Increasing the minimum age of sale for tobacco products to 21 shows very promising outcomes – NEJM

Source: Have Tobacco 21 Laws Come of Age? — NEJM

On January 20, 2016, New Jersey Governor Chris Christie vetoed a bill passed with strong bipartisan support by his state legislature that would have raised New Jersey’s minimum age of sale for tobacco products to 21. The veto is a setback in an otherwise accelerating movement toward dissemination of “Tobacco 21” laws as a new tool for reducing young people’s access to cigarettes and e-cigarettes. In 2013, only 8 U.S. localities had adopted Tobacco 21 laws. By March 2016, at least 125 localities and the state of Hawaii had done so, and California was on the cusp of following suit. In September 2015, the first federal Tobacco 21 legislation was introduced (Tobacco to 21 Act, S. 2100).

Are Tobacco 21 laws ready to go to scale, as these legislative developments suggest? We believe they are. In the past 2 years, research has generated new evidence that these laws are effective, enjoy very high levels of public support, and have minimal economic impact in the short term.

In 2012, when momentum for Tobacco 21 laws began to build, the arguments supporting their plausibility as a mechanism for deterring smoking initiation and reducing tobacco consumption among young people were strong. The vast majority of smokers begin smoking during adolescence, a period when the brain has heightened susceptibility to nicotine addiction. Nearly everyone who buys cigarettes for minors in the United States is under 21 years of age; raising the sale age prevents high school students from buying tobacco products for their peers.1 Raising the age to 21 also facilitates enforcement of sale restrictions, because many states use a different color or format for driver’s licenses for under-21s.

Today, new evidence greatly buttresses the case for Tobacco 21 laws. A multivariate analysis of the effects of the law adopted in Needham, Massachusetts, using pooled cross-sectional data, revealed a 47% reduction in the smoking rate among high school students, along with a reported decline in area retail tobacco purchases.2 These decreases were significantly greater than those in 16 comparison communities without Tobacco 21 laws. A 2015 report by an Institute of Medicine (IOM) committee provided evidence from two different simulation models that increasing the minimum age to 21 would lead to a 12% reduction in smoking prevalence.2

In terms of smoking initiation by young people, the IOM estimated a “large” (20.8–30.0%) effect among teens 15 to 17 years of age, with effects in the 12.5-to-18.0% range among other adolescents.

The health effects of such decreases are dramatic.

You can see the full NEJM article here.


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