A recent study led by economist Erik Nesson from Wake Forest University, published in the Journal of Health Economics, has revealed a discrepancy between self-reported tobacco use and biomarker evidence among young adults aged 18-20 under Tobacco 21 (T21) laws. While survey data indicate that these young adults claim to be smoking less, the analysis of biomarkers paints a different picture, showing that traces of nicotine and tobacco persist in their systems.
The current study used data from the ongoing Population Assessment of Tobacco Use and Health (PATH), which includes both self-reported information and medical tests for tobacco exposure. According to the research team, the self-reports suggest a decline in smoking and vaping among the 18-20 age group since the implementation of T21 policies between 2016 and 2019. However, when the researchers examined urinary biomarkers, the expected reduction in tobacco and nicotine exposure was not evident. This suggests that some underage users may be concealing their true levels of use, possibly due to the legal constraints imposed by the T21 law.
The findings carry significant implications for policymakers and public health officials. While T21 laws were designed to curb youth access to tobacco products and reduce long-term addiction, the persistence of nicotine biomarkers indicates that these measures might be less effective than anticipated. Moreover, the study highlights the potential for unintended consequences, such as young people resorting to alternative means—perhaps even switching back to traditional cigarettes—to satisfy their nicotine cravings if vaping options become restricted.
Nesson emphasizes that policymakers must carefully evaluate both self-reported data and objective biomarker measurements to fully understand the impact of T21 laws. He warns that overestimating the success of these policies could lead to complacency, ultimately undermining efforts to protect young people from nicotine addiction. The study calls for a more nuanced approach that recognizes the complexity of youth tobacco use and the need for robust enforcement and supportive cessation measures.
Prohibition vs tobacco harm reduction
Ultimately, restrictions such as Tobacco 21 laws, have shown limited success in reducing youth smoking. Despite raising the legal purchase age to 21, research indicates that many young people still access cigarettes and vaping products through peers and illicit channels. These findings suggest that strict age restrictions may drive tobacco users underground, leading to an expansion of black markets and inaccurate consumption statistics. Additionally, prohibitionist policies can inadvertently push some users back toward more harmful traditional cigarettes when legal alternatives are unavailable.
In contrast, tobacco harm reduction strategies offer a more effective public health approach by providing safer alternatives to combustible tobacco. Evidence from countries like the United Kingdom and Sweden demonstrates that products such as vapes, heated tobacco, and snus significantly reduce smokers’ exposure to toxic substances, while studies have consisyently shown that these alternatives can lower health risks by up to 95% compared to smoking.
Harm reduction policies support smokers in transitioning away from dangerous tobacco products by offering accessible, lower-risk options. Rather than relying solely on prohibition, a regulatory framework that embraces harm reduction can encourage quitting and minimize the long-term health burdens associated with smoking, ultimately leading to improved public health outcomes.
