Studies on tobacco use in middle school and high school students in Hawaii and Massachusetts found there was an increase in e-cigarette use after the age of sale was raised to 21.
There are currently 14 states and over 400 localities which have Tobacco 21 (T-21) laws in place.
In 2015, before the T-21 laws went into effect in Hawaii, almost a quarter of high school students and 5 percent of middle school students had tried an e-cigarette at least once and 12.9 percent of high school students and 7.6 percent of middle school students had used an e-cigarette in the 30 days before the survey.
Despite the hopes of lawmakers, the 2017 Hawaii Youth Tobacco Survey found there was an increase of e-cigarette use among Hawaiian teens.
In Massachusetts, T-21 data is only at the county level, but the results are similar to that of Hawaii according to the 2016 Franklin County/ North Quabbin Youth Risk Behavior Survey (YRBS). In the 2018 YRBS overall use of e-cigarettes was down but use among high school students had increased especially with 10th graders.
Additionally, in Pennsylvania, where there is a 40 percent wholesale tax, the 2015 Pennsylvania Youth Survey (PAYS) found that 15.5 percent of middle school and high school students used an e-cigarette within the thirty days prior to the survey. This increased to 16.3 percent in 2017.