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RetailImpactofRaisingTobaccoSalesAgeto21Years
<br />The majority of tobacco
<br />use emerges in individuals
<br />beforetheyreach21yearsof
<br />age, and many adult distrib-
<br />utors of tobacco to youths
<br />are young adults aged be-
<br />tween 18 and 20 years.
<br />Raising the tobacco sales
<br />minimum age to 21 years
<br />across the United States
<br />would decrease tobacco re-
<br />tailer and industry sales by
<br />approximately2%butcould
<br />contribute to a substantial
<br />reduction in the prevalence
<br />of youths’ tobacco use and
<br />dependency by limiting ac-
<br />cess. (Am J Public Health.
<br />2014;104:e18–e21. doi:10.
<br />2105/AJPH.2014.302174)
<br />Jonathan P. Winickoff, MD, MPH, Lester Hartman, MD, MPH, Minghua L. Chen, MD, MPH, Mark Gottlieb, JD,
<br />Emara Nabi-Burza, MBBS, MS, and Joseph R. DiFranza, MD
<br />RECENT RESEARCH HAS HIGH-
<br />lighted the susceptibility of the
<br />young adult brain torapid nicotine
<br />addiction.1,2 While individuals are
<br />still experimenting with tobacco
<br />use and before they are aware of
<br />their own level of addiction, they
<br />first want, then crave, then need
<br />cigarettes, at which point they are
<br />unable to quit.
<br />1 Individuals who
<br />begin smoking at a young age are
<br />more likely to become addicted,
<br />progress to daily smoking, become
<br />heavier tobacco users as adults,
<br />and have difficulty quitting.
<br />3,4
<br />The US Surgeon General has
<br />expressed concern about the po-
<br />tential long-term cognitive effects
<br />of exposure to nicotine during
<br />brain development with the potential
<br />for lasting adverse consequences.
<br />5
<br />For many years, public health
<br />strategies focused on preventing
<br />the onset of nicotine addiction by
<br />relying on the strict enforcement
<br />of laws that prevent the sale of
<br />tobacco to minors younger than
<br />18 years. Indeed, successful ef-
<br />forts to limit tobacco access of
<br />minors by disrupting the sale of
<br />tobacco to minors have made an
<br />important contribution toward
<br />reductions in the prevalence of
<br />tobacco use among minors.
<br />6
<br />A factor that might limit the
<br />impact of preventing the sale of
<br />tobacco to minors is the fact that,
<br />in most communities, 18- to
<br />20-year-olds who can legally pur-
<br />chase cigarettes provide them to
<br />younger friends and family mem-
<br />bers.7 The majority (59%) of
<br />18- and 19-year-olds have been
<br />asked by someone younger than
<br />18 years to buy cigarettes for
<br />them.8 Also, high-school students
<br />are less likely to have 21-year-old
<br />adults than 18- to 20-year-old
<br />adults in their social circles, sug-
<br />gesting reduced opportunities to
<br />access tobacco from older buyers.
<br />9
<br />Inhibiting this well-established
<br />distribution cycle provides one
<br />rationale for increasing the legal
<br />age for tobacco sales to 21 years.
<br />Another rationale stems from
<br />the 2012 Surgeon General’s re-
<br />port finding that almost 90% of
<br />smokers in the United States be-
<br />gan smoking before the age of 21
<br />years.4,10 The report concludes
<br />that if young people can remain
<br />free of tobacco, most will never
<br />start to smoke. Currently, people
<br />who reach the age of 21 years
<br />as a nonsmoker have a minimal
<br />chance of ever becoming a smoker.
<br />For these reasons, there is interest
<br />in extending the benefits of re-
<br />stricting tobacco sales to individ-
<br />uals younger than 21 years.
<br />RECENT CHANGES IN US
<br />TOBACCO SALES AGE LAWS
<br />In consideration of the potential
<br />beneficial public health impact
<br />of raising the tobacco sales age
<br />to 21 years, some US cities and
<br />counties (New York City; Suffolk
<br />County, NY; Hawaii County, HI;
<br />and Needham, Arlington, Sharon,
<br />Canton, Ashland, Wellesley, Dedham,
<br />Dover, Norwood, Scituate, West
<br />Boylston, Hudson, Winchester,
<br />Wakefield, Reading, and Melrose
<br />counties, MA) have already ap-
<br />proved legislation for raising the
<br />age to 21 years, and other cities,
<br />counties, and states are making
<br />legislative or regulatory efforts to
<br />approve similar proposals. With
<br />a single exception, all of these
<br />measures were adopted in either
<br />2013 or 2014. Clearly, the idea
<br />of increasing the minimum to-
<br />bacco sales age to 21 years has
<br />momentum.11
<br />The tobacco industry and re-
<br />tailers argue that raising the sales
<br />age to 21 years will significantly
<br />hurt businesses that depend on
<br />tobacco sales.
<br />12,13 We sought to
<br />determine the proportion of the
<br />current legal tobacco market (‡18
<br />years) that is consumed by18- to
<br />20-year-old smokers to determine
<br />the potential impact to retailers if
<br />the tobacco sales age of 21 years
<br />was universally implemented and
<br />enforced.
<br />We obtained self-reported data
<br />regarding cigarette consumption
<br />by age from the 2011 National
<br />Health Interview Survey (NHIS).
<br />The survey includes both citizen
<br />and noncitizen noninstitutional-
<br />ized civilian American house-
<br />holds. We analyzed data from
<br />33014 respondents who were
<br />asked questions about smoking
<br />in the NHIS Sample Core Adult
<br />Health Behavior Section (‡18
<br />years) database. Current smokers
<br />were identified as having smoked
<br />at least 100 cigarettes in their
<br />lifetime and still smoking when
<br />surveyed. We sought to calculate
<br />the volume of cigarette products
<br />consumed by individuals, between
<br />the ages of 18 and 20 years. Be-
<br />cause the data were derived from
<br />self-reported cigarettes smoked,
<br />it accounts for any tobacco used to
<br />“roll your own,”as well as small
<br />cigars that are functionally iden-
<br />tical to cigarettes. Tobacco con-
<br />sumed by 15- to 17-year-old
<br />smokers was not included as sales
<br />to this population are already
<br />illegal under federal law.
<br />PUBLIC HEALTH POLICY BRIEFS
<br />e18 |Public Health Policy Briefs |Peer Reviewed |Winickoff et al.American Journal of Public Health |November 2014, Vol 104, No. 11
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