BEMIDJI, Minn. -- Two years ago a push in Bemidji to raise the buying age for tobacco to 21 was matched at the federal level.
Now, there are signs the effort is achieving its goal.
In February 2019, the Beltrami County Board of Commissioners voted to raise the legal age to buy tobacco products to 21, and the city of Bemidji followed along a month later. Toward the end of that year, in December 2019, President Donald Trump signed legislation also raising the buying age to 21.
Last year, the state of Minnesota passed its own Tobacco 21 law, which went into effect in August 2020. The state law included additional provisions, such as those under 21 being prohibited from entering tobacco or vape shops, as well as conducting more compliance checks.
At the local level, Beltrami County Public Health Director Megan Heuer said there was minimal pushback on the new law.
"There was a lot of discussion about it ahead of time, but once it passed, there's been very little backlash on it," she said.
The Tobacco 21 laws were set in motion with the notion that they could decrease youth smoking. For example, the National Academy of Sciences' Institute of Medicine found that such laws would reduce smoking by 25% among 15- to 17-year-olds and by 15% among 18- to 20-year-olds.
Since such laws have passed, decreases have been reported across the country.
In 2016, California became one of the first states to implement a Tobacco 21 law. After it was implemented, researchers at the University of California, Davis, conducted a study finding that the law was associated with a major decrease among 18- to-20 year-olds.
"The great news is the prevalence of daily smoking among 18- to 20-year-olds went from 2.2% in 2016 to nearly zero in 2019," said UC Davis professor Susan Stewart in a school publication.
Heuer said limiting such exposure to the 18-year-old age group was one of the main goals of the Tobacco 21 effort.
"We still have so many 18-year-olds in our high schools, so it makes it much more accessible to our 15-, 16- and 17-year-olds," Heuer said. "What we know about nicotine is it really has a strong, negative effect on the brain, which is developing until 25, and most are addicted long before that. This is really to prevent people from smoking all together for brain development, on top of reducing rates."
Other studies conducted after Tobacco 21 laws have shown similar results. A study from the National Bureau of Economic Research found the laws were associated with a 2.5% to 3.9% decline in smoking among 18- to 20-year-olds.
Subsequently, the study found the laws have also resulted in a reduction in tobacco use among 16- to 17-year-olds.
"Given mounting evidence that modern cigarette tax increases have become less effective in curbing youth and young adult smoking, our findings point to potentially more effective modern tobacco control policy," the researchers stated.
State and federal agencies also report similar data. The Center for Disease Control and Prevention found there were 4.47 million youth tobacco product users in 2020, down from 6.2 million in 2019.
The CDC's data reflects a larger trend of youth smoking declines across the country. In 2020, the CDC found that nearly five of every 100 high school students, amounting to 4.6%, reported they had smoked cigarettes in the past 30 days, a decrease from 15.8% in 2011.
While progress has been made, though, health officials and researchers say more work needs to be done.
The study by the National Bureau of Economic Research found that tobacco companies may have been willing to lose sales from 18- to 20-year-olds in hope of retaining additional current and future smokers through flavored e-cigarettes. The researchers note how some argue the U.S. tobacco companies endorsed the Tobacco 21 laws to avoid regulation of flavored tobacco products.
The CDC also found that in 2020, 85% of high school students and 74% of middle school students who used tobacco products in the past 30 days reported using flavored tobacco during that time.
"A lot of what our work revolves around is where our funding comes from, and I don't see that drying up," Heuer said. "A lot of public health takes the youth smoking issue on as important work. My hope is that after COVID, when we have more capacity, that this is an issue we can dig back into and really see the impact this has had and what other things we need to put into place."
State officials in Minnesota are expecting to have a better picture of the Tobacco 21 law's impact regionally in the near future, as the Department of Health plans to conduct a student tobacco survey next year.