Raising tobacco age to 21 is best way to prevent lifelong addiction

Raising the national minimum age to buy cigarettes to 21 would save lives by preventing adolescents from ever taking up smoking, a new report suggests.

The minimum age to buy tobacco products in most of the country is 18.

In their analysis, Ohio State University public health experts detail how raising the minimum tobacco sales age would be effective in improving health and note the economic consequences to retailers would be minimal.

If the age were raised nationally, those U.S. residents born between 2000 and 2019 would experience 223,000 fewer premature deaths, 50,000 fewer lung cancer deaths and 4.2 million fewer years of life lost, according to a 2015 Institute of Medicine report cited in the Ohio State white paper. The IOM, the health arm of the National Academies of Science, is an independent organization that works to provide advice to decision makers and the public.

“The key point is that if people get through adolescence without smoking, it is highly unlikely they will ever start,” said Micah Berman, assistant professor of public health and law at Ohio State. “The flip side of that is if they do start smoking in adolescence, everything we have learned about teen brain development shows that it will be much harder for them to quit later.”The IOM report also estimated that raising the smoking age would, by 2100, result in 285,000 fewer pre-term births, 438,000 fewer low-birth-weight babies and 4,300 fewer sudden, unexplained deaths in infancy.

While cigarette smoking has declined among U.S. youth, overall use of tobacco (including e-cigarettes and cigars) has increased or remained stable. Nearly all adult smokers began by the age of 18 – almost no one starts after 21, the experts point out in their argument for changing the law nationally.If current trends continue, 5.6 million young people alive today will die prematurely from tobacco use, the Ohio State report says.

Nicotine’s effect on brain development leads adolescents to heavier daily tobacco use, a stronger nicotine addiction and more trouble with quitting later in life. At least 176 municipalities in 11 states have adopted a policy of restricting tobacco sales to those over 21, as have the entire states of California and Hawaii.

Berman co-authored the paper, published by Ohio State’s College of Public Health, with Rob Crane, clinical associate professor of family medicine; Natalie Hemmerich, an attorney and postdoctoral fellow in public health; and Thomas Geist, regional director of the Preventing Tobacco Addiction Foundation.The Ohio State researchers cite dozens of studies to support their conclusions. For example, previous research has suggested:

  • Raising the minimum sales age to 21 puts legal purchasers outside the social circle of most high-school students. Most people supplying cigarettes to teens are 18 to 20, and many of them are still in high school.
  • Raising the legal drinking age to 21 reduced alcohol use, daily drinking and binge drinking by more than a third among high-school seniors.
  • Raising the legal smoking age can reduce racial and ethnic disparities because nonwhite young adults are more likely than whites to start smoking after turning 18.

In 2005, Needham, Massachusetts, became the first U.S. city to increase its tobacco sales age to 21 – a case study that offers useful data as other cities consider the same change. After the law passed, tobacco use among high-school students dropped almost in half – and also decreased significantly faster in Needham than in the 16 surrounding communities that sold cigarettes to 18-year-olds.

“The Needham example is powerful,” said Berman, who consulted with New York City officials before they adopted a minimum tobacco sales age of 21 in the city in 2013.

Because sales to people under age 21 account for only 2 percent of total cigarette sales, the economic impact to retailers would be minimal, the authors noted.

“The percentage of cigarettes sold to people who are underage or even people who are 18, 19 and 20 is pretty small. But smoking at those ages sets them up for lifelong addiction,” Berman said.

The tobacco industry is sure to dislike this national movement because it knows that recruiting new “replacement smokers” is key to its survival, the authors wrote. In Ohio, the tobacco industry spends more than $1 million every day marketing its products. Meanwhile, Ohio spends less than nearly any other state on the delivery of messages that counter tobacco advertising.

Adult smokers have nothing to fear if the minimum sales age changes, said Berman, also a researcher in Ohio State’s Center of Excellence in Regulatory Tobacco Science.

“This has no impact on anyone who’s over the age of 21,” he said. “It’s really about preventing the next generation from starting to smoke.”

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