title: Community reductions in youth smoking after raising the minimum tobacco sales age to 21.
abstract: OBJECTIVE
  Raising the tobacco sales age to 21 has gained support as a promising strategy to reduce youth cigarette access, but there is little direct evidence of its impact on adolescent smoking. Using regional youth survey data, we compared youth smoking trends in Needham, Massachusetts--which raised the minimum purchase age in 2005--with those of 16 surrounding communities.
  
  
  METHODS
  The MetroWest Adolescent Health Survey is a biennial census survey of high school youth in communities west of Boston; over 16,000 students participated at each of four time points from 2006 to 2012. Using these pooled cross-section data, we used generalised estimating equation models to compare trends in current cigarette smoking and cigarette purchases in Needham relative to 16 comparison communities without similar ordinances. To determine whether trends were specific to tobacco, we also examined trends in youth alcohol use over the same time period.
  
  
  RESULTS
  From 2006 to 2010, the decrease in 30-day smoking in Needham (from 13% to 7%) was significantly greater than in the comparison communities (from 15% to 12%; p<.001). This larger decline was consistent for both genders, Caucasian and non-Caucasian youth, and grades 10, 11 and 12. Cigarette purchases among current smokers also declined significantly more in Needham than in the comparison communities during this time. In contrast, there were no comparable differences for current alcohol use.
  
  
  CONCLUSIONS
  Our results suggest that raising the minimum sales age to 21 for tobacco contributes to a greater decline in youth smoking relative to communities that did not pass this ordinance. These findings support local community-level action to raise the tobacco sales age to 21.
authors.affiliation: Education Development Center, Inc, Waltham, Massachusetts, USA.
authors.forename: Shari
authors.initials: S
authors.lastname: Kessel Schneider
authors.affiliation: Department of Epidemiology, Brown University, Providence, Rhode Island, USA.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Buka
authors.affiliation: Education Development Center, Inc, Waltham, Massachusetts, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Dash
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Winickoff
authors.affiliation: Education Development Center, Inc, Waltham, Massachusetts, USA.
authors.forename: Lydia
authors.initials: L
authors.lastname: O'Donnell
mesh_terms: D000293:Adolescent; D000367:Age Factors; D003132:Commerce / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends; D003430:Cross-Sectional Studies; D005260:Female; D033161:Government Regulation; D006306:Health Surveys; D006801:Humans; D008297:Male; D008404:Massachusetts; D011050:Policy Making; D011634:Public Health / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends; D012111:Residence Characteristics; D012907:Smoking / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends; D016540:Smoking Cessation / Q000191:economics / Q000331:legislation & jurisprudence*; D000074606:Smoking Prevention; D062789:Tobacco Products / Q000191:economics / Q000331:legislation & jurisprudence*; D055815:Young Adult
keywords: Prevention; Priority/special populations; Public policy