Raising minimum age to buy cigarettes to at least 21 would reduce smoking and save lives

Increasing the minimum age of legal access (MLA) to tobacco products will prevent or delay initiation of tobacco use by adolescents and young adults, particularly those ages 15 to 17, and improve the health of Americans across the lifespan, says a new report from the Institute of Medicine. The committee that conducted the study estimated the likely reduction in tobacco-use initiation that would be achieved by raising the MLA for tobacco products to either 19 years old, 21 years old, or 25 years, and used two tobacco-use simulation models to quantify the accompanying public health outcomes.

Raising the MLA to tobacco products to 21 likely will have a substantially greater impact on reducing the initiation of tobacco use - defined as having smoked 100 cigarettes - than raising it to 19. However, the added effect of raising the minimum age beyond age 21 to age 25 would probably be considerably smaller, the report says.

Underage users rely primarily on social sources - friends and relatives - to get tobacco, and there is little evidence that these individuals are obtaining tobacco from the illegal commercial market. Between ages 15 and 17, mobility increases with driving privileges, and social networks and potential sources of tobacco start to increase as some adolescents take on part-time jobs with co-workers who may be over the MLA. Therefore, increasing the MLA to 19 may not change social sources substantially for this age group, but raising the MLA to 21 is likely to have a considerable impact on initiation.

Over the past 50 years, tobacco control efforts in the U.S. have led to an estimated 8 million fewer premature deaths. However, tobacco use continues to significantly affect public health, and more than 40 million Americans still smoke. Although the Family Smoking Prevention and Tobacco Control Act of 2009 granted the U.S. Food and Drug Administration broad authorities over tobacco products, it prohibited FDA from establishing a nationwide MLA for tobacco products above 18 years of age. In response to congressional direction, FDA asked the IOM to assess the potential public health implications of raising the MLA without making a recommendation about whether the MLA should be raised. The committee conducted its analysis within the context of existing youth access laws and enforcement policies across the U.S., which vary considerably. Although most states currently set the MLA at 18, four states (Alabama, Alaska, New Jersey, and Utah) set it at 19, and New York City and several other localities around the country have raised it to 21.

"While the development of some cognitive abilities is achieved by age 16, the parts of the brain most responsible for decision making, impulse control, and peer susceptibility and conformity continue to develop until about age 25," said committee chair Richard J. Bonnie, Harrison Foundation Professor of Medicine and Law and director of the Institute of Law, Psychiatry, and Public Policy at the University of Virginia in Charlottesville. "A balance needs to be struck between the personal interests of young adults in being allowed to make their own choices and society's legitimate concerns about protecting the public health and discouraging young people from making decisions they may later regret, due to their vulnerability to nicotine addiction and immaturity of judgment. These concerns support an underage access restriction, but they do not resolve the policy question about the specific age at which the line should be drawn."