Minimum tobacco age laws
Minimum legal tobacco age (MLTA) laws set the legal age when an individual can purchase or consume tobacco products1. In the United States, Tobacco 21, also known as T21, sets the national minimum age for the sale of tobacco products, including cigarettes, cigars, and electronic cigarettes (e-cigarettes), to 21 years2. State and local minimum tobacco age laws can include additional restrictions, such as setting a minimum consumption age, to ensure adequate enforcement3. Some states have introduced or expanded preemption of local tobacco control4. Estimates indicate 95% of adult smokers began smoking before age 211.
Note: The term “tobacco” in this strategy refers to commercial tobacco, not ceremonial or traditional tobacco. County Health Rankings & Roadmaps recognizes the important role that ceremonial and traditional tobacco play for many Tribal Nations, and our tobacco-related work focuses on eliminating the harms and inequities associated with commercial tobacco.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced tobacco use
Reduced youth smoking
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Improved health outcomes
What does the research say about effectiveness?
There is strong evidence that raising the minimum legal tobacco age (MLTA) to 21 reduces tobacco use among 18- to 20-year-olds5, 6, 7, 8, 9, 10, 11.
Raising the MLTA to 21 can also reduce the use of tobacco cigarettes among 16- to 17-year-olds6 and reduce tobacco and nicotine use among Hispanic youth12. A study at an Ohio university found that implementing T21 may reduce smoking and the use of smokeless tobacco, however it has no impact on e-cigarette use. Minimum tobacco age laws may need to be paired with other control efforts to reduce e-cigarette use among youth10.
Raising the MLTA to 21 can reduce tobacco sales13, 14, 15. In a Hawaii-based study, T21 appeared to reduce sales of cigars and menthol cigarettes, which are disproportionately smoked by people of color and youths16. A study from Needham, MA, suggests that reductions in smoking rates and cigarette purchases are highest during the initial implementation period of a T21 policy, though reductions can continue for at least four years9.
Studies in New York City and Columbus, OH suggest retailer compliance with MLTA laws may decrease after the implementation of T2117, 18. Experts recommend that enforcement plans should include enforcement by a single agency; ongoing compliance check inspections; consequences for violations, including high penalties; and effective retailer education efforts19.
Models suggest a MLTA of 21 could lead to a 12% decrease in smoking prevalence over time, along with immediate improvements in the health of adolescents and young adults and decreases in related long-term mortality20.
Raising the MLTA to 21 may reduce marijuana consumption among 18-year-olds and alcohol consumption among 18- to 20-year-old males6.
How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples
Implementation Resources
Tobacco 21 - Preventing Tobacco Addiction Foundation. Tobacco 21.
PHLC-Tobacco sales restrictions - Tobacco Control Legal Consortium (TCLC). Sales restrictions. Saint Paul: Public Health Law Center (PHLC).
Dobbs 2020 - Dobbs PD, Chadwick G, Ungar KW, et al. Development of a Tobacco 21 policy assessment tool and state-level analysis in the USA, 2015-2019. Tobacco Control. 2020;29(5):487-495.
CDC-Tobacco 21 - Centers for Disease Control and Prevention (CDC). Tobacco 21: Policy evaluation for comprehensive tobacco control programs. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2020.
ChangeLab-Tobacco 21 - ChangeLab Solutions. Tobacco 21 model policy: Preventing early addiction by banning tobacco sales to youth under 21.
Footnotes
* Journal subscription may be required for access.
1 CTFK-Minimum tobacco age - Campaign for Tobacco-Free Kids (CTFK). Increasing the minimum legal sale age for tobacco products to 21.
2 Farber 2016 - Farber HJ, Pakhale S, Neptune ER. Tobacco 21: An important public policy to protect our youth. Annals of the American Thoracic Society. 2016;13(12):2115-2118.
3 CDC-Tobacco 21 - Centers for Disease Control and Prevention (CDC). Tobacco 21: Policy evaluation for comprehensive tobacco control programs. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2020.
4 Dobbs 2020 - Dobbs PD, Chadwick G, Ungar KW, et al. Development of a Tobacco 21 policy assessment tool and state-level analysis in the USA, 2015-2019. Tobacco Control. 2020;29(5):487-495.
