June 1, 2016

A national survey conducted by researchers from the University of North Carolina at Chapel Hill and East Carolina University has found strong support in all regions of the United States for raising the legal age of tobacco sales.

Dr. Joseph Lee

Dr. Joseph Lee

Dr. Marcy Boynton

Dr. Marcy Boynton

Joseph G.L. Lee, PhD, alumnus of UNC’s Gillings School of Global Public Health and assistant professor of health education and promotion at East Carolina, is first author of the study. Marcella H. Boynton, PhD, research assistant professor of health behavior at the Gillings School, and Amanda Richardson, PhD, health behavior research assistant professor during the study, are also co-authors.

The study, published online June 1 in the American Journal of Preventive Medicine, found that a majority of adults in all nine regions of the country supported increasing the minimum legal age for tobacco product sales. They also found the most support for increasing the minimum age to 21 rather than to 20 or 19.

“With these findings, policy makers and public health advocates can move forward knowing that people in their states support raising the minimum legal age for selling tobacco products and that this issue is not viewed as partisan,” said co-author Adam O. Goldstein, MD, MPH, a University of North Carolina Lineberger Comprehensive Cancer Center member and professor in the UNC School of Medicine’s Department of Family Medicine. “It seems to cross political lines, and it is one policy measure that the majority of those surveyed can agree on.”

The study comes as two states recently have moved to increase the legal age of tobacco sales to 21. On Jan. 1, Hawaii became the first U.S. state to make the change, and California followed suit earlier this year, with laws that go into effect on June 9. Already, a number of counties and cities, including New York City, have increased the minimum legal age.

“With the strong support indicated in our data, I think we will continue to see strong momentum,” Goldstein said. “It appears likely that increasingly, lawmakers are going to be interested in doing this.”

According to a National Academy of Medicine report in 2015, increasing the legal age for purchasing tobacco products likely would lower health-care costs and would prevent or delay young adults from starting smoking.  The U.S. Food and Drug Administration-sponsored report predicted that raising the legal age to 21 nationally would result in a 12 percent reduction in smoking prevalence.

“By restricting tobacco use to people 21 and older, the compelling evidence is that you have fewer people who end up using it. They don’t end up taking up smoking and tobacco,” Goldstein said. “And if you cut down on adolescents using tobacco, you’ll ultimately cut down on how many adults use tobacco, and then you cut down on tobacco-related diseases such as heart disease and cancer.”

In the study, researchers surveyed 4,880 adults ages 18 and older to learn their views about raising the minimum age of tobacco sales to 19, 20 or 21. The telephone survey was offered in both English and Spanish and conducted on landline and cell phones.

A majority of people surveyed supported raising the minimum age in all regions of the country. Levels of support ranged from 59.6 percent in a seven-state Midwestern region that included Iowa and Kansas to 73.1 percent of residents in a four-state region of the South that included Texas and Louisiana. In the South Atlantic region, which included North Carolina, seven other states, and the District of Columbia, 68.1 percent of people supported an increase.

“Even in regions with historically strong ties to tobacco growing and manufacturing, a strong majority of the public, including smokers, is in favor of raising the minimum legal age of tobacco sales,” said first author Lee, who began the study as a doctoral student at the UNC Gillings School.

Women, non-white adults, Latinos and non-smokers were more supportive of an increase as were those who were over the age of 21.

Although there was no association found between the proportion of voters in a state who voted Republican in the last presidential election and the likelihood that person would be in favor of a higher age of sale for tobacco products, there was an association with a respondent’s level of trust in the government. A person who trusted the government was 8 percent more likely to support an increase in the minimum age.

“What we found was really an overall trend of broad support for this policy,” Goldstein said.

Other co-authors include Kristen Jarman, MSPH, and Leah M. Ranney, PhD, of the UNC School of Medicine’s Department of Family Medicine.

The study was supported by grants from the National Institutes of Health, National Cancer Institute and the FDA Center for Tobacco Products.

This news originally was published by UNC Lineberger Comprehensive Cancer Center.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu


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