Abstract Summary/Description
Tobacco use is strongly associated with an increased risk of lung disease, respiratory issues, and stroke. To reduce the risk of tobacco consumption, in the United States, many individual states established a minimum legal sale age (MLSA) law for Tobacco products between 2016 and 2019, which prohibits the sale of tobacco products to individuals under 21 before a federal Tobacco 21 MLSA came into place in December 2019. I leverage the heterogeneous timing across states in the adoption of the policy from a sample of 8,175 individuals between the ages of 18 and 21. Using the 2011 to 2019 Behavioral Risk Factor Surveillance System (BRFSS), I estimate the impact of the Tobacco 21 MLSA policy on the prevalence of chronic obstructive pulmonary disease (COPD), a progressive lung condition marked by airflow obstruction due to prolonged exposure to irritants like cigarette smoke and air pollution. I find that the T21 MLSA policy lowered the prevalence of respiratory health issues by 6.7 percentage points, or approximately 4%, among young adults between the ages of 18 and 21. Additionally, the policy had a greater effect in reducing respiratory issues among males than females. While there was no significant effect on respiratory health problems among white individuals, the policy effectively decreased respiratory health issues among Black and Hispanic populations. The T21 MLSA policy also had a greater impact on unemployed young adults than on those employed and was particularly effective among 20-year-olds compared to other ages within the sample. Furthermore, the policy also showed a stronger effect on respiratory health outcomes among young adults with some college education compared to those with a high school diploma or less. These findings suggest that the T21 MLSA policy effectively reduces respiratory health problems, which supports its public health benefit. Therefore, states that are yet to adopt the T21 MLSA policy should consider its potential to decrease the prevalence of respiratory health problems and, ultimately, tobacco-related mortality as a valuable component of their health policy.
