Addict Behav. 2026 Aug 1;183:108823. doi: 10.1016/j.addbeh.2026.108823. Online ahead of print.
ABSTRACT
BACKGROUND: The federal Tobacco 21 (T21) law, enacted in December 2019, raised the U.S. minimum legal purchasing age for all tobacco products from 18 to 21. Yet overall nicotine use among young adults aged 18-24 has remained nearly unchanged, as declining combustible cigarette use has been offset by rising e-cigarette use. Few studies have examined T21’s association with cessation, and none have found statistically significant effects.
METHODS: Using nationally representative data from the 2014-2024 National Health Interview Survey (NHIS; N = 13,238) and a difference-in-differences design, we estimate T21’s effects on 19-20-year-olds relative to 21-22-year-old counterparts. Outcomes include combustible cigarette or e-cigarette use, recent cigarette cessation (quit smoking within 24 months with no current nicotine use), and demographic heterogeneity in continued use after T21 (non-compliance). Falsification (placebo) tests, which apply the design to ages and periods that T21 did not restrict, and a COVID-period robustness check assess the design.
RESULTS: Federal T21 was associated with a 4.3-4.6 percentage-point reduction in combustible cigarette or e-cigarette use among 19-20-year-olds relative to 21-22-year-olds (p < 0.01; a 26-28 % relative reduction). Excluding COVID years yielded larger estimates (4.8-5.2 percentage points). Both falsification tests yielded null results. The law was associated with a 4.3-5.4 percentage-point increase in recent cessation, stable in magnitude across specifications but less precisely estimated (p = 0.08-0.13).
CONCLUSIONS: Federal T21 was associated with reduced cigarette or e-cigarette use among 19-20-year-olds and suggestive increases in recent cessation. Continued enforcement of the law, with cessation support for young adults, could strengthen its effectiveness.
PMID:42551119 | DOI:10.1016/j.addbeh.2026.108823
