Evaluating the Impact of the Federal Tobacco 21 Legislation on Adolescent E-Cigarette Use and Risk Perceptions

Objectives: The rise in popularity of electronic cigarettes (e-cigarettes) among adolescents in the United States during the past decade is concerning because of the device’s novelty and potential long-term health effects. In response, a federal Tobacco 21 (T21) law was enacted in 2019 to raise the minimum age for purchasing tobacco products and e-cigarettes from 18 to 21 years. We examined changes in adolescent e-cigarette use after implementation of T21 during a period of broader federal tobacco control activity. Methods: We analyzed data from the 2019 and 2020 National Youth Tobacco Survey (NYTS) to assess changes in e-cigarette use among middle and high school students aged 9 to 19 years (most aged 13-17 y) following implementation of the federal T21 law. Weighted logistic regression models examined associations between policy implementation and current e-cigarette use, controlling for demographic characteristics and perceived harm and addictiveness. Results: The prevalence of current e‑cigarette use declined from 16% (95% CI, 15%-18%) in 2019 to 11% (95% CI, 10%-13%) in 2020. After implementation of the federal T21 law in December 2019, adolescents were significantly less likely to use e‑cigarettes, with a 24% reduction in the odds of current use (odds ratio = 0.76; 95% CI, 0.64-0.91; P = .003). Conclusions: Federal legislation such as increasing the minimum age for purchasing tobacco and nicotine products may be an effective strategy in reducing and preventing e-cigarette use among adolescents. Future research should assess the sustainability of the effects of T21 legislation over time and examine how federal policies interact with other public health interventions to influence adolescent e-cigarette use.