WHERE THERE’S SMOKE

Research finds broad support for raising minimum age to buy tobacco

An East Carolina University researcher and colleagues at the University of North Carolina at Chapel Hill have found broad support for raising the minimum age for tobacco sales in North Carolina and across the country.

Dr. Joseph G. Lee, assistant professor in the ECU College of Health and Human Performance, began working on the study as a doctoral student at the UNC Gillings School of Global Public Health. He joined ECU’s faculty last fall.

Lee and fellow researchers reported in the American Journal of Preventive Medicine on June 1 that a majority of adults support an increase in the legal age to purchase tobacco products in all regions of the country. They also found the most support for increasing the minimum age to 21 rather than 19 or 20. The legal age to buy tobacco products in North Carolina and most states is 18.

“Bringing the minimum age for tobacco purchase up to the minimum age for alcohol makes a lot of sense given that tobacco use remains a leading cause of premature death in the United States,” Lee said. “The number of preventable deaths from tobacco each year in the U.S. is more than double the entire population of both Pitt County and Lenoir County.”

Researchers saw support across the nation regardless of how conservative or liberal the state participants lived in were, Lee said.

“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,” Lee said.

In the study, researchers surveyed 4,880 adults aged 18 or older to learn their views on 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.

“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 is an issue that is not viewed as partisan,” said Dr. Adam O. Goldstein, a University of North Carolina Lineberger Comprehensive Cancer Center member and professor in the UNC School of Medicine 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.”

A discarded cigarette butt lies on a campus walkway.

The study comes as two states have recently moved to increase the legal age of tobacco sales to 21. Hawaii became the first U.S. state to make the change Jan. 1, and California followed suit earlier this year. 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 would likely lower health care costs and 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 less 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 like heart disease and cancer.”

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.

“While youth need to take responsibility to be tobacco-free, policies raising the age to purchase tobacco products can give young people a better opportunity to avoid becoming addicted to tobacco products,” Lee said. “It’s nice to see that regardless of what region of the country you’re in, about two-thirds of adults think it’s a policy worth supporting.”

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

In addition to Goldstein and Lee, the study was co-authored by Dr. Marcella H. Boynton and Dr. Amanda Richardson of the UNC Gillings School of Global Public Health Department of Health Behavior, and Kristen Jarman and Dr. Leah M. Ranney of the UNC School of Medicine Department of Family Medicine.

Laura Oleniacz, science communications manager with UNC Lineberger Comprehensive Cancer Center, contributed to this story.