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Cigarette and cigar sales in Hawaii before and after implementation of a Tobacco 21 Law
  1. Rebecca Glover-Kudon1,
  2. Doris G Gammon2,
  3. Todd Rogers2,
  4. Ellen M Coats2,
  5. Brett Loomis2,
  6. Lila Johnson3,
  7. MaryBeth Welton1,
  8. René Lavinghouze1
  1. 1 Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2 Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
  3. 3 Tobacco Prevention and Education Program, Hawaii State Department of Health, Honolulu, Hawaii, USA
  1. Correspondence to Dr Rebecca Glover-Kudon, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; rgloverkudon{at}


Introduction On 1 January 2016, Hawaii raised the minimum legal age for tobacco access from 18 to 21 years (‘Tobacco 21 (T21)’) statewide, with no special population exemptions. We assessed the impact of Hawaii’s T21 policy on sales of cigarettes and large cigars/cigarillos in civilian food stores, including menthol/flavoured product sales share.

Methods Cigarette and large cigar/cigarillo sales and menthol/flavoured sales share were assessed in Hawaii, California (implemented T21 in June 2016 with a military exemption), and the US mainland using the only Nielsen data consistently available for each geographical area. Approximate monthly sales data from large-scale food stores with sales greater than US$2 million/year covered June 2012 to February 2017. Segmented regression analyses estimated changes in sales from prepolicy to postpolicy implementation periods.

Results Following T21 in Hawaii, average monthly cigarette unit sales dropped significantly (−4.4%, p<0.01) coupled with a significant decrease in menthol market share (−0.8, p<0.01). This combination of effects was not observed in comparison areas. Unit sales of large cigars/cigarillos decreased significantly in each region following T21 implementation. T21 policies in Hawaii and California showed no association with flavoured/menthol cigar sales share, but there was a significant increase in flavoured/menthol cigar sales share in the USA (7.1%, p<0.01) relative to Hawaii’s implementation date, suggesting T21 may have attenuated an otherwise upward trend.

Conclusions As part of a comprehensive approach to prevent or delay tobacco use initiation, T21 laws may help to reduce sales of cigarette and large cigar products most preferred by US youth and young adults.

  • surveillance and monitoring
  • public policy
  • prevention

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  • Contributors All coauthors have made substantial contributions to the creation of the manuscript and take responsibility for it. RG-K, DGG, TR, EMC, BL and RL conceptualised the study. DGG, TR, EMC and BL conducted data analysis and interpreted results. RG-K, DGG, TR, EMC, BL, LJ and MW drafted portions of the manuscript. RG-K, DGG, TR, EMC, BL, RL, LJ and MW critically reviewed and/or revised the manuscript during peer review. RG-K was responsible for overall content and manuscript submission.

  • Funding Funding support was provided by the US Centers for Disease Control and Prevention, Office on Smoking and Health.

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or RTI International.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.