Can States Continue to Set the Agenda for Tobacco 21? Insights From US News Coverage Between 2012 and 2020

Abstract

Introduction

Existing research on media examining the news content related to Tobacco 21 (T21) predate the adoption of most T21 laws. This study examined the discussion of T21 laws in top-circulating print media sources in the United States between 2012 and 2020.

Aims and Methods

Systematic database searches using Access World News and Factiva identified T21-related news articles appearing in the top daily circulating newspapers in each state between January 2012 and December 2020 (n = 586 articles). Content analyses documented prevalence, types of articles and context related to framing of arguments for or against T21 laws.

Results

Newspaper coverage of T21 was highest in 2019 (42.8% of articles). The majority were news or features (75.4%) followed by editorials or opinions (24.6%) which largely supported T21. Most articles focused on state or local T21 action. Coverage of federal T21 increased in 2019. The most common argument supporting T21 included reducing youth tobacco prevalence (64.8%) while the most frequent objection was freedom infringement (25.1%). Tobacco and vape industries began voicing support for T21 in 2019.

Conclusions

News coverage of state-level T21 in the United States began to increase in 2015 and peaked in 2019 with enactment of federal T21, a newsworthy event. As states adopt and amend T21 laws to align with federal law, advocates can use media to help shape the narrative and encourage strong T21 policies.

Implications

This study described the volume and content of T21 print media coverage from 2012 to 2020, including common arguments used to support and oppose T21. Arguments in support of T21 included reducing youth tobacco use, particularly use of e-cigarettes, and related health effects while arguments against T21 focused on individual rights. Support for T21 reached a tipping point in 2019, including the tobacco industry’s reversal in opposing such laws. States can and should continue to improve existing T21 laws and policies and increase public awareness about critical policy components such as inspection procedures and penalties.

Introduction

Despite notable reductions in cigarette smoking in the United States, concerns about tobacco use among youth remain. Experimentation before 18 is a strong predictor of adult tobacco use.¹ Thus, efforts to delay initiation are priorities for tobacco control. Increasing the minimum legal sales age for tobacco products to age 21, or Tobacco 21 (T21), has been promoted as a promising strategy to delay tobacco initiation and reduce tobacco prevalence among youth.

T21 is supported by a growing evidence base, bolstered by the 2015 Institute of Medicine (IOM) report which concluded that raising the age to 21 would reduce smoking initiation among youth.¹ Recent observational data from early adopters of T21 policies provide evidence that such policies may curb rates of youth and young adult tobacco use.^2–4 Soon after the IOM report, there was rapid diffusion of local and state T21 policies in the United States, particularly in the year before the federal law was signed in late 2019.⁵ By 2020, over 500 localities and 19 states passed T21 laws, with 13 state laws passed in 2019 alone.⁶

The media plays an important role in the public policy debate, both reflecting and influencing public opinion and legislators’ policy decisions. The agenda setting function of the media is well established⁷ and the volume of policy-relevant media coverage can influence public perceptions, thereby increasing its support.⁸ Previous content analysis on tobacco control issues has supported the US news media’s agenda setting ability, in which the content and frequency of such messaging can affect public and policymaker support as well as policy progression.^9,10

Two studies, which predate adoption of most state T21 policies, examined news content about T21 and found the coverage was primarily neutral.^11,12 As jurisdictions continue to legislate and implement T21 laws following federal T21 legislation, it remains critical to understand T21 news content and how it may change and shape policy over time. This study documents the volume and content of print media coverage of T21 in major US newspapers between 2012 and 2020 and describes the types of arguments used to support or oppose T21 laws.

Methods

Data Sample

We searched online news databases (Access World News, Factiva, Newspapers.com) to obtain US news articles from the top two highest circulating newspapers for each state in addition to the top five national daily US newspapers (Wall Street Journal, USA Today, The New York Times, Los Angeles Times), adapting methods from previous content analyses.¹³ The time period for our news article search spanned from January 1, 2012 to December 31, 2020.

