PRP182: Tobacco 21 policy impact on adolescent tobacco use in Minnesota

April Wilhelm, MD, MPH


Context: Adolescent tobacco use is increasing, particularly in the form of alternative tobacco products like e-cigarettes. Increasing the minimum tobacco purchasing age to 21 years (T21 policies) has shown promise in reducing adolescent tobacco use. However, few studies have examined differences in tobacco use behaviors across a range of tobacco products among adolescents with heterogeneous exposure to T21 policies. Objective: To examine whether adoption of county- and municipality-level T21 policies affect youth tobacco use prevalence. Datasets: A variable indicating the presence of a T21 policy in the community was merged with the 2016 and 2019 Minnesota Student Survey, a school-administered, statewide cross-sectional survey. Study Design: Quasi-experimental study examining tobacco product use in 2019 among Minnesota adolescents with differential exposure to T21 policies. Bivariate analyses examined prevalence of eight types of tobacco use based on respondents’ attendance at a school within a T21 policy area. Mixed effects logistic regressions modeled adolescent tobacco use behaviors by T21 policy exposure, controlling for baseline tobacco use prevalence at the school-level in 2016 and other demographic characteristics. Population studied: 8th, 9th, and 11th grade survey respondents in Minnesota (n=117,973 in 2016 and n=123,289 in 2019). Outcome Measures: Past 30-day use of any tobacco product, cigarettes, cigars, e-cigarettes, hookah, chewing tobacco, flavored tobacco products, and dual/poly (two or more) tobacco product use (all dichotomized outcomes) in 2019. Anticipated outcomes: Unadjusted results indicate that increasing e-cigarette and flavored tobacco use accounted for the higher overall tobacco use prevalence in 2019 relative to 2016; all other forms of tobacco use declined over this interval. Students attending T21-exposed schools in 2019 reported significantly lower prevalence of any tobacco use (12.3 vs. 17.0%), flavored tobacco use (6.2 vs. 8.7%), e-cigarettes (13.8 vs. 17.7%) and other tobacco products (all p<0.005) relative to students attending unexposed schools with the exception of hookah. This resulted in a smaller increase in overall tobacco use among students in T21-exposed schools compared with their non-exposed peers over this period (3.8 vs. 4.4% difference). Adjusted mixed effects logistic regression models are forthcoming.

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