Researchers from the University of North Carolina at Chapel Hill, including UNC Lineberger member Adam Goldstein, MD, MPH, and East Carolina University reported in the American Journal of Preventive Medicine that in all nine regions of the country, a majority of adults supported increasing the minimum legal age for tobacco product sales. They also found the most support for increasing the minimum age to 21 rather than to 20 or 19.

Although the United States’ current political environment is rancorous, a national survey has found strong support in all regions of the United States for raising the legal age of tobacco sales.

Researchers from the University of North Carolina at Chapel Hill and East Carolina University report in the American Journal of Preventive Medicine that in all nine regions of the country, a majority of adults supported increasing the minimum legal age for tobacco product sales. They also found the most support for increasing the minimum age to 21 rather than to 20 or 19.

“With these findings, policy makers and public health advocates can move forward knowing that people in their states support raising the minimum legal age for selling tobacco products, and that this is an issue that is not viewed as partisan,” said Adam O. Goldstein, MD, MPH, a University of North Carolina Lineberger Comprehensive Cancer Center member and a professor in the UNC School of Medicine Department of Family Medicine. “It seems to cross political lines, and it is one policy measure that the majority of those surveyed can agree on.”

The study comes as two states have recently moved to increase the legal age of tobacco sales to 21. Hawaii became the first U.S. state to make the change Jan. 1, and California followed suit earlier this year. Already, a number of counties and cities, including New York City, have increased the minimum legal age.

“With the strong support indicated in our data, I think we will continue to see strong momentum,” Goldstein said. “It appears likely that increasingly, lawmakers are going to be interested in doing this.”

According to a National Academy of Medicine report in 2015, increasing the legal age for purchasing tobacco products would likely lower health care costs, and would prevent or delay young adults from starting smoking. The U.S. Food and Drug Administration-sponsored report predicted that raising the legal age to 21 nationally would result in a 12 percent reduction in smoking prevalence.

“By restricting tobacco use to people 21 and older, the compelling evidence is that you have less people who end up using it. They don’t end up taking up smoking and tobacco.”

“By restricting tobacco use to people 21 and older, the compelling evidence is that you have less people who end up using it. They don’t end up taking up smoking and tobacco,” Goldstein said. “And if you cut down on adolescents using tobacco, you’ll ultimately cut down on how many adults use tobacco, and then you cut down on tobacco-related diseases like heart disease and cancer.”

In the study, researchers surveyed 4,880 adults aged 18 or older to learn their views on raising the minimum age of tobacco sales to 19, 20 or 21. The telephone survey was offered in both English and Spanish and conducted on land-line and cell phones.

A majority of people surveyed supported raising the minimum age in all regions of the country. Levels of support ranged from 59.6 percent in a seven-state Midwestern region that included Iowa and Kansas to 73.1 percent of residents in a four-state region of the South that included Texas and Louisiana. In the South Atlantic region, which included North Carolina, seven other states, and the District of Columbia, 68.1 percent of people supported an increase.

“Even in regions with historically strong ties to tobacco growing and manufacturing, a strong majority of the public, including smokers, is in favor of raising the minimum legal age of tobacco sales,” said the study’s first author Joseph G. L. Lee, PhD, MPH, an assistant professor in the East Carolina University College of Health & Human Performance. Lee began the study as a doctoral student at the UNC Gillings School of Global Public Health.

Women, non-white adults, Latinos and non-smokers were more supportive of an increase as were those who were over the age of 21.

Although there was no association found between the proportion of voters in a state who voted Republican in the last presidential election and the likelihood that person would be in favor of a higher age of sale for tobacco products, there was an association with a respondent’s level of trust in the government. A person who trusted the government was 8 percent more likely to support an increase in the minimum age.

“What we found was really an overall trend of broad support for this policy,” Goldstein said.

The study was supported by grants from the National Institutes of Health, National Cancer Institute and the FDA Center for Tobacco Products.

In addition to Goldstein and Lee, the study was co-authored by Marcella H. Boynton, PhD, and Amanda Richardson, PhD, of the UNC Gillings School of Global Public Health Department of Health Behavior; and Kristen Jarman, MSPH, and Leah M. Ranney, PhD, of the UNC School of Medicine Department of Family Medicine.