Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products (2015) / Chapter Skim
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The Tobacco Control Act directed FDA to, among other things, issue regulations to restrict cigarette and smokeless tobacco retail sales to youth and to restrict tobacco product advertising and marketing to youth. The act, however, prohibits FDA from taking several specific steps, including establishing a minimum age of sale 1
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The committee did not consider the economic impact of raising the MLA, nor did it compare the effects of raising the MLA with other youth-oriented tobacco control policies. The Tobacco Control Act refers to both minimum age for purchase2 and minimum age for sale.3 The committee focused on the implications of raising the MLA in the context of the body of youth access laws and enforcement policies currently in place across the country.
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These data strongly suggest that if someone is not a regular tobacco user by 25 years of age, it is highly unlikely they will become one. CURRENT PRACTICES REGARDING YOUTH ACCESS RESTRICTIONS Although most states currently set the minimum age of legal access to tobacco at 18, four states set it at 19, and New York City and several other localities around the country have raised the MLA to 21.
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However, it is difficult to know precisely how much increasing retailer compliance reduces the availability of retail tobacco to underage persons or how much the decreased retail availability of tobacco affects underage tobacco use because of the continued availability of tobacco from noncommercial sources. Underage users rely primarily on "social sources" (friends and relatives)
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These age groupings reflect not just differences in years from the MLA but also several important developmental transitions that play a role in tobacco use. Conclusion 7-2: Although changes in the minimum age of legal access to tobacco products will directly pertain to individuals who are age 18 or older, the largest proportionate reduction in the initiation of tobacco use will likely occur among adolescents 15 to 17 years old.
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Social networks and potential social sources of tobacco start to increase as some adolescents take on formal, part-time jobs with coworkers who may be over the MLA. Changing the MLA to 19 may not change social sources substantially for these adolescents, but the committee expects that raising the MLA to 21 will substantially impact initiation.
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The committee expects similar effects on initiation rates for 19- and 20-year-olds as for 18-year-olds with an MLA of 21 or 25. This expectation of increased effect is due primarily to the increased social distancing expected when the MLA is raised to 21 or 25, but it also takes into account the benefit of the additional maturing of executive functions among young adults, the decreased sensitivity to the rewarding properties of nicotine, the additional social norms proscribing tobacco use, and tobacco's decreased social value and the decreased motives for use as individuals enter the workforce or parenthood.
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The models predict that raising the MLA would lead to considerable additional reductions in smoking prevalence based on the committee's conclusions about the likely reductions in smoking initiation described above. Specifically, both models estimate that raising the MLA will lead to approximately a 3 percent decrease in smoking prevalence for an MLA of 19, a 12 percent decrease for an MLA of 21, and a 16 percent decrease for an MLA of 25 above and beyond the decrease predicted in the status quo scenario.
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from cigarette smoking. Given the status quo projections, this translates to approximately 249,000 fewer premature deaths, 45,000 fewer deaths from lung cancer, and 4.2 million fewer YLL.4 Smoking combustible tobacco products other than cigarettes, such as pipes and cigars, is causally associated with a broad spectrum of adverse health effects.
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Although access to social sources could be reduced significantly if the laws prohibiting transfers to underage persons were aggressively enforced, the committee does not expect such a radical change in enforcement policy in the foreseeable future, especially under a higher MLA, because of likely public resistance. However, if a state or locality ramped up the threat of detection and punishment against social sources, 5 All absolute differences, including the numbers of cases of pre-term births, low birth weight, and SIDS, are relative to underlying status quo projections.
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, and that the intensity of enforcement will be the same for all products. The committee sees no reason to believe that the effects of the legal norm and its enforcement on retailer compliance, retail availability, or access to social sources would differ materially for ENDS as compared with other tobacco products.
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However, in the absence of transformative changes in the tobacco market, social norms and attitudes, or the epidemiology of tobacco use, the committee is reasonably confident that raising the MLA will reduce tobacco initiation, particularly among adolescents 15 to 17 years of age, will improve health across the life span, and will save lives. REFERENCES Adriani, W., V
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2012. Should the science of adolescent brain development inform public policy?
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