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We used SAS version 9.3 (SAS Institute, Cary, NC) to conduct data analysis. We calculated mean average daily and annual cigarette consumption for current smokers aged 18 to 20 years and those aged 21 years or older to determine the proportion of total cigarette consumption that is attributable to 18- to 20-year-old smokers. In our sample of 33014 (Table 1), there were 6138 (18.6%) cur- rent smokers, 188 (15.2% smoking prevalence) in the 18- to 20-year- old group and 5950 (18.7% smoking prevalence) in the group aged 21 years and older. The 18- to 20-year-old group of cur- rent smokers were 49% female, 77% White, 18% Hispanic, and 16% Black, and the current smokers aged 21 years or older were 48% female, 77% White, 12% Hispanic, and 17% Black. About 37% of 18- to 20-year-old respondents lived with 3 or more household members compared with 4% of those aged 21 years or older (P <.001). Table 2 demonstrates the lower daily cigarette consumption of those aged 18 to 20 years versus those aged 21 years or older (8.6 per day vs 12.5 per day; P <.001). We also found out that 18- to 20-year-old smokers make up 3.06% of the total adult smoking population but ac- count for just 2.12% of cigarette consumption. EFFECTS ON TOBACCO INDUSTRY AND RETAILERS If one assumes that the number of cigarettes smoked by 18- to 20-year-old smokers corresponds to the number of cigarettes sold to them or to others on their behalf, the maximum immediate loss of sales would be just 2% of the total cigarette sales in the United States. If we assume that this intervention would have a long-term impact on the prevalence of smoking by adolescents and young adults, the gradual aging of this low-tobacco- use cohort would give plenty of time for small businesses to adjust to changing market conditions were the minimum legal tobacco sales age raised to 21 years. Similar objections were raised decades ago when the national minimum drinking age was pro- posed to be raised to 21 years. After the law was passed and implemented by most states in the 1980s, a reduction in drinking, problematic drinking, drinking and driving, and alcohol-related crashes among youths was seen. 14 The alcohol industry still survived by adapting to the changing mar- ket despite the loss of sales to those younger than 21 years. Fur- thermore, retailers are already required under federal rules to check the ID of anyone who ap- pears to be younger than 27 years seeking to purchase tobacco, 15 so an age-21 requirement would place no additional compliance burdens on their staff. The fact that more than one third of the 18- to 20-year-old young adults live with 3 or more individuals highlights the additional potential for blocking the transfer of to- bacco use behavior to other household members. OVERALL IMPLICATIONS The evolving neuroscience of the young adult brain demonstrates TABLE 1—Basic Characteristics of Respondents and Current Smokers: 2011 National Health Interview Survey, United States Characteristics Respondents Aged 18–20 Years (n =1239), No. (%) or Mean 6SD Current Smokers Aged 18–20 Years (n=188), No. (%) or Mean 6SD Respondents Aged ‡21 Years (n =31775), No. (%) or Mean 6SD Current Smokers Aged ‡21 Years (n=5950), No. (%) or Mean 6SD Gender Male 610 (49.23) 96 (51.06) 14201 (44.69) 3112 (52.30) Female 629 (50.77) 92 (48.94) 17574 (55.31) 2838 (47.70) Race/ethnicity White 867 (69.98) 144 (76.6) 24207 (76.18) 4570 (76.81) Black 245 (19.77) 31 (16.49) 4948 (15.57) 1031 (17.33) American Indian/Alaska Native 22 (1.78) 2 (1.06) 375 (1.18) 108 (1.82) Asian Indian 9 (0.73) 0 (0) 394 (1.24) 28 (0.47) Chinese 19 (1.53) 1 (0.53) 458 (1.44) 35 (0.59) Filipino 18 (1.45) 3 (1.6) 450 (1.42) 49 (0.82) Other Asian 43 (3.47) 6 (3.19) 775 (2.44) 100 (1.68) Not released 4 (0.32) 0 (0) 74 (0.23) 8 (0.13) Multiple race 12 (0.97) 1 (0.53) 94 (0.30) 21 (0.35) Hispanic 318 (25.67) 33 (17.55) 5549 (17.46) 721 (12.12) Household number per family 1 524 (42.29) 87 (46.28) 22369 (70.4) 4368 (73.41) 2 257 (20.74) 55 (29.26) 8159 (25.68) 1328 (22.32) 3 305 (24.62) 34 (18.09) 841 (2.65) 178 (2.99) ‡4 153 (12.35) 12 (6.38) 406 (1.28) 76 (1.28) Mean 6SD 2.12 61.2 1.88 61.07 1.36 60.66 1.33 60.66 Current smoker 188 (15.2) 5950 (18.7) Note. The sample size was n=33014 participants. PUBLIC HEALTH POLICY BRIEFS November 2014, Vol 104, No. 11 |American Journal of Public Health Winickoff et al.|Peer Reviewed |Public Health Policy Briefs |e19