Search terms included “tobacco 21,” “tobacco law,” “legal age for tobacco,” “tobacco purchasing age,” “age of sale,” “minimum purchasing age,” and “smoking age.” Articles were screened for inclusion based on: (1) the aforementioned search terms appeared in headline or body, (2) at least one paragraph of tobacco-related content, and (3) main theme was related to T21 laws or policies. Resulting news and opinion articles meeting these criteria were included for analysis.

Data Coding and Analysis

We developed a coding sheet and coding guide based on an iterative review including pilot coding of 10 articles by two authors (MH and BS) and two research assistants. The coding guide was subsequently revised with additional instructions by MH, BS, and OAW. All articles were coded for date of publication, type of article (eg, news, opinion), focus of the article (ie, local, state, national), common arguments referenced in support or opposition to T21 (see Supplementary Table 1), and people or organizations named as in support or opposition of T21 policies. We also coded for the mention of other relevant issues such as mention of other T21 cities and states, JUUL e-cigarettes, and EVALI, as well as negative policy components such as a preemption (eg, bans local governments from passing laws more stringent than state law), grandfather clauses which exempt those who could purchase tobacco under the previous law (eg, those ages 18–20), or youth tobacco purchase, use, and/or possession (PUP) penalties.¹⁴

Opinion articles only (ie, editorials, letters to the editor) were additionally coded for overall T21-related slant (ie, the authors’ position or opinion about T21) as pro or positive toward T21 (eg, author described T21 advantages and expressed support for T21), anti or negative (eg, author described disadvantages or concerns about T21, arguments against T21), or neutral toward T21 (eg, opinion articles in which authors discussed both advantages and disadvantages without a clear leaning toward either side). The sample of articles was divided for coding amongst three trained coders (including BS), who read news articles and then manually coded articles assigned to them using the coding sheet; coding was completed between August 2019 and March 2021. To assess intercoder reliability, 10% of articles were randomly sampled and coded by another member of the coding team, yielding an average overall Kappa value of 0.87. Disagreements were resolved through review and discussion.

Results

Volume and Type of Articles

A total of 586 articles from January 1, 2012 to December 31, 2020 were coded. Figure 1 reflects the total volume of articles across the 8 years by quarters, with peaks in print media prevalence corresponding to when major cities and states passed T21 laws. Media coverage spiked in 2019, accounting for nearly half the total volume (n = 251) as states proposed and enacted T21 and federal T21 legislation was introduced and passed. As shown in Table 1, most articles were news articles (75.4%); the remainder were opinion articles. Among opinion articles, the majority (79.9%) supported T21 while a small percent opposed (13.2%) or were neutral or mixed (6.9%). The proportion of articles focused on state and local policy action were fairly comparable until 2019, when articles focused more on federal T21 (21.1%).

Table 1.

Characteristics of Tobacco 21-Related Newspaper Content in the United States, by Year, 2012–2020

