Eastern Economic Journal

, Volume 40, Issue 3, pp 289–308 | Cite as

The Effects of a Minimum Cigarette Purchase Age of 21 on Prenatal Smoking and Infant Health



A key goal of US public health policies is to reduce costly adverse birth outcomes to which prenatal smoking is a crucial contributor. This study is the first to evaluate the impacts of a minimum cigarette purchase age of 21 implemented in the state of Pennsylvania on prenatal smoking and infant health. Using a regression discontinuity method, it shows this smoking age of 21 reduces the prenatal daily cigarette consumption by 15 percent and lowers the incidence of low birth weight infants by 19 percent. These findings shed new light on the current political debate over raising the smoking age.


minimum cigarette purchase age of 21 tobacco control prenatal smoking birth weight low birth weight 

JEL Classifications

D13 I12 I18 



This article was originally circulated as a working paper titled “Does a Minimum Cigarette Purchase Age of 21 Protect Young Mothers from Cigarettes, Help Their Babies?” I am very grateful to Kathleen Adams, Reagan Baughmann, Lee Benham, David Bradford, Bill Evans, Angela Fertig, Sebastian Galiani, Daniel Hamermesh, Bart Hamilton, James Heckman, Joseph Hotz, Sukkoo Kim, Tim Mcbride, Edward Miguel, Karen Norberg, Juan Pantano, Bob Pollak, and Ping Wang for many helpful comments. I am also grateful to David Bishai, Kruti Dholakia, Lauren Heller, Angelo Mele, Nicholas Papageorge, Bo Yu, and other participants in the seminars of Economics Department and Brown School of Social Work at Washington University in Saint Louis, Population Association of America Annual Meeting, Southern Economics Association Meeting, Missouri Valley Economics Association Meeting, and Washington University Graduate Research Conference. Special acknowledgment is due Craig Edelman for facilitating access to the Pennsylvania Natality Detail File. Funding support was provided by the Center for Research in Economics and Strategy (CRES) and the Center for New Institutional Social Sciences (CNISS) at Washington University in Saint Louis. The errors are mine.


