Background Recently, the US Institute of Medicine has proposed that raising the minimum age for tobacco purchasing/sales to 21 years would likely lead to reductions in smoking behavior among young people. Surprisingly few studies, however, have assessed the potential impacts of minimum-age tobacco restrictions on youth smoking.
Objective To estimate the impacts of Canadian minimum age for tobacco sales (MATS) laws on youth smoking behaviour.
Design A regression-discontinuity design, using seven merged cycles of the Canadian Community Health Survey, 2000–2014.
Participants Survey respondents aged 14–22 years (n=98 320).
Exposure Current Canadian MATS laws are 18 years in Alberta, Saskatchewan, Manitoba, Quebec, the Yukon and Northwest Territories, and 19 years of age in the rest of the country.
Main outcomes Current, occasional and daily smoking status; smoking frequency and intensity; and average monthly cigarette consumption.
Results In comparison to age groups slightly younger than the MATS, those just older had significant and abrupt increases immediately after the MATS in the prevalence of current smokers (absolute increase: 2.71%; 95% CI 0.70% to 4.80%; P=0.009) and daily smokers (absolute increase: 2.43%; 95% CI 0.74% to 4.12%; P=0.005). Average past-month cigarette consumption within age groups increased immediately following the MATS by 18% (95% CI 3% to 39%; P=0.02). There was no evidence of significant increases in smoking intensity for daily or occasional smokers after release from MATS restrictions.
Conclusion The study provides relevant evidence supporting the effectiveness of Canadian MATS laws for limiting smoking among tobacco-restricted youth.
- public policy
- priority/special populations
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Contributors RCC and MS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. RCC oversaw all aspects of the study design and scientific requirements for its completion. In particular, RCC contributed to the conception and design of the work, as well as the acquisition, analysis and interpretation of the data. He prepared the initial manuscript and provided oversight for the final revision. MS contributed expertise in the design of the study and conducted the statistical analyses. He helped to prepare and revise the manuscript and provided critically important insight into the interpretation of the findings. JG made substantial contributions to the original design of the study, especially in the acquisition of the data and drafting the initial draft of the guiding research plan. JKC provided substantial contributions to the interpretation of the data and the revision of the final manuscript. MOC and RS made substantial contributions to the interpretation of the findings, and both made important contributions to the final version of the manuscript. SB made substantial contributions to the design of the project, as well as to the revision of the final manuscript. CB provided substantial contributions to the interpretation of the data and the preparation and revision of important content in the final version of the manuscript. All authors take responsibility for the contents of the paper.
Funding The Canadian Institutes of Health Research (CIHR) provided an operating grant to the lead author (RCC) to support the conduct of this research study. CIHR had no role in the following aspects of the study: design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The analyses presented in this paper were conducted at the Regional Data Centre (RDC) at the University of Toronto, with vetting of the analytic results occurring at the Regional Data Centre at the University of Victoria. Both of these RDCs are part of the Canadian Research Data Centre Network (CRDCN). The services and activities provided by the University of Toronto and the University of Victoria are made possible by the financial or in-kind support of the Social Sciences and Humanities Research Council of Canada (SSHRC), the CIHR, the Canadian Foundation for Innovation (CFI), Statistics Canada and the University of Toronto/University of Victoria. This work was supported by the Institute of Human Development, Child and Youth Health (grant number 383501).
Disclaimer The views expressed in this paper do not necessarily represent the CRDCN’s or that of its partners’.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.