The Effects of the Tobacco 21 Minimum Legal Sales Age Policy on Respiratory Health

Emmanuel, Zachariah and Emmanuel, Maria and Aipoh, Godwin and Dickson, Vonke and Collins, Emma (2025): The Effects of the Tobacco 21 Minimum Legal Sales Age Policy on Respiratory Health.

Abstract

This paper examines the effects of tobacco restrictions policy on respiratory health. We 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), we 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. We find that the T21 MLSA policy lowered the risk of COPD by 11.4 percentage points, or approximately 6.7%, among young adults between the ages of 18 and 21. In addition, we find that the policy had a greater effect on male, black, and Hispanic populations. We also find the policy to be more effective among 20-year-old unemployed young adults with some college education. These findings suggest that the T21 MLSA policy has effectively reduced respiratory health problems among teenagers and young adults, supporting its public health benefits to society. Therefore, states that are yet to adopt the T21 MLSA policy should consider its potential to decrease the risk of COPD and, ultimately, tobacco-related mortality as a valuable component of their health policy.

• Item Type: MPRA Paper
• Language: English
• Keywords: Tobacco 21 MLSA policy, respiratory health, copd,
• Subjects: I - Health, Education, and Welfare > I1 - Health; I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health

References

Abouk, R. and Adams, S. (2017). Compliance inspections of tobacco retailers and youth smoking. American Journal of Health Economics, 3(1):10–32. Abouk, R., De, P., and Pesko, M. F. (2024). Estimating the effects of tobacco-21 on youth tobacco use and sales. Journal of Health Economics, page 102860. Apollonio, D. E. and Glantz, S. A. (2016). Minimum ages of legal access for tobacco in the united states from 1863 to 2015. American journal of public health, 106(7):1200–1207. Bircan, E., Bezirhan, U., Porter, A., Fagan, P., and Orloff, M. S. (2021). Electronic cigarette use and its association with asthma, chronic obstructive pulmonary disease (copd) and asthma-copd overlap syndrome among never cigarette smokers. Tobacco induced diseases, 19. Borusyak, K., Jaravel, X., and Spiess, J. (2021). Revisiting event study designs: Robust and efficient estimation. arXiv preprint arXiv:2108.12419. Bryan, C., Hansen, B., McNichols, D., and Sabia, J. J. (2020). Do state tobacco 21 laws work? Technical report, National Bureau of Economic Research. Callaway, B. and Sant’Anna, P. H. (2021). Difference-in-differences with multiple time periods. Journal of econometrics, 225(2):200–230. Center for Disease Control and Prevention (2020). Tobacco related mortality. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. Center for Disease Control and Prevention (2023). Wide-ranging online data for epidemiologic research (wonder). Atlanta, GA: National Center for Health Statistics. de Chaisemartin, C. and d’Haultfoeuille, X. (2020). Two-way fixed effects estimators with heterogeneous treatment effects. American Economic Review, 110(9):2964–2996. Feng, B. and Pesko, M. F. (2019). Revisiting the effects of tobacco retailer compliance inspections on youth tobacco use. American Journal of Health Economics, 5(4):509–532. Friedman, A. S. and Pesko, M. F. (2024). Tobacco 21 laws and youth tobacco use: The role of policy attributes. American Journal of Public Health, 114(1):90–97. Goodman-Bacon, A. (2021). Difference-in-differences with variation in treatment timing. Journal of Econometrics, 225(2):254–277. 23 Working Paper Kwan, L. Y., Stratton, K., Bonnie, R. J., et al. (2015). Public health implications of raising the minimum age of legal access to tobacco products. National Academies Press. Mtenga, E. L. and Pesko, M. F. (2024). The effect of vertical identification card laws on teenage tobacco and alcohol use. Health Economics. Sloan, F. A., Ostermann, J., Conover, C., Taylor, D. H., and Picone, G. (2006). The price of smoking. MIT press. Sun, L. and Abraham, S. (2021). Estimating dynamic treatment effects in event studies with heterogeneous treatment effects. Journal of Econometrics, 225(2):175–199. U.S. Department of Health and Human services (2014). The health consequencs of smoking—50years of progress. U.S. Department of Health and Human services (2018). Physical activity guidelines for americans. Xu, X., Bishop, E. E., Kennedy, S. M., Simpson, S. A., and Pechacek, T. F. (2015). Annual healthcare spend- ing attributable to cigarette smoking: an update. American journal of preventive medicine, 48(3):326–333.