Abstract
Raising the minimum age of sale for tobacco products to 21 years (Tobacco 21) could help prevent and delay tobacco product initiation among youth. This study examined changes in U.S. adults' attitudes toward Tobacco 21 policies during 2014-2017. Data came from the 2014-2017 annual Summer Styles surveys, an Internet-based, cross-sectional survey of U.S. adults aged ≥18 years, drawn from GfK's KnowledgePanel®. Sample sizes ranged from 4107 in 2017 to 4269 in 2014. Each year, respondents were asked if they "strongly favor," "somewhat favor," "somewhat oppose," or "strongly oppose" Tobacco 21 policies. Weighted prevalence estimates of favorability (strongly or somewhat favor) were assessed each year; differences in favorability between years were assessed by chi square tests. Adjusted odds ratios (aOR) of favorability with 95% confidence intervals (CI) were calculated using logistic regression for the year 2017. Tobacco 21 policy favorability was reported by 75.0% in 2014; 72.3% in 2015; 78.4% in 2016; and 75.2% in 2017; the difference in favorability between 2014 and 2017 was not statistically significant. In 2017, lower odds of favorability toward Tobacco 21 policies were observed for current (aOR = 0.49, CI = 0.37-0.64) and former (aOR = 0.54, CI = 0.44-0.66) cigarette smokers, and current other tobacco product users (aOR = 0.54, CI = 0.49-0.64) than respective nonusers. Among U.S. adults, Tobacco 21 favorability has remained high since 2014, coinciding with a period of rapid state and local-level policy adoption. These results could be helpful for states and localities as they work to understand the feasibility of Tobacco 21 policies in their jurisdiction.