Early adoption of tobacco 21 policies can avert premature mortality, study suggests

Early adoption and implementation of Tobacco 21 (T21) policies, with a minimum legal access age for tobacco products of 21 years, is associated with potential premature mortality reductions, according to a study published online Dec. 20 in JAMA Health Forum.

Jamie Tam, M.P.H., Ph.D., from the Yale School of Public Health in New Haven, Connecticut, and colleagues quantified potential reductions in smoking-attributable mortality associated with T21 policies.

State-specific data on smoking initiation, smoking cessation, and mortality rates for 50 U.S. states and the District of Columbia were integrated with comprehensive data on T21 policy coverage at the local and state levels from 2005 to 2024; potential mortality reductions were quantified from 2005 to 2100.

The researchers found that early statewide adoption of T21 in California, combined with its large population, was associated with prevention of more than 27,000 premature deaths through 2100, while statewide implementation in Kentucky was associated with prevention of 15,000 premature deaths.

T21 policies were associated with 8,000 averted premature deaths in Massachusetts, mainly attributed to municipal T21 policies covering most residents. In Wisconsin, which lacks state or local policies, enforcement of federal T21 policies would be required to prevent up to 10,000 premature deaths.

Comprehensive enforcement of federal, state, and local T21 laws across the country was associated with up to 526,000 premature deaths averted and 13.3 million life-years gained by 2100. Overall, 442,000 premature deaths would be averted with enforcement of only state and local policies.

“These analyses quantify the potential benefits achieved through T21 policies and demonstrate the urgent need for federal and state lawmakers to enhance their enforcement,” the authors write.

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