Sharon Lipperman-Kreda, PhD., email@example.com
Grisel Garcia-Ramirez, PhD., GGarcia-Ramirez@PREV.org
M.J. Paschall, PhD., paschall@PREV.org
Joel W. Grube, PhD., firstname.lastname@example.org
Melissa Abadi, PhD., email@example.com
California’s law raising the minimum tobacco purchase age to 21 (T21) went into effect on June 9, 2016. Little is known about how T21 affects tobacco use, nor whether impact varies across disparate groups. Using a quasi-experimental design, we examined changes in tobacco use among adolescents in California pre- and post-T21 law. We also examined whether changes in tobacco use differed across racial minority groups.
A statewide sample of 6th through 12th graders (N=2,078,575; 51% females) from 4,427 schools in California participated in California Healthy Kids Survey (CHKS) from 2007 to 2018. Participants reported sex, race and grade, and lifetime and past month cigarette smoking and smokeless tobacco use. Controlling for demographics, multilevel mixed effects logistic regression models showed that implementation of T21 law was negatively associated with lifetime (OR=0.75, p<0.001) and past month (OR=0.74, p<0.001) cigarette smoking, and with lifetime (OR=0.73, p<0.001) and past month (OR=0.67, p<0.001) smokeless tobacco use in the general population.
Moderation analyses, however, showed that T21 was associated with greater likelihood of lifetime (OR=1.06, p<0.05) and past month (OR=1.27, p<0.001) cigarette smoking and smokeless tobacco use (OR = 1.15, p < 0.01; OR=1.22, p<0.01) among African American adolescents relative to others. Greater odds of lifetime (OR=1.11, p<0.05) and past month (OR=1.24, p<0.001) smokeless tobacco use and past month cigarette smoking (OR=1.21, p<0.001) were also observed among Native Hawaiian/Pacific Islander adolescents.
In contrast, significant negative interactions between T21 and being American Indian/Alaska Native (AIAN) on lifetime cigarette smoking (OR=0.90, p<0.001) and lifetime and past month smokeless tobacco use (OR=0.92, p<0.001; OR=0.91, p<0.001) indicate that AIAN adolescents may be more responsive to the T21 law. Results suggest that California’s T21 contributed to overall reductions in adolescent tobacco use but may differentially impact minority groups. These findings emphasize the importance of understanding potential unintended consequences of this policy to address tobacco-related health disparities.
Funding: This research and analysis were supported by grant 25IR-0029 from the California Tobacco-Related Disease Research Program (TRDRP), grant P60-AA006282 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH), grant R03-DA041899 from the National Institute on Drug Abuse (NIDA) of the NIH and Food and Drug Administration (FDA) Center for Tobacco Products (CTP), and grant R01-CA190238 from the National Cancer Institute (NCI) of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of TRDRP, NIAAA, NIDA, NCI, or NIH.
Key Words: Adolescent/youth; Health disparities