Abstract
PURPOSE: Tobacco 21 (T21) is a population-based strategy to prevent tobacco initiation. A majority of U.S. youths support T21; however, the extent to which individual, interpersonal, and community factors influence T21 support is uncertain. This study explored predictors of T21 support among U.S. youth. METHODS: We analyzed data from the 2015 National Youth Tobacco Survey (n = 17,683) to assess the association of peer influence and access to tobacco products on T21 support. We used multivariable logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals for T21 support. For tobacco nonusers, the model included peer influence along with covariates including sex, age, race/ethnicity, household tobacco use, and perceived harm. For tobacco users, the model included tobacco access sources (direct purchase, social sources, and other means), the aforementioned covariates, and tobacco product type. RESULTS: Among nonusers, students least receptive to peer influence (aOR = 2.5), those youngest in age (11-14 years, aOR = 2.3), and those who believe tobacco is dangerous (aOR = 2.5) had higher odds of T21 support. Among users, lower odds of T21 support were observed among those who purchased tobacco (aOR = .3) and accessed tobacco through social sources (aOR = .7) or other means (aOR = .6) in the past 30 days. Younger tobacco users (11-14 years, aOR = 2.2), black, non-Hispanic users (aOR = 3.8), e-cigarette users (aOR = 2.5), and users who believe that tobacco is dangerous (aOR = 2.8) had higher odds of T21 support. CONCLUSIONS: Low receptivity to peer influence and lack of access to tobacco products are associated with T21 support. Results underscore that T21 implementation may require a social-ecological approach.