Tam Jamie, Crippen Alyssa, Friedman Abigail, Jeon Jihyoun, Colston David C, Fleischer Nancy L, Vander Woude Catherine A, Boelter Megan A, Holford Theodore R, Levy David T, Meza Rafael
Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
JAMA Health Forum. 2024 Dec 6;5(12):e244445. doi: 10.1001/jamahealthforum.2024.4445.
Research shows that Tobacco 21 (T21) policies with a minimum legal access age for tobacco products of 21 years reduce smoking, yet their impact varies across US states due to differences in smoking behaviors, mortality rates, and policy coverage.
To quantify potential reductions in smoking-attributable mortality associated with Tobacco 21 policies for each of the 50 states and Washington, DC.
DESIGN, SETTING, AND PARTICIPANTS: The Cancer Intervention Surveillance and Modeling Network (CISNET) Tobacco Control Policy Model of smoking was used with detailed state-specific data on smoking initiation, smoking cessation and mortality rates as they vary by age, gender, and birth cohort for 50 US states and the District of Columbia. This was integrated with comprehensive data on T21 policy coverage at the local and state levels from 2005 to 2024, and then T21 policy effects from quasi-experimental studies were applied to simulate each state's experience of T21 policies, quantifying potential mortality reductions from 2005 to 2100.
Cigarette smoking.
Estimated smoking-attributable deaths averted and life-years gained compared with a baseline scenario.
Early statewide T21 adoption in California, combined with its large population, was associated with more than 27 000 premature deaths averted through 2100, whereas statewide implementation in Kentucky was associated with 15 000 averted premature deaths. In Massachusetts, T21 policies were associated with 8000 averted premature deaths, largely attributed to municipal T21 policies covering most residents. Wisconsin-lacking state or local policies-requires enforcement of federal T21 to prevent up to 10 000 premature deaths. Across the country, comprehensive enforcement of federal, state, and local T21 laws were associated with up to 526 000 premature deaths averted and 13.3 million life-years gained by 2100. Enforcement of only state and local policies was associated with 442 000 premature deaths averted.
This study found that early adoption and implementation of T21 policies maximizes potential premature mortality reductions. However, the strength of T21 policies and enforcement varies widely across states. Enforcement of the federal T21 law is critical in the 8 states without state-level T21 cigarette policies of their own.
研究表明，将烟草制品最低合法购买年龄设定为21岁的“烟草21”（T21）政策可减少吸烟，但由于吸烟行为、死亡率和政策覆盖范围的差异，其在美国各州的影响有所不同。
量化与“烟草21”政策相关的50个州及华盛顿特区吸烟所致死亡率的潜在降低情况。
设计、背景和参与者：采用癌症干预监测与建模网络（CISNET）的吸烟控制政策模型，并结合美国50个州和哥伦比亚特区按年龄、性别和出生队列划分的详细的特定州吸烟起始、戒烟和死亡率数据。将其与2005年至2024年地方和州层面“烟草21”政策覆盖的综合数据相结合，然后应用准实验研究的“烟草21”政策效果来模拟每个州的“烟草21”政策实施情况，量化2005年至2100年潜在的死亡率降低情况。
吸烟。
与基线情景相比，估计避免的吸烟所致死亡人数和获得的生命年数。
加利福尼亚州早期在全州范围内采用“烟草21”政策，加上其人口众多，到2100年可避免超过27000例过早死亡，而肯塔基州在全州范围内实施该政策可避免15000例过早死亡。在马萨诸塞州，“烟草21”政策与8000例过早死亡的避免相关，这主要归因于覆盖大多数居民的市级“烟草21”政策。威斯康星州缺乏州或地方政策，需要执行联邦“烟草21”政策以防止多达10000例过早死亡。在全国范围内，全面执行联邦、州和地方法律的“烟草21”政策到2100年可避免多达526000例过早死亡，并获得1330万个生命年。仅执行州和地方法规可避免442000例过早死亡。
本研究发现，早期采用和实施“烟草21”政策可最大程度地降低潜在的过早死亡率。然而，“烟草21”政策的力度和执行情况在各州差异很大。在没有本州“烟草21”香烟政策的8个州，执行联邦“烟草21”法律至关重要。
