Purchase restrictions as a tobacco control policy: An analysis of the effect on adverse birth outcomes.

The association between smoking during pregnancy and adverse birth outcomes is well known. Various tobacco control policies, however, may improve birth outcomes differently. We first study the effects of legal restrictions on purchasing tobacco products on adverse birth outcomes. The main outcome measure of interest is the causal effect of a purchase restriction on tobacco products on the probability of an adverse birth outcome. Our identification strategy utilizes the variation in the minimum legal sales age of tobacco products over time and across geographic regions within the US during 2013–2018 in a two-way fixed effects framework. We used restricted-use birth records of all live births in the US during that period by birthing people who were 18–21 years at delivery. We find that an age-based purchase restriction on tobacco products causes the incidence of adverse birth outcome to reduce by 9.5%. Our results suggest that purchase restrictions are highly effective in reducing adverse birth outcomes in deliveries by birthing people in the 18–21 age group and provide additional support for the campaign for further increasing the minimum legal sales age of tobacco products. [ABSTRACT FROM AUTHOR]