Most countries place Minimum Legal Age (MLA) laws on a number of substances as a core policy intervention to reduce their use among young people. The primary aim of MLA laws is to restrict supply to minors, as defined by each country (e.g., for tobacco, typically below the age of 18). There is substantial evidence that such laws are associated with lower consumption of these substances among young people.
For example, in 2007, the MLA for tobacco products in England was raised from 16 to 18 years and long-term trend analysis indicates that a declining trend in “ever smoking” was greater in 16–17-year-olds than 18–24-year-olds. Furthermore, Canadian national survey data between 2000 and 2014 showed that smoking prevalence was lower among age-restricted youth in provinces with higher MLA for tobacco sales. More recently, evidence indicates that changes to tobacco MLA laws from 18 to 21 (T21) in 12 states across the US were associated with declines in past 30-day smoking among 18-20-year-olds.
It is widely accepted that MLA reduces retail access to tobacco and e-cigarettes among young people, but it may also impact perceived availability. Both young people access and perceived access to alcohol, tobacco, and cannabis are associated with the use of these substances. For example, according to longitudinal research by Doubeni et al., perceived accessibility to tobacco “increases the risk for smoking among youths.”
Nevertheless, research examining perceived access and the impact of MLA laws remains limited. Therefore, the authors of a recent study aimed to examine the perceived ease of access to seven legal and illegal substances most commonly used by young people in Canada, the US, and England, between 2017 and 2021.
Methods of the Study
The aims of the study were to assess address: 1) whether perceived access varied by substance and country, including between countries with differing MLA; and, 2) whether perceived access to cigarettes, e-cigarettes, cannabis, and alcohol changed over time within and between countries, including before and after any changes in legal status and/or MLA. The researchers also compared differences in state/provincial MLA laws, including differences in perceived access by cannabis legalisation in the US and Canada.
Data was assessed from the International Tobacco control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Survey – a self-completed online survey examining tobacco use and vaping among young people in Canada, England, and the US. The survey consisted of sociodemographic measures, detailed questions on e-cigarette and tobacco use and perceptions, and additional questions on other health behaviours, including cannabis use.
Findings of the Study
Perceived ease of access to cigarettes and e-cigarettes
In August 2021, young people in the US were less likely to perceive easy access to cigarettes compared with England and Canada. However, young people in England were most likely to perceive ease of access to cigarettes. Furthermore, the data shows that perceptions that cigarettes were easy to access among adolescents in the US declined in three waves following T21 implementation in 2019. A US-specific model found that, compared to young people in states where T21 was not implemented, people below the MLA had lower odds of reporting that cigarettes were easy to access when state-level T21 was implemented. T21 policy implementation was also associated with a lesser likelihood of young people reporting that e-cigarettes were easy to access.
In Canada, adolescents in provinces where MLA was 19 were less likely to report that cigarettes were easy to access compared to in provinces where MLA was 18. However, there was no overall association between MLA of 18 versus 19 years and perceptions that e-cigarettes were easy to access.
Perceived ease of access to cannabis
Following cannabis legalisation in Canada, there was a significant increase in perceived ease of accessing cannabis among young people (2019 vs 2018), however, there was no change between subsequent waves, except for a decrease between February 2020 and August 2020. Nonetheless, adolescents in Canada were more likely to perceive access to cannabis as easy compared with those in the US and England.
Adolescents in the US, where a number of states have legalised cannabis, were also more likely to perceive easy access to cannabis than in England where cannabis remains illegal. Perceived ease of access to cannabis in the US varied significantly by state policy. Compared to states that had not legalised any form of medical cannabis, young people in states that had legalised only medical cannabis use or legalised both medical and non-medical use of cannabis were more likely to perceive easy access. Furthermore, adolescents in states that had legalised both medical and recreational cannabis were more likely to perceive cannabis as easy to access than in states that had legalised medical cannabis only.
In Canada, there was a significant association between legalisation and a MLA of 18 vs 19 vs 21 years and perceptions that cannabis was easy to access.
Perceived ease of access to other substances
Young people in the US were generally less likely to perceive alcohol as easy to access compared to Canada and England. Still, in all countries, the largest proportions perceived alcohol and e-cigarettes as the easiest to access, followed by cigarettes, cannabis, prescription painkillers/opiates, and lastly, ecstasy/MDMA and hallucinogens.
Conclusions
The data assessed in this study yields three key findings: 1) young people perceived easy access to a range of substances and perceived access was greater for legal substances; 2) higher MLA was strongly associated with lower perceived access, including comparisons across countries and between different substances within countries; 3) implementation of T21 laws in the US was associated with substantial reductions in perceived ease of accessing cigarettes and e-cigarettes among adolescents.
The researchers note that factors other than MLA changes, such as perceived availability of and opportunities to obtain tobacco/e-cigarettes/cannabis, can also affect perceived access. However, the patterns highlighted in the current data suggest that the changes in perceived access are at least partly attributable to MLA laws. These findings may support calls for raising the MLA for tobacco to 21 as indicated by national surveys in Canada, England, and the US.
