Tobacco use by adolescents and young adults poses serious concerns. Nearly all adults who have ever smoked daily first tried a cigarette before 26 years of age. Current cigarette use among adults is highest among persons aged 21 to 25 years. The parts of the brain most responsible for cognitive and psychosocial maturity continue to develop and change through young adulthood, and adolescent brains are uniquely vulnerable to the effects of nicotine.

At the request of the U.S. Food and Drug Administration, Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products considers the likely public health impact of raising the minimum age for purchasing tobacco products. The report reviews the existing literature on tobacco use patterns, developmental biology and psychology, health effects of tobacco use, and the current landscape regarding youth access laws, including minimum age laws and their enforcement. Based on this literature, the report makes conclusions about the likely effect of raising the minimum age to 19, 21, and 25 years on tobacco use initiation. The report also quantifies the accompanying public health outcomes based on findings from two tobacco use simulation models. According to the report, raising the minimum age of legal access to tobacco products, particularly to ages 21 and 25, will lead to substantial reductions in tobacco use, improve the health of Americans across the lifespan, and save lives. Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products will be a valuable reference for federal policy makers and state and local health departments and legislators.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE PUBLIC HEALTH IMPLICATIONS OF RAISING THE MINIMUM AGE FOR PURCHASING TOBACCO PRODUCTS
• Reviewers
• Preface
• Acknowledgments
• Summary
  • STATEMENT OF TASK
  • ADOLESCENT AND YOUNG ADULT DEVELOPMENTAL TRAJECTORIES AND PATTERNS OF TOBACCO USE
  • CURRENT PRACTICES REGARDING YOUTH ACCESS RESTRICTIONS
  • EFFECTS OF RAISING THE MLA ON TOBACCO USE
  • HEALTH EFFECTS OF RAISING THE MLA
  • CONSIDERATIONS FOR POLICY MAKERS
  • REFERENCES
• 1. Introduction
  • TOBACCO USE IN ADOLESCENTS AND YOUNG ADULTS
  • HIGH-RISK POPULATIONS
  • BRIEF HISTORY OF TOBACCO CONTROL
  • STATEMENT OF TASK
  • OUTLINE OF THE REPORT
  • REFERENCES
• 2. Patterns of Tobacco Use by Adolescents and Young Adults
  • PREVALENCE OF CIGARETTE SMOKING
  • GEOGRAPHIC VARIATION
  • OTHER INDIVIDUAL RISK FACTORS FOR TOBACCO USE
  • INITIATION
  • SMOKING INTENSITY
  • OTHER TOBACCO PRODUCTS
  • PATTERNS OF USE AND PROGRESSION OF NICOTINE DEPENDENCE
  • TOBACCO CESSATION AMONG ADOLESCENTS AND YOUNG ADULTS
  • REFERENCES
• 3. The Developmental and Environmental Context of Adolescent and Young Adult Tobacco Use
  • COGNITIVE, PSYCHOSOCIAL, AND BIOLOGICAL DEVELOPMENT IN ADOLESCENTS AND YOUNG ADULTS
  • TOBACCO-RELATED DECISION MAKING BY ADOLESCENTS AND YOUNG ADULTS
  • TOBACCO INDUSTRY TARGETING ADOLESCENTS AND YOUNG ADULTS
  • IMPLICATIONS
  • REFERENCES
• 4. The Effects of Tobacco Use on Health
  • TIME HORIZON FOR THE HEALTH EFFECTS OF CIGARETTE SMOKING
  • SPECTRUM OF HEALTH EFFECTS
  • MORBIDITY
  • IMPACT OF CIGARETTE SMOKING ON MORTALITY
  • IMPACT OF EXPOSURE TO SECONDHAND SMOKE ON MORTALITY
  • REFERENCES
• 5. Restrictions on Youth Access to Tobacco Products
  • YOUTH TOBACCO ACCESS LAWS IN THE UNITED STATES
  • ENFORCEMENT OF YOUTH ACCESS LAWS
  • SOURCES OF CIGARETTES FOR UNDERAGE INDIVIDUALS
  • REFERENCES
• 6. Evidence on the Effects of Youth Access Restrictions
  • THE IMPACT OF ENACTING OR RAISING THE MINIMUM LEGAL AGE TO PURCHASE TOBACCO PRODUCTS
  • LESSONS FROM ALCOHOL
  • A LOGIC MODEL FOR PREDICTING THE EFFECTS OF AN MLA
  • EFFECTS OF RETAILER INTERVENTIONS ON ACCESS TO AND USE OF TOBACCO
  • UNDERAGE ACCESS RESTRICTIONS IN THE CONTEXT OF OTHER TOBACCO CONTROL POLICIES
  • TOBACCO PURCHASE, USE, AND POSSESSION LAWS
  • SUMMARY
  • REFERENCES
• 7. The Effect on Tobacco Use of Raising the Minimum Age of Legal Access to Tobacco Products
  • METHODS
  • RATIONALE FOR EXPECTED IMPACT OF RAISING THE MINIMUM AGE OF LEGAL ACCESS ON INITIATION OF TOBACCO USE
  • ESTIMATED INITIATION EFFECT SIZES
  • MODELING
  • REFERENCES
• 8. Health Benefits of Raising the Minimum Age of Legal Access to Tobacco Products
  • PREMATURE DEATHS PREVENTED
  • LUNG CANCER DEATHS
  • MATERNAL AND CHILD HEALTH OUTCOMES
  • TIME TO ACCRUE BENEFITS
  • OTHER HEALTH EFFECTS
  • IMPLICATIONS OF RAISING THE MINIMUM AGE OF LEGAL ACCESS TO TOBACCO PRODUCTS ON HEALTH
  • REFERENCES
• 9. Other Considerations for Policy Makers
  • NATIONAL OR STATE ENACTMENT OF MLA
  • EFFECTS OF OTHER TOBACCO CONTROL POLICIES
  • SCOPE AND ENFORCEMENT OF MLA RESTRICTIONS
  • ADOLESCENT DEVELOPMENT AND THE MLA FOR TOBACCO
  • POSSIBLE PUBLIC HEALTH EFFECTS OF NEW TOBACCO PRODUCTS
  • POSSIBLE EFFECTS OF RAISING THE TOBACCO MLA ON USE OF ALCOHOL AND OTHER DRUGS
  • CONCLUDING REMARKS
  • REFERENCES
• APPENDIXES
  • Appendix A State and Local Laws on the Minimum Age of Legal Access to Tobacco Products
  • Appendix B State Laws—Tobacco Transfers to Minors
  • Appendix C State Laws—Tobacco Purchase–Use–Possession by Minors
  • Appendix D Supplemental Information About the Models
  • Appendix E Open Meeting Agendas
  • Appendix F Committee Biographical Sketches

This study was supported by Contract/Grant No. HHSF22301031T between the National Academy of Sciences and the Department of Health and Human Services: Food and Drug Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

Suggested citation:

IOM (Institute of Medicine). 2015. Public health implications of raising the minimum age of legal access to tobacco products. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.