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Tobacco 21 adoption decreased sales of cigarette brands purchased by young people: a translation of population health survey data to gain insight into market data for policy analysis
  1. Alex C Liber1,2,
  2. Zheng Xue2,3,
  3. Zachary Cahn2,
  4. Jeffrey Drope4,
  5. Michal Stoklosa4
  1. 1Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
  2. 2Economic and Health Policy Research, American Cancer Society, Atlanta, Georgia, USA
  3. 3Health Policy and Management, Rollins School of Public Health, Atlanta, Georgia, USA
  4. 4Health Policy and Administration, University of Illinois Chicago School of Public Health, Chicago, Illinois, USA
  1. Correspondence to Dr Alex C Liber, Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA; alex.liber{at}


Introduction Policies raising the minimum age of sale of tobacco products to 21 (T21) proliferated at state and local levels across the USA before a federal policy was adopted. Evidence of the effectiveness of these policies is building and lags implementation. This study exploits demographic patterns of cigarette brand purchasing to evaluate the effectiveness of T21.

Methods To capture the effect of T21 implementation on cigarette sales, we used universal product code-level data from Nielsen Scantrack data covering January 2015 to October 2019. We used the 2015 to 2018 National Survey on Drug Use and Health to identify cigarette brands where smokers under 21 comprised a disproportionately high (young) and low (old) share of consumption. We fit fixed-effects linear regressions in Nielsen designated market areas to test if sales of young or old cigarette brands were changed by T21. Unadjusted models controlled for time and T21 implementation date. Adjusted models controlled for price, seasonality and unemployment. A permutation test of 5000 randomised placebo T21 policies were fit to determine how well the true date of implementation fit sales data stratified by brand group.

Results Sales of disproportionately young brands declined after T21 implementation. T21 policy implementation dates fit disproportionately young brand sales trends better than 99% of adjusted randomised placebo models. T21 implementation fit disproportionately old brand sales trends better than just 1% of adjusted randomised placebo models.

Conclusion This study adds compelling empirical evidence that T21 decreased purchases of the cigarette brands consumed disproportionately by young people, the policy’s target demographic.

  • public policy
  • surveillance and monitoring
  • tobacco industry

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  • Contributors ACL conceived of the project and led data analysis and manuscript drafting. ZX performed data cleaning and management and assisted in manuscript drafting. MS and ZC designed the analytical strategy and assisted in manuscript drafting. JD supervised manuscript revisions.

  • Funding Data used to conduct this analysis was purchased by American Cancer Society, Inc.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data was provided to the authors under a user agreement with the Nielsen Company and the authors are not authorised to share the underlying data without permission from Nielsen.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.