The public health benefits of barring people under age 21 from buying cigarettes could be tremendous, including “4.2 million fewer years of life lost” among the next generation of American adults, according to a report released this week by the Institute of Medicine.
Setting the minimum age at 21 nationwide, the report estimates, would result in nearly a quarter-million fewer premature deaths and 50,000 fewer deaths from lung cancer among people born between 2000 and 2019.
The study, conducted at the request of the U.S. Food and Drug Administration, compared the predicted benefits of raising the minimum legal age for buying tobacco products — currently 18 in most states — to 19, 21, and 25 years. It concludes that the greatest benefits would arise if the legal age nationwide were 25, at which point the prevalence of smokers among today’s teens, when they become adults, would decline by 16%.
Predicted smoking prevalence falls an estimated 12% with the minimum age set at 21, and only 3% if set at 19, according to the report, titled “Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products.”
Even though fewer teenagers are using tobacco than ever before, more than half of current smokers say they started smoking before they were 18, according to the report.
Teenagers, especially those between ages 15 and 17, are most vulnerable to addiction at a time when their brains are still developing, the report notes, and would be the group that benefits most from raising the minimum age of legal access (MLA) more in line with the minimum age to buy alcohol.
It says that raising the minimum age to 21 or 25, rather than just to 19, would greatly reduce the number of people younger than 18 who are introduced to tobacco through “social sources” such as co-workers or friends. Research has shown that teen smoking is primarily fueled by legal sales to older youth, who then pass them along to their underage friends and relatives.
The study was conducted by a committee of experts who reviewed “existing literature on tobacco use initiation, developmental biology and psychology and tobacco policy” and used mathematical modeling to arrive at their predictions, the report states.
The American Academy of Pediatrics issued a statement calling the report “a crucial contribution to the debate on tobacco access for young people.”
“There is no safe way to use tobacco,” said Dr. Sandra G. Hassink, the academy’s president. “Smoking harms nearly every organ in the body. Protecting young people from addiction will improve their health in the short term, and will dramatically reduce their risk of long-term health problems including heart disease, stroke and lung cancer.”
The report notes that the FDA, which requested the study in 2013, cannot raise the age limit nationwide. While the report serves as a call to action in ending the leading cause of preventable death in the United States, it makes no recommendation on raising the MLA.
“The public health impact of raising the MLA for tobacco products depends on the degree to which local and state governments change their policies,” the report says. “These decisions will depend on each state’s or locality’s balance between personal interests and the privacy of young adults to make their own choices versus society’s legitimate concerns about protecting public health.”
Most states today allow people to legally buy cigarettes at age 18. Four states — Alabama, Alaska, New Jersey and Utah — allow tobacco to be sold only to those 19 and older. Fifty-eight localities in seven states, including New York City, ban cigarette sales to people under 21, according to the Campaign for Tobacco-Free Kids.
The IOM report coincides with a new Series in The Lancet medical journal in which leading public health experts issued a call to action to create a ‘tobacco-free world’ by the year 2040. Although the prevalence of smoking has dropped in many Western countries, like the U.S., it remains on the rise in other parts of the world including Africa and the Middle East. Without accelerated tobacco control efforts, one billion deaths from smoking and other forms of tobacco use are expected by the end of this century.
Not surprisingly, the tobacco industry is not on board with increasing the legal purchasing age. Brian May, a spokesman for tobacco giant Altria, formerly known as Philip Morris, told USA Today that states “shouldn’t rush” to raise the age for buying tobacco.
“Our perspective is that this is a complex issue and Congress has established a thoughtful process to better understand it,” May said. “We believe states and localities should defer to this process and allow Congress the opportunity to think through this issue further before enacting different minimum-age laws.”
While tobacco companies claim they don’t target young people, recent data suggest otherwise. The tobacco industry spends approximately $23 million a day on marketing in the U.S., much of which is directed towards teens and young adults. In recent years, tobacco companies have ramped up their efforts to directly target young adults (ages 18 to 21) through a variety of marketing activities—such as music and sporting events, bar promotions, college marketing programs, college scholarships, and parties—because they know it is a critical time period for solidifying a tobacco addiction.
In fact, ironically, it was the tobacco industry itself that made perhaps the most compelling argument for raising the legal purchasing age in a 1986 report, in which a Philip Morris strategist wrote, “Raising the legal minimum age for cigarette purchase to 21 could gut our key young-adult market (17-20).”