5 Dove 2021 - Dove MS, Stewart SL, Tong EK. Smoking behavior in 18–20 year-olds after Tobacco 21 policy implementation in California: A difference-in-differences analysis with other states. Preventive Medicine. 2021;148:106553.
6 NBER-Bryan 2021 - Bryan C, Hansen B, McNichols D, Sabia JJ. Do state Tobacco 21 laws work? National Bureau of Economic Research (NBER). 2021: Working Paper 28173.
7 Friedman 2020 - Friedman AS, Wu RJ. Do local Tobacco 21 Laws reduce smoking among 18 to 20 year-olds? Nicotine and Tobacco Research. 2020;22(7):1195-1201.
8 Yoruk 2016 - Yörük CE, Yörük BK. Do minimum legal tobacco purchase age laws work? Contemporary Economic Policy. 2016;34(3):415-429.
9 Schneider 2016 - Schneider SK, Buka SL, Dash K, Winickoff JP, O’Donnell L. Community reductions in youth smoking after raising the minimum tobacco sales age to 21. Tobacco Control. 2016;25(3):355-359.
10 Roberts 2022 - Roberts ME, Keller-Hamilton B, Teferra AA. Tobacco 21’s impact amid the e-cigarette surge. Public Health Reports. 2022.
11 Friedman 2019 - Friedman AS, Buckell J, Sindelar JL. Tobacco-21 laws and young adult smoking: Quasi-experimental evidence. Addiction. 2019;114(10):1816-1823.
12 Grube 2021 - Grube JW, Lipperman-Kreda S, García-Ramírez G, Paschall MJ, Abadi MH. California’s Tobacco 21 minimum sales age law and adolescents’ tobacco and nicotine use: Differential associations among racial and ethnic groups. Tobacco Control. 2021.
13 Liber 2020 - Liber AC, Xue Z, Cahn Z, Drope J, Stoklosa M. Tobacco 21 adoption decreased sales of cigarette brands purchased by young people: A translation of population health survey data to gain insight into market data for policy analysis. Tobacco Control. 2020.
14 Ali 2020 - Ali FRM, Rice K, Fang X, Xu X. Tobacco 21 policies in California and Hawaii and sales of cigarette packs: A difference-in-differences analysis. Tobacco Control. 2020;29(5):588-592.
15 Boettiger 2020 - Boettiger DC, White JS. Cigarette pack prices and sales following policy changes in California, 2011-2018. American Journal of Public Health. 2020;110(7):1002-1005.
16 Glover-Kudon 2021 - Glover-Kudon R, Gammon DG, Rogers T, et al. Cigarette and cigar sales in Hawaii before and after implementation of a Tobacco 21 Law. Tobacco Control. 2021;30(1):98-102.
17 Roberts 2021 - Roberts ME, Klein EG, Ferketich AK, et al. Beyond strong enforcement: Understanding the factors related to retailer compliance with Tobacco 21. Nicotine & Tobacco Research. 2021;23(12):2084-2090.
18 Silver 2016 - Silver D, Macinko J, Giorgio M, Bae JY, Jimenez G. Retailer compliance with tobacco control laws in New York City before and after raising the minimum legal purchase age to 21. Tobacco Control. 2016;25(6):624-627.
19 Winickoff 2018 - Winickoff JP. Maximizing the impact of Tobacco 21 laws across the United States. American Journal of Public Health. 2018;108(5):594-595.
20 IOM-Bonnie 2015 - Bonnie RJ, Stratton K, Kwan LY. Public health implications of raising the minimum age of legal access to tobacco products. Washington, D.C.: Institute of Medicine of the National Academies; 2015.
21 CDC MMWR-Marynak 2020 - Marynak K, Mahoney M, Williams KAS, et al. State and territorial laws prohibiting sales of tobacco products to persons aged <21 years — United States, December 20, 2019. Morbidity and Mortality Weekly Report (MMWR). 2020;69(7):189-192.
22 US FDA-Tobacco 21 - U.S. Food and Drug Administration (U.S. FDA). Center for Tobacco Products. Tobacco 21.
Related What Works for Health Strategies
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