February 6, 2018

Stanton A. Glantz, PhD

Age Requirements For e-Cigarette Purchases Protect U.S. Youth

Minimum Legal Sales Age laws for e-cigarettes associated with less or the same cigarette smoking among adolescents

Lauren Dutra, colleagues at the CDC, and I just published “Impact of E-Cigarette Minimum Legal Sale Age Laws on Current Cigarette Smoking” in Journal of Adolescent Health that found that states with age requirements for e-cigarette purchases have the same or less adolescent cigarette smoking compared to states without these age requirements. The results of this study suggest that these minimum age of sale policies benefit youth.

We analyzed tobacco product use, including e-cigarettes, from over 80,000 adolescents across the United States and found that the amount of adolescent cigarette smoking was less or the same in states with age requirements on e-cigarettes compared to states without these laws.

The findings from this study are consistent with a 2015 report published by the Institute of Medicine, which found that raising the minimum age of sale to buy tobacco products to at least 21 would reduce youth tobacco product use and save lives. To date, five states (California, Hawaii, Maine, New Jersey, and Oregon) and hundreds of communities have implemented laws that increased the minimum age of sale of tobacco products to 21.

 In the RTI press release announcing publication of the paper, Lauren observed, “If properly enforced, laws that set a minimum age for buying e-cigarettes are effective at preventing youth use.  In fact, these laws would be much more effective if the age requirement was increased. If the age requirement for all tobacco products was set to 21, we could prevent even more young people from ever trying tobacco products.” 

We also confirmed the importance of smoke-free indoor air laws. We determined whether each adolescent in the study was covered by smoke-free laws and found that participants living in areas with smoke-free workplaces were less likely to smoke cigarettes.  This finding reinforces the fact that smokefree policies bans continue to be an important part of protecting youth from tobacco.

Previous research that examined average cigarette use by state and concluded that e-cigarette age requirements were associated with more cigarette smoking among youth did not use individual-level data or account for the use of e-cigarettes and other tobacco products (such as little cigars) among adolescents. Our new study, which yielded different results, was the first to account for these factors.

Here is the abstract:

Purpose.  The purpose of this study was to use individual-level data to examine the relationship between e-cigarette minimum legal sale age (MLSA) laws and cigarette smoking among U.S. adolescents, adjusting for e-cigarette use.

Methods. In 2016 and 2017, we regressed (logistic) current (past 30-day) cigarette smoking (from 2009–2014 National Youth Tobacco Surveys [NYTS]) on lagged (laws enacted each year counted for the following year) and unlagged (laws enacted January–June counted for that year) state e-cigarette MLSA laws prohibiting sales to youth aged <18 or <19 years (depending on the state). Models were adjusted for year and individual- (e-cigarette and other tobacco use, sex, race/ethnicity, and age) and state-level (smoke-free laws, cigarette taxes, medical marijuana legalization, income, and unemployment) covariates.

Results.  Cigarette smoking was not significantly associated with lagged MLSA laws after adjusting for year (odds ratio [OR] = .87, 95% confidence interval [CI]: .73–1.03; p = .10) and covariates (OR = .85, .69–1.03; p = .10). Unlagged laws were significantly and negatively associated with cigarette smoking (OR = .84, .71–.98, p = .02), but not after adjusting for covariates (OR = .84, .70–1.01, p = .07). E-cigarette and other tobacco use, sex, race/ethnicity, age, and smoke-free laws were associated with cigarette smoking (p < .05). Results unadjusted for e-cigarette use and other tobacco use yielded a significant negative association between e-cigarette MLSA laws and cigarette smoking (lagged: OR = .78, .64–.93, p = .01; unlagged: OR = .80, .68–.95, p = .01).
Conclusions.  After adjusting for covariates, state e-cigarette MLSA laws did not affect youth cigarette smoking. Unadjusted for e-cigarette and other tobacco use, these laws were associated with lower cigarette smoking.


The full citation is Dutra et al.  Impact of E-Cigarette Minimum Legal Sale Age Laws on Current Cigarette SmokingJournal of Adolescent Health. Epub ahead of print 5 Feb 2018 DOI: https://doi.org/10.1016/j.jadohealth.2017.11.302

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