Cleveland: beneficial effect on consumption of raising the legal age for tobacco sales to 21

August 18, 2022

Par: National Committee Against Smoking

Dernière mise à jour: August 18, 2022

Temps de lecture: 5 minutes

Raising the age of sale to 21 has had an impact on the prevalence of smoking among young people in the city, with a decline in the consumption of cigars, the form of tobacco most commonly used by young people, and a reduction in consumption disparities between ethnic minorities, a study has found.

Based on the observation that 90% of smokers started smoking during adolescence and that it is more difficult to quit when you started very young, several countries have considered raising the legal age for the sale of tobacco to 21 instead of 18.[1]. This type of measure has been adopted, to date, mainly in the United States and Singapore.

Before the generalization of the increase in the legal age of sale of tobacco at the federal level, at the end of 2019, some American states had anticipated this measure. In Cleveland (Ohio), it had been adopted in April 2016, while most of Ohio did not implement it until 2019. A recently published study evaluated the impact of this measure on young people in the city of Cleveland, looking at the period 2013-2019[2].

A drop in consumption observed in all categories

The comparison of smoking prevalence is based on data from the biennial surveys on youth risk behaviors, carried out in 2013, 2015, 2017 and 2019 in local schools, among 12,616 secondary school students. The data from the city of Cleveland were compared with those from cities in the first ring of its metropolitan area, where the measure to raise the legal age was only adopted in 2019. This made it possible to better highlight ethnic differences, since the population of Cleveland is poorer, smokes more and is more composed of black or Hispanic people. Consumption of cigarettes, cigars (in particular cigarillos and flavored cigars, very popular with young people) and e-cigarettes was recorded over the last 30 days. Questions on ethnicity were also asked during data collection.

It appears that the effect of raising the legal age of sale allows us to observe a decline in all types of consumption, including e-cigarettes, in Cleveland from 2017, while cigarette and especially cigar consumption increased between 2013 and 2015. Overall, the prevalence of cigar consumption, which had increased from 19.8 % in 2013 to 21.3 % in 2015, fell to 16.8 % in 2019, and this decline was significantly greater than in the suburbs of Cleveland where sales were still authorized after the age of 18. These declines are more or less marked depending on the types of products and the ethno-demographic profiles of the respondents, but are observed in all categories (with the exception of an increase in cigarette consumption among black adolescents between 2017 and 2019).

A reduction in ethnic disparities

The observed declines were accompanied by a reduction in consumption disparities between different gender or ethnic groups (e.g., reduction in the largest gaps observed between cigar consumption among black adolescent girls and white adolescent boys, between 2013 and 2019, or between cigarette consumption among white adolescent girls and black adolescent boys, between 2015 and 2019).

This measure followed an increase in the price of cigarettes in Ohio in July 2015, and was contemporaneous with the spread of disposable e-cigarettes; however, the decline in e-cigarette use continued steadily across population groups before and after the increase in the age of sale. It is worth noting that a 2016 study found that the effect of anti-smoking measures on adolescents is most noticeable in the period immediately following the adoption of the measure, with the persistence of the effect over time to be assessed.[3]. Finally, the effective application of the ban on the sale of tobacco to those under 21 seemed to be less respected in the black neighborhoods of Cleveland, as well as the display of the new legal age at the point of sale.

The study demonstrates the positive effect of raising the legal age of sale of tobacco on the consumption of tobacco products and electronic cigarettes, in particular cigars, the most popular products among young people in Cleveland, with a reduction in disparities between ethnic groups. This local increase in the legal age of sale of tobacco products, initiated in Cleveland by civil society, confirms that local measures can be effective, even before being deployed on a larger scale.[4].

Keywords: legal selling age, 21, ethnic disparities, Cleveland