Do Tobacco-21 Laws Decrease Smoking in Young Adults? Interview with:

Abigail S. Friedman, Ph.D.     Assistant Professor Department of Health Policy and Management Yale School of Public Health 

Dr. Friedman

Abigail S. Friedman, Ph.D.
Assistant Professor
Department of Health Policy and Management
Yale School of Public Health What is the background for this study?

Response: Smoking is responsible for approximately 1 in 5 deaths in the United States each year. Despite the fact that all US states ban tobacco sales to minors, the vast majority of smokers begin this habit as adolescents. As of July 25, 2019, 18 states and over 450 localities have passed laws banning tobacco sales to those under age-21. The laws are commonly referred to as “tobacco-21” laws.

Concurrently, 16 states without state-level tobacco-21 laws prohibit counties and municipalities from raising their legal sales age for tobacco products above the state-mandated age; typically, 18. If local tobacco-21 laws reduce youth smoking, then preemption policies impede population health.

To consider this, we estimated the impact of county- and municipality-level tobacco-21 policies on smoking among 18 to 20 year-olds residing in MMSAs (metropolitan and micropolitan statistical areas). Specifically, regression analyses compared smoking among 18-20 year-olds in areas with more vs. less tobacco-21 coverage, before vs. after these policies were adopted. What are the main findings?

Response: For the average 18 to 20 year-old in our sample, exposure to local tobacco-21 policies yielded a 1.2 percentage point reduction in their likelihood of being a current smoker. This is equivalent to a 10% reduction in the smoking rate among 18-20 year-olds in these data.

This effect was not present among 23 to 25 year-olds, suggesting that the change in smoking among 18-20 year-olds reflects a response to the tobacco-21 policies themselves, and not some unobserved factor affecting all age-groups in areas that adopted tobacco-21 laws. What should readers take away from your report?

Response: This research provides strong evidence that tobacco-21 laws reduce smoking among 18 to 20 year-olds. Moreover, this finding suggests that state preemption laws impede  public health, as they prevent communities from passing regulations that would reduce smoking. Is there anything else you would like to add? Any disclosures?

Response: This research was supported by an Evidence for Action grant from the Robert Wood Johnson Foundation (grant #74869). The Robert Wood Johnson Foundation had no role in the study’s design or conduct; the data’s collection, analysis, or interpretation; or the manuscript’s preparation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Robert Wood Johnson Foundation. 


Abigail S Friedman, Rachel J Wu, Do Local Tobacco-21 Laws Reduce Smoking among 18 to 20 Year-Olds?, Nicotine & Tobacco Research, , ntz123,

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Last Updated on July 28, 2019 by Marie Benz MD FAAD