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An Executive SummaryThe Case For Taking Tobacco to Age 21
43 million Americans are addicted to nicotine. Over 90% became addicted as teenagers and more than half of them will die prematurely as a result. Moving the legal minimum sale age for tobacco (LMSAT) to age 21 is a logical and sensible step with substantial evidence suggesting an immediate and positive effect on youth usage.
The health consequences of smoking are staggering. It provokes 400,000 annual premature deaths from primary smoking, and 50,000 non-smokers die each year from exposure to second hand smoke. For teens, cigarettes are a gateway drug to alcohol, marijuana and cocaine use. All told tobacco takes more lives than AIDS, auto accidents, homicides, alcohol, illegal drugs, suicides and fires combined.
 The economic losses are equally sobering. The direct health care costs and indirect losses to the American economy from tobacco use are greater than $157 billion per year, much of that at the expense of employers paying health insurance premiums and taxpayers financing Medicaid and Medicare. Each pack of cigarettes consumed costs our society $7.17 increased health care and work related expenditures.
We have made some progress, but more is needed. Over the last five decades since the first surgeon general's report announcing the health hazards of tobacco, use has fallen significantly. States such as California and Massachussets have helped lead the way with progressive and comprehensive programs promoting clean air, encouraging cessation and denormalizing tobacco use. Yet nationally one in five teens and adults still smoke.. Taking tobacco to 21 adds to other important tobacco control initiatives, yet another arrow in the quiver.
 Youth access laws at age 18 have not worked. Certainly, one reason is poor enforcement, but perhaps more important, these laws target the wrong population. The majority of smokers under age 17 are intermittent users who obtain cigarettes from social sources, friends and family, not retailers. Addictive smoking requiring a daily purchase begins in the later teen years. That is where access restriction is likely to have greatest effect.
We have strong evidence that moving alcohol to age 21 reduced youth usage. America performed a striking social experiment with alcohol access during the 70's and 80's. After the Vietnam War and the reduction of the voting age to 18, many states lowered their drinking age. The disastrous drunk driving results of this action prompted our nation to move all states drinking ages to 21. Not only did drunk driving deaths plummet, but youth usage and binge drinking fell by a third.
Good enforcement is important, but not critical. In the 1980’s and 1990’s, drinking age laws are arguably enforced nearly as poorly as youth access to tobacco laws, yet age 21 for alcohol still has a powerful effect on the prevalence of youth drinking and teen alcoholism. The effect is likely to be greater for tobacco where addictive smoking generally requires a daily individual purchase.
Age 21 protects younger teens better. The younger the buyer is, the less likely they are to achieve a purchase even with current shoddy enforcement. Moreover, most social sources of tobacco for teens are themselves younger than 21. Age 21 reduces initiation in younger kids and inhibits consolidation of addiction in older teens.
 Age 18 is not magic. Well-heeled industry lobbyists constantly whisper to lawmakers the mantra, "Old enough to fight and vote, old enough to drink and smoke."
They imply smoking is a right and a benefit, not an addiction and a societal burden. Our society has always recognized that young people are vulnerable to impulsive and risky behaviors and granted our kids gradually increasing access to potentially dangerous activities. We allow partial work permits at age 14 then driver's licenses at 16 and legal responsibilities at 18. Finally we grant access to alcohol and handguns at age 21. This system is both wise and practical. How many hundreds of thousand of lives should be traded for the shortsighted sophistry of "18 = adult"?
The most compelling argument for raising the LMSAT to 21 comes from the tobacco industry itself via documents recovered during the states' lawsuits against the manufacturers. In 1986 when the American Medical Association first championed taking tobacco to age 21, an industry strategist complained, "Raising the legal minimum age for cigarette purchase to 21 could gut our key young adult market (17-20) where we sell about 25 billion cigarettes and enjoy a 70 percent market share.1
Perhaps we can finally take a tobacco industry executive at his word!
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