non-Hispanic Black, non-Hispanic Asian, Hispanic, or of other races or ethnicities. Consistent findings were seen among high school students.
Greater compliance with the federal T21 law is needed as most youth who attempted buying cigarettes in 2020 were successful. Comparative analysis of states with versus states without statewide T21 policies in 2019 suggest the policies were differentially more protective of non-Hispanic White participants than other participants. Equitable and intensified enforcement of T21 policies can benefit public health.
2019 年 12 月 20 日，美国将购买烟草的最低年龄全国范围内提高到 21 岁。我们在实施一年后评估了这项法律（Tobacco 21 [T21]）。我们还比较了 2019 年有和没有 T21 政策的州，以探索 T21 政策的潜在公平影响。
我们使用全国青少年烟草调查（National Youth Tobacco Survey），评估了 6 至 12 年级学生烟草获取情况的变化。为了探索 T21 政策在青少年和年轻人中的公平性，我们使用 2019 年行为风险因素监测系统（针对 18 至 20 岁的人群）和 2019 年青年风险行为调查（针对高中生）的数据，分别按种族和族裔对州 T21 政策与烟草使用之间的关联进行了探讨。
认为从商店购买烟草产品很容易的 6 至 12 年级学生的比例从 2019 年的 67.2%下降到 2020 年的 58.9%。然而，只有 17.0%的尝试购买香烟的学生因年龄原因而未成功。在 2019 年的 BRFSS 中，居住在有 T21 政策的州的 18 至 20 岁的年轻人，作为当前吸烟者的可能性较低（调整后的流行率比 [APR]，0.58）或每天吸烟（APR，0.41）。当分析仅限于非西班牙裔白人参与者时，也观察到了类似的显著关联，但对于非西班牙裔黑人、非西班牙裔亚裔、西班牙裔或其他种族或族裔的参与者则没有观察到这种关联。在高中生中也观察到了一致的结果。
需要更严格地遵守联邦 T21 法律，因为大多数在 2020 年尝试购买香烟的青少年都成功了。对 2019 年有和没有全州 T21 政策的州进行比较分析表明，这些政策对非西班牙裔白人参与者的保护作用明显大于其他参与者。公平和加强 T21 政策的执行可以使公共卫生受益。
