Tobacco age restrictions may not be working, new research shows

Based on survey data, young adults covered by Tobacco 21 (T21) laws say they are smoking less. Biomarkers paint a smokier picture. Despite recent reports of tobacco bans’ success, new research shows 18- to 20-year-olds are finding ways to get cigarettes and vapes. Traces of nicotine and tobacco in their bodies prove it.

First-of-its-kind research developed by Wake Forest University economist Erik Nesson and published in the peer-reviewed Journal of Health Economics shows that since the enactment of state T21 laws between 2016 and 2019, young adults aged 18–20 are more likely to report that they don’t smoke—although a study of biomarkers for their tobacco and nicotine exposure tells a different story.

The study comes on the heels of the latest U.S. Surgeon General report on tobacco use, which says more than 36 million U.S. adults and 760,000 middle and high school students use some kind of tobacco product.

A National T21 law raised the minimum age for purchasing tobacco products in response to a huge increase in the use of e-cigarettes, or vapes, by young people. The law followed a series of state and local T21 bans, with Hawaii enacting the first such law in 2016.

To determine the effectiveness of such laws, Nesson and a team including Chad Cotti of Michigan State University and Phillip DeCicca of Ball State University used data from the Population Assessment of Tobacco Use and Health (PATH), an ongoing study that has been collecting information from thousands of participants since 2013.

What makes this new study unique?

PATH data include self-reported answers to survey questions in addition to the results of medical tests that detect biomarkers for tobacco and nicotine exposure.

Nesson’s study, “The effects of tobacco 21 laws on smoking and vaping: Evidence from panel data and biomarkers,” is the first to analyze both the PATH survey data and the biomarker results, which makes all the difference.

“When you measure tobacco use using only self-reported survey data, you find T21 policies are effective at reducing tobacco use, especially cigarette smoking,” said Nesson. “But when you measure the same young adults’ recent exposure to tobacco through biomarkers in their urine, you don’t see any changes in recent exposure. Policymakers need to be aware of the unintended consequences of the policies they put in place. Sometimes they can be positive, but sometimes they can be negative.”

And that means underage smokers might be hiding the fact that they smoke because it is now illegal.

It’s an important distinction for policymakers, lawmakers and health care providers who are focused on preventing young people from smoking in an effort to curb the number of adults addicted to nicotine.

Why the findings matter

According to the National Survey on Drug Use and Health, conducted each year by the federal Substance Abuse and Mental Health Services Administration, daily smokers tried their first cigarette around age 15 and formed a daily habit around age 18.

For instance, Nesson is working on a paper that shows that state bans on flavored vape cartridges likely have reduced vaping among youths, as intended. However, an unintended consequence is that many of the youths who vaped before the ban just turned to smoking traditional cigarettes after the ban took effect.

“If you make it harder to vape, they’ll fall back on what’s available,” he explained.

Meanwhile, in another study underway, the researchers find that bans on flavored tobacco products have had very little or no effect on LGBTQ youth—they continue to vape with the same frequency, despite restrictions.

Without further study, researchers suggest, any estimates of the effects of T21 bans on the smoking habits of young adults aged 18–20 might be overstated.