Raising the minimum age of legal access (MLA) to tobacco products to 21 decreases access and would likely
prevent or delay initiation of tobacco use by adolescents and young adults. However, modern tobacco behavior
use among young people is increasingly complex and is characterized by decreased cigarette use, increased
use of non-cigarette tobacco product use and, poly tobacco use. In addition, tobacco use patterns and tobacco
sales to minors vary based on race/ethnicity. While there has been recent and rapid diffusion of Tobacco 21
policies, little data exist on the process, content, or outcomes of Tobacco 21 laws. The existing evidence for
increasing the MLA to 21 holds promise to further reduce tobacco use among young people but the extent to
which such policies will be effective for all tobacco products as well as all racial/ethnic groups is largely
unknown. Using the Multiple Streams Framework and the Reach, Effectiveness, Adoption, Implementation and
Maintenance (RE-AIM) Framework as our conceptual frames we operationalize and assess health policy
factors that impact Tobacco 21 Adoption, Implementation and Maintenance. This project uses a mixed
methods approach to understand the implementation and impact of policies that raise the MLA to 21,
seeking to expand the evidence base with a focus on racial/ethnic groups in the context of a diverse
tobacco environment. Specifically, we will: (1) carry out a comparative case study of 15 states using
document analysis of Tobacco 21 bills, news media content analysis, and key informant interviews to identify
factors that may contribute to the adoption or rejection of Tobacco 21 legislation; (2) conduct a repeated cross
sectional tobacco product purchase study to examine implementation of a statewide Tobacco 21 law in New
Jersey; and, (3) describe the impact of Tobacco 21 laws by modeling tobacco use behavior among 13 to 25
year olds in states with and without Tobacco 21 laws using data from the National Survey on Drug Use and
Health. The relevance of the proposed research to public health is its ability to improve existing and future
Tobacco 21 policies and reduce tobacco use disparities.
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