The Centers for Disease Control and Prevention (CDC) recently published results from the 2020 National Youth Tobacco Survey (NYTS). According to the results published in a September Morbidity and Mortality Weekly Report, youth use of vapor products decreased between 2019 and 2020.

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Indeed, data found that current e-cigarette use – defined as using an e-cigarette on at least one occasion in the 30 days prior to the survey – decreased from 27.5 percent of high school students and 10.5 percent of middle school students, to 19.6 percent and 4.7 percent respectively.

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Although some media have attributed this decline to due to the federal Tobacco 21 (T-21) law, which went into effect December 20, 2019, data from the Youth Risk Behavior Surveillance Survey (YRBSS) show that state T-21 laws had little-to-no effect on lowering the smoking rates among high school students.

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Hawaii’s T-21 law went into effect January 1, 2016, making the Aloha State the first state to implement the age restriction. Between 2015 and 2017, cigarette smoking rates increased 10 percent, from 9.7 percent of high school students to 10.8 percent. Further, e-cigarette use increased 1.5 percent in the same time period, from 25.1 percent of Hawaii high school students to 25.5 percent. In 2019, although youth combustible cigarette use did decrease, to 5.3 percent (a 45 percent decrease from 2015 and a 51 percent decrease from 2017), current vaping rates increased to 30.6 percent of students.

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On July 1, 2018, Maine’s T-21 law went into effect. Similar to Hawaii, combustible cigarette use declined by 28 percent, from 8.7 percent of high school students reporting current use in 2017 to 6.8 percent in 2019. Between 2017 and 2019, youth vaping increased by 47.6 percent, from 15. 8 percent of high school students reporting current e-cigarette use in 2017 to 30.2 percent in 2019. Interestingly, youth vaping did decrease between 2015 and 2017, from 16. 8 percent to 15.8 percent of high school students.

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Massachusetts’ T-21 went into effect on December 31, 2018. Between 2017 and 2019, combustible use by high school students decreased 28 percent from 6.4 percent to 5 percent. Current vapor product use increased by 37 percent in the same time period, from 20.1 percent of high school students to 32.2 percent.

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The only state to implement T-21and see decreases in both youth tobacco and vapor product use was California. The T-21 law went into effect on June 9, 2016, making the Golden State the second state to enact such legislation. From 2015 to 2017, cigarette smoking among high school students decreased by 42 percent from 7.7 percent to 5.4 percent. There is no data available on 2019 youth cigarette rates. Regarding current vaping use among California high school students, between 2015 and 2017, current vaping rates decreased by 23.6 percent, from 21.4 percent of students to 17.3 percent. Interestingly, youth vaping increased by 4 percent from 2017 to 2019, to 18.2 percent of high school students, but it is still a 17 percent decrease from 2015.

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Although preventing youth use of tobacco and vapor products is laudable, T-21 does not seem like an effective strategy to combat youth vapor product use. Rather, states should utilize existing tobacco-related monies from taxes and lawsuit settlements on programs that can reduce youth use.

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Of the mentioned states, only California dedicates tobacco control funding that matches the recommended funding levels from the CDC. Indeed, in 2019, California spent $250.4 million on tobacco control programs – or 72 percent of the CDC recommended funding. In 2019, Hawaii spent $4.5 million on tobacco control programs (32.9 percent of CDC recommendations), Maine allocated $4.8 million (30.4 percent of CDC recommendations), and Massachusetts spent $4.2 million (6.3 percent of CDC recommendations).

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It is evident that prohibitionist policies do not reduce youth tobacco and vapor product use, but robust and well-funded tobacco control programs can and do work. Lawmakers should take note of the effects of T-21 in these states when looking at future tobacco and vapor policies.

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Nothing in this analysis is intended to is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101. For more information on tobacco and vapor products, please visit Tobacco Harm Reduction 101 at https://www.thr101.org.  

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