MINNEAPOLIS/ST. PAUL (11/02/2021) — Researchers from the University of Minnesota Medical School and the Minnesota Department of Health published a study in Nicotine & Tobacco Research that described the relationship between local Tobacco 21 policies in Minnesota and middle and high school student tobacco use, including e-cigarettes. Using data from the 2019 MInnesota Student Survey, the team analyzed to see if the effects of these policies differ by age. 

The researchers found that eighth- and ninth-grade students who lived in communities that had Tobacco 21 policies were significantly less likely to report use of tobacco products than their peers in communities without Tobacco 21. These products include cigarettes, e-cigarettes and flavored tobacco. They did not observe this relationship between Tobacco 21 policies and tobacco use among eleventh-grade students.

“Many factors may be contributing to the age-related differences that we observed with locally implemented Tobacco 21 policies in Minnesota, including compliance challenges with proof-of-age identification checks, increased mobility and social connections of older adolescents in their daily lives,” said April Wilhelm, MD, MPH, a family medicine physician with the U of M Medical School and M Health Fairview. 

Tobacco 21 policies raise the minimum legal age-of-sale for all tobacco products to 21 in an attempt to reduce adolescent access to tobacco products and to prevent initiation of use. However, real-world data on Tobacco 21 policies are limited, especially among younger adolescents.

“Our findings suggest that Tobacco 21 policies are an effective strategy to reduce adolescent tobacco use, particularly among middle school and early high school-age adolescents,” Wilhelm said, who is also a member of the Masonic Cancer Center. “It’s crucial to better understand the underlying reasons for the age-related differences in Tobacco 21 policy effects that we observed so that the policies can be optimized for a broader range of adolescents.”

Researchers suggest future studies should explore whether differences in policy implementation or enforcement of Tobacco 21 create challenges and if these variations undermine policy effectiveness among older adolescents. Wilhelm mentioned that more studies should be done to assess if flavored tobacco or menthol restrictions influence Tobacco 21 policy effects on adolescent tobacco use.


Research authors are April Wilhelm, Marla Eisenberg, Michael Shyne and Iris Borowsky of the University of Minnesota Medical School and John Kingsbury and Sharrilyn Helgertz of the Minnesota Department of Health.

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