	Total (n = 586)	2012 (n = 3)	2013 (n = 16)	2014 (n = 16)	2015 (n = 61)	2016 (n = 70)	2017 (n = 53)	2018 (n = 69)	2019 (n = 251)	2020 (n = 47)
Type of article
News or feature	442 (75.4)	2 (66.7)	14 (87.5)	13 (81.3)	46 (75.4)	57 (81.4)	37 (69.8)	50 (72.5)	191 (76.1)	32 (68.1)
Opinion	144 (24.6)	1 (33.3)	2 (12.5)	3 (18.7)	15 (24.6)	13 (18.6)	16 (30.2)	19 (27.5)	60 (23.9)	15 (31.9)
Focus
Local	183 (31.2)	2 (66.7)	9 (56.3)	6 (37.5)	26 (42.6)	37 (52.9)	18 (34.0)	34 (49.3)	49 (19.5)	2 (4.3)
State	330 (56.3)	1 (33.3)	7 (43.7)	10 (62.5)	27 (44.3)	31 (44.3)	35 (66.0)	34 (49.3)	149 (59.4)	39 (83.0)
National	70 (11.9)	0 (0)	0 (0)	0 (0)	8 (13.1)	2 (2.8)	0 (0)	1 (1.4)	53 (21.1)	6 (12.8)
Framing (opinion)	(n = 144)	(n = 1)	(n = 2)	(n = 3)	(n = 15)	(n = 13)	(n = 16)	(n = 19)	(n = 60)	(n = 15)
Pro	115 (79.9)	1 (100)	2 (100)	3 (100)	13 (86.7)	11 (84.6)	15 (93.8)	14 (73.7)	48 (80.0)	8 (53.3)
Anti	19 (13.2)	0 (0)	0 (0)	0 (0)	2 (13.3)	0 (0)	0 (0)	3 (15.8)	9 (15.0)	5 (33.3)
Neutral or mixed	10 (6.9)	0 (0)	0 (0)	0 (0)	0 (0)	2 (15.4)	1 (6.2)	2 (10.5)	3 (5.0)	2 (13.3)

Figure 1.

Volume of US newspaper articles on state T21 laws, January 1, 2012–December 31, 2020.

Type, Source, and Evidence Presented for T21 Arguments

Details on the common arguments used for and against T21, as well as their sources, evidence cited, and other issues mentioned are found in Supplementary Table 2.

Supporting Arguments

The most common argument used in support of T21 laws included reducing prevalence of tobacco products by youth to prevent dependence and damaging health effects (64.8%). Over time, rising e-cigarette use was specifically mentioned as an argument favoring T21 laws. The argument for law uniformity (ie, that a T21 law provide uniformity across the state or federal level) was most frequent in 2020.

Opposing Arguments

Overall, anti-T21 arguments grew and peaked during 2015–2018, a time period coinciding with state T21 law passage, and then declined when federal T21 was passed. The most frequently expressed objection in T21 news coverage involved the perception that the law infringed on freedom and violated individual rights (25.1%), including those of young adults old enough to perform other activities. Other arguments included that T21 would hurt small businesses (11.9%) and lead to cross border, online, and/or black market sales (10.4%). Few articles (2.8%) referred to concerns about criminalization.

Sources of Supporting and Opposing Arguments

Overall, a large proportion of articles described politicians as in favor of T21 legislation (58.9%); there were fewer articles that documented political opposition (17.2%). Early in the debate, the tobacco and vape industries were not often mentioned, either in support or opposition of T21, but the proportion of articles that delineated support from the industry increased in 2019 (18.7% tobacco industry, 9.9% vape industry). In addition, we saw a greater number of articles mentioning youth or young adult support of T21 laws beginning in 2015 while only four total articles referred to young people as opposed to T21.

Evidence

Articles were also coded for any reference to evidence in support of increased age of sale (eg, research articles or reports) and was present in 25.1% of articles. Coverage of research that supported T21 (including the 2015 IOM report) was highest in the years preceding the peak of state-level T21 passage (Supplementary Table 2).

Coverage of Other Issues

Article content routinely mentioned the passage of T21 in other localities (61.8% of all articles and over 70% of articles from 2012 to 2018). In addition, we coded for the mention of JUUL specifically given the rise in the brand’s popularity and its suspected link to increased youth e-cigarette use. JUUL was specifically mentioned in 14.2% of T21 news articles during this time period, with the greatest volume (27.1%) documented in 2019. Finally, we also coded for coverage of EVALI, a vaping-associated lung injury first detected in 2019. EVALI was mentioned in 9.6% of T21-related news articles in 2019 and 8.5% of articles in 2020.

