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Are Laws Regulating Minimum Age for Tobacco Sales Uniformly Effective? :

April 20, 2021

There are data that suggest that overall tobacco use among adolescents is more common among those who live in rural areas.

There are data that suggest that overall tobacco use among adolescents is more common among those who live in rural areas. We also know that laws that increase the minimum age for tobacco sales are associated with decreased tobacco use among adolescents and young adults. Is this also true for e-cigarettes?

This week, Pediatrics is releasing a new article by Dr. Hongying Dai and colleagues at the University of Nebraska and the University of Kansas that looks at the impact of tobacco use minimum age laws on e-cigarette use among adolescents and young adults in both urban and rural areas. (10.1542/peds.2020-020651)

The authors analyzed 2018 and 2019 data from an annual statewide survey of >132,000 Kansas middle and high school students. They compared data from youth in both rural and urban areas. They also compared data from youth in areas with and without Tobacco 21 (T21) policies (which raise the minimum age of tobacco sales from 18 to 21 years of age).

The authors found a mean 50% increase in e-cigarette use in 2019 (12.4% use), compared with 2018 (8.0% use). This increase was much larger in rural areas (6.6% to 13.3%) than in urban areas (9.5% to 11.3%). While there was an increase in e-cigarette use, from 7.1% to 12.8%, in areas without T21 laws, overall there was no statistically significant increase in areas with such laws. However, when the authors then stratified the analysis by area of residence, this protective effect of T21 laws was less robust in rural areas.

In an accompanying commentary, Drs. Summer Hawkins and Christopher Baum from Boston College note that this sort of multi-layered analysis is unusual in tobacco research. (10.1542/peds.2020-049586) They suggest that, while T21 laws are extremely helpful and important in decreasing e-cigarette use in adolescents, more needs to be done to both understand the urban-rural disparities in tobacco use and to specifically target rural youth.

I hope that you will read both the article and commentary, which provide food for thought. When we think about health disparities, geographic disparities sometimes may get lost in the shuffle. We need to be thoughtful in our approach to these disparities as well.

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