  1. Ahmad, Sajjad, and John Billimek . 2007. Limiting Youth Access to Tobacco: Comparing the Long-Term Health Impacts of Increasing Cigarette Exercise Taxes and Raising the Legal Smoking Age to 21 in the United State. Health Policy, 80 (3): 378–391.CrossRefGoogle Scholar
  2. Almond, Douglas, Kenneth Y. Chay, and David S. Lee . 2005. The Costs of Low Birth Weight. Quarterly Journal of Economics, 120 (3): 1031–1083.Google Scholar
  3. Almond, Douglas, and Janet Currie . 2011. Killing Me Softly: The Fetal Origins Hypothesis. Journal of Economic Perspective, 25 (3): 153–172.CrossRefGoogle Scholar
  4. American Lung Association. 1988–2007. State Legislated Actions on Tobacco Issues. Coalition on Smoking OR Health. Washington DC: American Lung Association.Google Scholar
  5. Behrman, Jere R., and Mark R. Rosenzweig . 2004. The Returns to Birth Weight. Review of Economics and Statistics, 86 (2): 586–601.CrossRefGoogle Scholar
  6. Black, Sandra E., Paul J. Devereux, and Kjell G. Salvanes . 2007. From the Cradle to the Labor Market? The Effect of Birth Weight on Adult Outcomes. The Quarterly Journal of Economics, 122 (1): 409–439.CrossRefGoogle Scholar
  7. Brooke, Oliver G., Ross H. Anderson, Martin J. Bland, Janet L. Peacock, and Malcolm C. Stewart . 1989. Effects on Birth Weight of Smoking, Alcohol, Caffeine, Socioeconomic Factors, and Psychosocial Stress. BMJ: British Medical Journal, 298 (6676): 795–801.CrossRefGoogle Scholar
  8. Case, Anne, Angela Fertig, and Christina Paxson . 2005. The Lasting Impact of Childhood Health and Circumstance. Journal of Health Economics, 24 (2): 365–389.CrossRefGoogle Scholar
  9. Centers for Disease Control and Prevention. 2001. Women and Smoking: A Report of the Surgeon General. Washington DC: Office of the Surgeon General.Google Scholar
  10. Chaloupka, Frank J., and Kenneth E. Warner 2000. The Economics of Smoking, in Handbook of Health Economics, Vol. 1B, edited by Anthony J. Culyer, and Joseph P. Newhouse. Amsterdam, The Netherlands: North Holland.Google Scholar
  11. Colman, Greg, Michael Grossman, and Ted Joyce . 2003. The Effect of Cigarette Excise Taxes on Smoking before, during and after Pregnancy. Journal of Health Economics, 22 (6): 1053–1072.CrossRefGoogle Scholar
  12. Corman, Hope, and Stephen Chaikind . 1998. The Effect of Low Birthweight on the School Performance and Behavior of School-Aged Children. Economics of Education Review, 17 (3): 307–316.CrossRefGoogle Scholar
  13. Currie, Janet, and Rosemary Hyson . 1999. Is the Impact of Health Shocks Cushioned by Socioeconomic Status? The Case of Low Birthweight. American Economic Review, Papers and Proceedings, 89 (2): 245–250.CrossRefGoogle Scholar
  14. Denny, Clark H., James Tsai, Louise R. Floyd, and Patricia P. Green . 2009. Alcohol Use among Pregnant and Non-Pregnant Women of Childbearing Age – United States, 1991–2005. Morbidity and Mortality Weekly Report, 58 (19): 529–532.Google Scholar
  15. DiFranza, Joseph R., and Gretchen Dussault . 2005. The Federal Initiative to Halt the Sale of Tobacco to Children – The Synar Amendment, 1992–2000: Lessons Learned. Tobacco Control, 14 (2): 93–98.CrossRefGoogle Scholar
  16. DiFranza, Joseph R., and William T. Godshall . 1996. Tobacco Industry Efforts Hindering Enforcement of the Ban on Tobacco Sales to Minors: Actions Speak Louder than Words. Tobacco Control, 5 (2): 127–131.CrossRefGoogle Scholar
  17. Evans, William N., and Jeanne S. Ringel . 1999. Can Higher Cigarette Taxes Improve Birth Outcomes? Journal of Public Economics, 72 (1): 135–154.CrossRefGoogle Scholar
  18. Fertig, Angela R., and Tara Watson . 2009. Minimum Drinking Age Laws and Infant Health Outcomes. Journal of Health Economics, 28 (3): 737–747.CrossRefGoogle Scholar
  19. Hack, Maureen, Nancy K. Klein, and Gerry H. Taylor . 1995. Long-Term Developmental Outcomes of Low Birth Weight Infants. The Future of Children, 5 (1): 176–196.CrossRefGoogle Scholar
  20. Henderson, Jane, Ron Gray, and Peter Brocklehurst . 2007. Systematic Review of Effects of Low to Moderate Prenatal Alcohol Exposure on Pregnancy Outcome. BJOG: An International Journal of Obstetrics & Gynaecology, 114 (3): 243–252.CrossRefGoogle Scholar
