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Sunday, August 1, 2021

Researchers discover the implementation of the California Tobacco 21 law is associated with a decreased prevalence of daily smoking in youth

Raising the purchasing age of tobacco presents potential to discourage tobacco use in adolescents, according to research from the UC Davis Comprehensive Cancer Center

In 2016, California implemented the Tobacco 21 (T21) law that raised the age for purchasing tobacco from 18 to 21 years old. A recent UC Davis study by the UC Davis Comprehensive Cancer Center discovered just how impactful this law was—the prevalence of daily smoking in 18 to 20-year-olds in California decreased to 0.4% in association with this policy.  

Melanie Dove, an assistant adjunct professor in the Department of Public Health Sciences at UC Davis Health and first author of the study, explained that tobacco is the single most preventable cause of disease and a serious problem in youth. The T21 policy presents the potential to reduce tobacco initiation and addiction in young people, according to Dove.

Despite the significant reduction in 18 to 20-year-olds in California’s daily smoking rate, the study did not find such an association between the policy and non-daily smoking in youth. Dove explained that this is because daily smokers are more likely to buy cigarettes from a store, whereas non-daily smokers are more likely to receive cigarettes from friends or other social sources. 

In order to help target these non-daily smokers, Elisa Tong, the Stop Tobacco Program leader and medical director, explained that it is important to offer free cessation support along with implementing policies to help support people who smoke. She also expressed the importance of educating the general public about the significant risks associated with non-daily smoking and secondhand smoke. 

“Reducing the availability of tobacco with T21 may have contributed to reducing daily smoking and consumption of cigarettes,” Tong said via email. “The hope is that an environmental change will encourage and support individual behavior change.” 

Dove expressed that in order to continue preventing tobacco initiation and use in youth, it is important to continue enforcing T21 policies and researching what factors would be helpful in improving such enforcement, such as educating tobacco retailers or monitoring retailers to make sure they are not selling tobacco products to underage youth. 

In addition to the T21 policy, Tong explained that California has passed a ban on the retail sale of flavored tobacco products. In addition, the Food and Drug Administration has recently made a ruling to start taking menthol—a kid-friendly flavor—out of cigarettes and cigars. Dove emphasized the need to research the effectiveness of these new policies as well as find ways to enforce those policies. Since the law has been passed across the entire U.S., Tong also identified the implementation of the T21 policy across the country and its national impact as a future area of research.

However, this issue cannot simply be solved with the implementation of policies. Cari Shulkin, a national certified tobacco treatment specialist at the UC Davis Comprehensive Cancer Center, emphasized that nicotine is a highly addictive substance that can be as difficult—if not more difficult—to quit as alcohol, heroin or methamphetamines. In addition to the substance being highly addictive, she added that those with comorbidities, such as mental health issues, may struggle even more with quitting. Shulkin expressed the need for a combination of medications and counseling to ensure patients are given the highest chance to stop smoking. 

“For me, if they’re a light smoker or a daily user, [it] doesn’t matter,” Shulkin said. “We’re going to get them connected to resources and medication use, whatever it takes to make sure that they become smoke-free or tobacco-free.”

Dove also expressed that in addition to policies such as T21, youth need to be educated on the harms of smoking behaviors and provided with evidence-based cessation tools to help them stop smoking. In addition, she emphasized a need to change the social norms surrounding smoking behaviors such as vaping. Dove explained that while smoking cigarettes used to be considered “cool” by society, this standard has slowly faded. Similarly, she believes equivalent public health strategies need to be applied to help reduce all other smoking behaviors.  

“It’s not just going to take one policy such as the Tobacco 21 policy or one city banning flavors from e-cigarettes,” Dove said. “We really need a whole comprehensive approach to tackle this problem.”
Written by: Michelle Wong —science@theaggie.org

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