Area-Level Predictors of Tobacco 21 Coverage in the U.S. Before the National Law: Exploring Potential Disparities

Abstract

The goal of the paper is to characterize the geographic and sociodemographic patterns of policies prohibiting tobacco sales to people aged <21 years (i.e., Tobacco 21) at the local, county, and state levels in the U.S. before the national law. This study assessed area-level markers for region, race/ethnicity, education, poverty status, and smoke-free law coverage as predictors of Tobacco 21 passage as of December 20, 2019, using modified Poisson and negative binomial regression models with robust SEs. Data were analyzed in 2020. Before the passage of the national policy, 191 million people were covered by Tobacco 21 laws. Counties with higher percentages of non-Hispanic Blacks and individuals living below the poverty line had a lower probability of coverage, whereas counties with higher percentages of Hispanics/Latinxs and individuals with a college degree had a higher probability of coverage. Tobacco 21 coverage also varied by region, with far greater coverage in the Northeast than in the Midwest and South. The national Tobacco 21 law may address disparities in coverage by SES, race/ethnicity, and region that could have lasting implications with regard to health equity.