Raising sale age for tobacco products to 21 may prevent adolescents from taking up smoking

Raising the 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 a new white paper released today (March 3), 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.

The white paper focuses on Ohio, but the results would be the same for any region that raises the minimum sales age, the authors say.

"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."

Berman co-authored the white paper, published by Ohio State's College of Public Health, with Rob Crane, clinical associate professor of family medicine, and Natalie Hemmerich, an attorney and postdoctoral fellow in public health.

Though this is the first report that examines raising the minimum tobacco sales age in Ohio, the idea is catching on nationally. More than 50 municipalities in the United States have adopted this policy and at least eight states have proposals pending in their legislatures.

The Institute of Medicine (IOM) is scheduled to release a report on March 12 that will discuss raising the minimum tobacco sales age. The IOM, the health arm of the National Academies of Science, is an independent organization that works outside of government to provide advice to decision makers and the public.

Berman, Crane and Hemmerich cite dozens of studies to support their conclusions. For example, previous research has suggested:
•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.
•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.

In 2005, Needham, Mass., 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."