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On June 9, 2016, California implemented Tobacco 21 and became the second state to raise the minimum legal sales age (MLSA) for tobacco products from 18 to 21. The law applies to all tobacco products, including e-cigarettes, other vaping devices, hookah, cigars, chewing tobacco, snus, and pipes as well as cigarettes. The law is expected to reduce tobacco consumption among young adults aged 18-20. It may also influence the smoking behavior of older adolescents (aged 15-17) who often rely on older friends to obtain their cigarettes. Furthermore, the impact is likely to be more far-reaching, because most adults begin smoking before the age of 21, and if they are not able to purchase tobacco before age 21 they may never initiate tobacco use. The reduction in tobacco use prevalence, both in the short-term among 15-20 year olds, and in the longer-term among adults aged 21 and older, is likely to have an impact on healthcare expenditures. Finally, the law may impact retail sales for vendors who sell tobacco products. To analyze the impact of Tobacco 21, this study has 3 specific aims: Aim 1: The impact of Tobacco 21 on statewide tobacco use. We will analyze the impact of Tobacco 21 on California tobacco use immediately after implementation of the law. For adolescents 15-17, we will compare the prevalence of current use of cigarettes, cigars, kreteks, hookah, e-cigarettes, and smokeless tobacco before and after Tobacco 21 was implemented. For adults aged 18-20, we will compare the prevalence of current use of cigarettes and e-cigarettes before and after Tobacco 21 was implemented. We hypothesize that smoking prevalence will be decreased among 15-20 year olds in the years immediately following the implementation of Tobacco 21. Aim 2: The impact of Tobacco 21 on healthcare costs from cigarette smoking. The difference in smoking-attributable healthcare costs over the course of 50 years will be estimated for a scenario with Tobacco 21 and one without Tobacco 21. We will project smoking prevalence for each scenario, and use this to estimate healthcare costs using econometric models that include the impact of smoking on health and healthcare costs controlling for many other factors. We hypothesize that healthcare costs will be lower for the Tobacco 21 scenario, reflecting reduced uptake during late adolescence and young adulthood. Over the years, fewer young people smoking will result in fewer adults smoking and lower healthcare costs. Aim 3: The impact of Tobacco 21 on tobacco vendors. We will analyze the impact of Tobacco 21 on retail tobacco vendors’ sales revenues for tobacco (cigarettes, e-cigarettes, and all types of tobacco products) and total sales for all products before and after Tobacco 21 to see whether there is a change in revenue trends after Tobacco 21 was implemented. These analyses will also allow us to determine the proportion of total sales revenue accounted for by tobacco products for different types of vendors (grocery stores, drug stores, convenience stores, and mass merchandisers). We hypothesize that there will be little if any change in revenues in the years immediately following the implementation of T21 and that tobacco sales account for a small proportion of sales revenue for most vendors, but that the impact may vary by type of vendor. The proposed study will provide the first estimates of the economic impact of Tobacco 21 in CA, and will be the first study of the economic impact of raising the MLSA based on actual experience anywhere in the US. This project will generate information on the impact of the Tobacco 21 law that will indicate the extent to which the law reduces tobacco use among young people, reduces smoking prevalence in the future due to reduced uptake during the critical early years, results in savings in healthcare expenditures due to reduced tobacco use, and impacts the revenues of tobacco retailers. By providing evidence of the economic impact of the law, this study will help strengthen our tobacco control efforts, particularly those focusing on reducing tobacco use uptake among our younger citizens. |
