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To regulate these purchases, the researchers suggest routine surveillance of online retailers that may identify opportunities to strengthen the implementation of existing public health laws designed to reduce sales of tobacco products to individuals aged 20 years or younger. In 2019, Congress raised the legal purchasing age for tobacco products from 18 to 21, including a requirement for retailers to verify photo ID

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When other federal healthcare programs are included, the total price that the federal government pays increases to 64.5% of all healthcare spending attributable to adult cigarette smoking

The generalizability of the results to other populations (e.g., among youth) and settings (e.g., outside the US) remains unknown