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Primary Submission Category: Health behaviors
Changes in Smoking Inequalities among U.S. Young Adults, 2017-2023
Authors: Mingyue Lu, Nathaniel Tran,
Presenting Author: Mingyue Lu*
Background
Tobacco is responsible for approximately 30% of cancer deaths, with significant racial, ethnic, and socioeconomic inequalities. A federal tobacco 21 (T21) law, which increased the minimum legal sales age of tobacco products in the U.S. from 18 to 21, was enacted in December 2019.
Methods
Data were drawn from the 2017-2023 Behavioral Risk Factor Surveillance System (BRFSS). We used linear regression techniques to estimate the pooled smoking prevalence in three periods: pre-T21 implementation (2017-2019), T21 implementation transition (2020-2021), and post-T21 implementation (2022-2023).
Results
In the overall sample of 62,626 U.S. young adults aged 18-20, 8.67% [95% CI 8.08 to 9.25%] of respondents were current smokers in the pre-T21 implementation period which declined to 5.01% [95% CI 4.48 to 5.54%] at T21 implementation transition, and declined to 4.17% [95% CI 3.62 to 4.72%] in the post-T21 implementation period, an absolute reduction of -4.50 percentage points (pp) [95% CI -5.30 to -3.69pp, p<.001]. The absolute reduction in current smoking was significant for all demographic subgroups. The relative inequality between subgroups was only significant by education level.
Conclusions
We find that current smoking significantly declined in the overall study sample, as well as across all subgroups studied. While smoking declined throughout the study period for all subgroups, federal T21 implementation was not associated with reductions in smoking inequalities by binary sex, household income, or sexual and gender minority (SGM) identity. Prevention and cessation policies that are accessible to SGM respondents and respondents from lower socioeconomic backgrounds are needed to mitigate tobacco-related harms.