Limit Tobacco to Those 21 and Up?

Health officials have long understood that if we’re serious about reducing tobacco use, we must target the young. That’s because the younger the person, the more sensitive they are to nicotine and the more likely they are to become addicted and to have trouble quitting. In fact, 96 percent of those who become cigarette smokers had their first puff by age 21. Almost no one becomes a smoker after age 25, according to Surgeon General data.

Despite these vulnerabilities, 18-year-olds can legally buy tobacco throughout most of the country, three years before they’ll be able to order a legal drink. Are we ready for that to change?

According to a survey reported by the Centers for Disease Control and Prevention (CDC) and published in July 2015 in the American Journal of Preventive Medicine, the answer is yes. Three-quarters of the more than 4,000 adults who responded to the nationally representative online survey said they support making 21 the minimum age for buying tobacco products. Only 11 percent strongly opposed the plan. Even seven in 10 current smokers backed the idea.

Currently only Hawaii restricts tobacco sales to buyers age 21 and up. Most states allow purchase of tobacco products starting at age 18, although a handful limit sales to buyers age 19 and up. Several communities and cities have also taken matters into their own hands and imposed higher age restrictions, overriding state rules.

The survey results are good news to those on the front lines of tobacco prevention, who hope increased public support will translate to tougher laws and greater national wellness. “Raising the minimum age of sale to 21 could benefit the health of Americans in several ways,” said Brian King, PhD, an acting deputy director in the CDC’s Office on Smoking and Health. “It could delay the age of first experimenting with tobacco, reducing the likelihood of transitioning to regular use and increasing the likelihood that those who do become regular users can quit.”

A recent Institute of Medicine (IOM) report on age-of-sale restrictions confirms that limiting purchases to those 21 and up has the power to reduce tobacco use and dependence. If adopted across the nation, the strategy could translate to a 12 percent decrease in smoking by 2100, the IOM report concluded, as well as to a quarter-million fewer early deaths due to smoking among those born between 2000 and 2019.

Although rates of cigarette smoking in the U.S. are half what they were 50 years ago, more than 42 million adults, 3 million high school students and 600,000 middle-school students smoke. Tobacco use remains the nation’s leading cause of preventable death, claiming more than 480,000 annually.

The CDC notes that each day around 2,100 youth and young adults go from smoking occasionally to daily smoking. Of those who continue to smoke, one out of three will die prematurely, usually about 13 years sooner than the peers who didn’t pick up the habit.

Working against young smokers may be their genetic makeup. A 2013 Duke University study identified a genetic risk profile for heavy smoking but found that those identified as having the risky genes only seemed affected by them if they started smoking as teens. “This suggests there may be something special about nicotine exposure in the adolescent brain, with respect to these genetic variants,” said Daniel Belsky, PhD, who led the research as a post-doctoral research fellow at Duke University’s Center for the Study of Aging and Human Development and the Duke Institute for Genome Sciences & Policy. “Teens at a high genetic risk transitioned quickly from trying cigarettes to becoming regular, heavy smokers.”

Early prevention is key. Each day that a youth or young adult is dissuaded from taking that first puff means they are one day closer to an age when they will be less likely to become a grim statistic. Dr. Belsky concluded: “Public health policies that make it harder for teens to become regular smokers should continue to be a focus in antismoking efforts.”

There is still hope.

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