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Pediatrics. 2017 Jul;140(1). pii: e20170570. doi: 10.1542/peds.2017-0570. Epub 2017 Jun 19.

Attitudes Toward Tobacco 21 Among US Youth.

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Departments of Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri; and Biomedical and Health Informatics and Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri



An important movement in reducing youth smoking is to restrict the supply of cigarettes to youth by raising the minimum age of sales to 21, termed Tobacco 21. This study examined attitudes toward Tobacco 21 among youth and their correlations with tobacco use.


Data from the 2015 National Youth Tobacco Survey (n = 17 092, the typical age of 11-18 years) were analyzed to examine the prevalence of support toward Tobacco 21 among youth. This study further assessed whether attitudes toward Tobacco 21 were associated with (1) intention to initiate cigarette smoking among never-smoking youth (n = 16 449); and (2) intention to quit tobacco use among current tobacco users (n = 2914).


Approximately 63.9% of respondents reported supporting Tobacco 21. Support for Tobacco 21 was higher among middle school students (versus high school students), girls (versus boys), and noncurrent users of cigarettes or electronic cigarettes (versus current users). Youth support attitudes were significantly associated with perceptions of tobacco's danger and tobacco use by household members. Never smokers who supported Tobacco 21 had lower odds of intention to initiate cigarette use (adjusted odds ratio = 0.2, P < .0001). Current tobacco users who supported Tobacco 21 had higher odds of intention to quit tobacco use in the next 12 months (adjusted odds ratio = 2.6, P < .0001).


Tobacco 21 is supported by the majority of youth nationwide and youth attitudes were correlated with smoking behaviors. Education programs about the harm of smoking and nicotine addiction at the early stages of life may help increase support of this policy among young tobacco users.

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