Articles also discussed specific policy components included in a T21 bill or law such as preemption (6.5%), youth tobacco PUP penalties (8.2%), grandfather clauses (6.3%), and other specific exemptions (7.8%). Again, these policy components were most often mentioned in 2019, the time period with the greatest volume of T21 articles overall.

Discussion

Consistent with prior research,¹¹ we found that common arguments in support of T21 included reducing youth smoking and related health effects while arguments against T21 focused on individual rights. Not unlike other tobacco policy debates,^15,16 opponents also argued that, in addition to restricting freedom of choice, T21 would have negative economic consequences for retail businesses and/or divert sales to other markets. Retailers, wholesalers, and/or businesses along with legislators or politicians made up most of the sources opposing T21. However, the tobacco industry shrewdly reconsidered their longstanding opposition to T21 and in recent years, shifted to voicing support for T21. We found that the number of articles mentioning industry opposition to T21 declined in 2019 while articles mentioning their support for T21 increased substantially.

Ribisl and Mills⁵ previously used diffusion of innovation and multiple streams theories to explain the rise of T21 policies and highlighted that certain characteristics of the innovation such as relative advantage, compatibility, observability, and trialability, likely increased the chances of T21 being adopted and spread. Our results further illustrate the successful diffusion of the T21 movement, including high levels of observability, as print media coverage rose over time reflected by the growing number of states and localities that passed and enacted such laws.

Reducing e-cigarette use became a dominant argument for T21 during 2019. Indeed, the policy window for state T21 began to open when news reports in 2017 documented the rapid rise in JUUL and its popularity among youth.¹⁷ Public attention regarding youth e-cigarette use grew as news volume reporting on youth use quadrupled from 2017 to 2018.¹³ National survey data released in fall 2018 and 2019 showing increased use of e-cigarettes among youth, as well as the widespread use of devices to vape THC that fueled the EVALI crisis in summer and fall 2019, may have also influenced news coverage and/or passage of T21 laws.¹³

Our research is not without limitations. We selected articles published between 2012 and 2020 in major newspapers and thus, did not include articles published in other locations, time periods, or media platforms. We also focused on T21 laws so the findings may not generalize to media coverage of other tobacco policy debates; for example, we found that criminalization was rarely used to argue against T21 whereas recent articles on a proposed menthol ban suggest such this argument may play a larger role in debates around flavor restrictions.¹⁸

While over 30 states have now passed T21, remaining states can continue to adopt T21 laws to align with federal law. Given the tobacco industry’s recent public support for T21, it will be important to closely monitor proposed bills for negative policy components (eg, preemption, PUP clauses) that may undermine the protection of public health. Policies, like T21, that focus on youth are popular, having significantly higher odds of enactment compared with other tobacco control strategies.¹⁹ However, previous case studies find that industry players often^20,21 support prohibiting sales to minors but without meaningful enforcement. Tobacco control advocates can still shape the narrative around T21 and thus, ongoing efforts to keep T21 in the news is essential. Indeed, the media can serve as source of influence and power in the policy change process. The combination of media, both earned and paid, with community advocacy can increase public awareness and engage policymakers to encourage strong, consistent T21 enforcement.

Supplementary Material

A Contributorship Form detailing each author’s specific involvement with this content, as well as any supplementary data, are available online at https://academic.oup.com/ntr.

Acknowledgments

We would like to thank Marin Kurti and Dmitriy Nikitin for their assistance with coding.

Funding

This work was supported in part by the National Cancer Institute (NCI) under R01CA231139. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Declaration of Interests

None declared.

Authors’ Contribution

SVH and CDD conceptualized the study and acquired funding. OAW contributed to the design of the study and interpretation of the data. BS led the data collection and coding and contributed to data analysis. MH led the data analysis and wrote the first draft of the article. All authors were involved in revisions, approved the final version of the article, and agreed to be accountable for all aspects of the work.

Ethical Approval

As this study did not involve human subjects, IRB review was not necessary.

Data Availability

The data used for this study are publicly available.