Cigarette smoking prevalence in the United States has significantly decreased over the past few decades to 15.1% among adults1 and 9.3% among high school students.2 Declines are a result of a variety of tobacco control initiatives, including limits on tobacco marketing, higher per-unit cost of tobacco products, clean air legislation, mass media campaigns, and reductions in youth access.3 At the same time, use of electronic nicotine delivery systems (ENDS) has rapidly increased.2 The role of ENDS in reducing or exacerbating population-level morbidity and mortality from tobacco products remains hotly contested. The increased use of ENDS, and the fact that smoking remains the leading cause of preventable death in the United States3 indicate that additional policy interventions are needed to work toward the tobacco “endgame.” One such intervention is raising the minimum legal sales age (MLSA) to 21 years.4 As more states and localities enact...

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