  21. Henderson, Jane, Ulrik Kesmodel, and Ron Gray . 2007. Systematic Review of the Fetal Effects of Prenatal Binge-Drinking. Journal of Epidemiology and Community Health, 61 (12): 1069–1073.CrossRefGoogle Scholar
  22. Imbens, Guido W., and Thomas Lemieux . 2008. Regression Discontinuity Designs: A Guide to Practice. Journal of Econometrics, 142 (2): 615–635.CrossRefGoogle Scholar
  23. Kline, Jennie, Zena Stein, and Michelle Hutzler . 1987. Cigarettes, Alcohol and Marijuana: Varying Associations with Birthweight. International Journal of Epidemiology, 16 (1): 44–51.CrossRefGoogle Scholar
  24. Kramer, Michael S. 1987. Intrauterine Growth and Gestational Duration Determinants. Pediatrics, 80 (4): 502–511.Google Scholar
  25. Lee, David S., and Thomas Lemieux . 2010. Regression Discontinuity Designs in Economics. Journal of Economic Literature, 48 (2): 281–355.CrossRefGoogle Scholar
  26. Lee, Myoung J. 2005. Micro-Econometrics for Policy, Program, and Treatment Effects. Oxford: Oxford University Press.CrossRefGoogle Scholar
  27. Lien, Diana S., and William N. Evans . 2005. Estimating the Impact of Large Cigarette Tax Hikes: The Case of Maternal Smoking and Infant Birth Weight. Journal of Human Resources, 40 (2): 373–392.CrossRefGoogle Scholar
  28. Matthews, Thomas J., and Carole C. Rivera . 2004. Smoking During Pregnancy: United States, 1990 to 2002. Morbidity and Mortality Weekly Report, 53 (39): 911–915.Google Scholar
  29. McCowan, Lesley M., Gustaaf A. Dekker, Eliza Chan, Alistair Stewart, Lucy C. Chappell, Misty Hunter, Rona Moss-Morris, and Robyn A. North . 2009. Spontaneous Preterm Birth and Small for Gestational Age Infants in Women Who Stop Smoking Early in Pregnancy: Prospective Cohort Study. BMJ: British Medical Journal, 338 (1081): 1–6.Google Scholar
  30. McDonald, Alison D., Ben G. Armstrong, and Margaret Sloan . 1992. Cigarette, Alcohol and Coffee Consumption and Prematurity. American Journal of Public Health, 82 (1): 87–90.CrossRefGoogle Scholar
  31. Ringel, Jeanne S., and William N. Evans . 2001. Cigarette Taxes and Smoking during Pregnancy. American Journal of Public Health, 91 (11): 1851–1856.CrossRefGoogle Scholar
  32. Rosenzweig, Mark R., and Kenneth I. Wolpin . 1995. Sisters, Siblings, and Mothers: The Effect of Teen-Age Childbearing on Birth Outcomes in a Dynamic Family Context. Econometrica, 63 (2): 303–326.CrossRefGoogle Scholar
  33. Shiono, Patricia H., Mark A. Klebanoff, and George G. Rhoads . 1986. Smoking and Drinking During Pregnancy: Their Effects on Preterm Birth. The Journal of American Medical Association, 255 (1): 82–84.CrossRefGoogle Scholar
  34. Sulaiman, Nabeel D., Charles du V. Florey, Daniel J. Taylor, and Simon A. Ogston . 1988. Alcohol Consumption in Dundee Primigravidas and Its Effects on Outcome of Pregnancy. British Medical Journal, 296 (6635): 1500–1503.CrossRefGoogle Scholar
  35. US Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. 2002. Summary of Findings from the 1996–2002 National Household Survey on Drug Abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  36. Wagenaar, Alexander C., and Traci L. Toomey . 2002. Effects of Minimum Drinking Age Laws: Review and Analyses of the Literature from 1960 to 2000. Journal of Studies on Alcohol, 14 (1): 206–225.CrossRefGoogle Scholar
  37. Wang, Xiaobin, Barry Zuckerman, Colleen Pearson, Gary Kaufman, Changzhong Chen, Guoying Wang, Tianhua Niu, Paul H. Wise, Howard Bauchner, and Xiping Xu . 2002. Maternal Cigarette Smoking, Metabolic Gene Polymorphism, and Infant Birth Weight. The Journal of American Medical Association, 287 (2): 195–202.CrossRefGoogle Scholar
  38. Wooldridge, Jeffrey M. 2001. Econometric Analysis of Cross Section and Panel Data. Cambridge, MA: MIT Press.Google Scholar

Copyright information

© Eastern Economic Association 2013

Authors and Affiliations

  • Ji Yan
    • 1
  1. 1.Department of EconomicsAppalachian State UniversityNCUSA

Personalised recommendations