Statistics show that 90% of the people who have ever smoked daily tried their first cigarette before the age of 19.
The report notes that over the past half a century, there have been an estimated 8 million fewer premature deaths thanks to increased tobacco control efforts in the US. More than 40 million Americans still smoke, however.
Currently, the minimum age of legal access (MLA) for tobacco products is set at 18 years for most states. Alabama, Alaska, New Jersey and Utah have an MLA of 19 years, however. Some localities - such as New York City - have raised it to 21.
Because the Food and Drug Administration (FDA) were prohibited from raising the MLA for tobacco products above 18 years of age by the Family Smoking Prevention and Tobacco Control Act of 2009, the FDA commissioned the Institute of Medicine (IOM) to produce a report investigating the public health implications of raising the MLA. However, the IOM were told to do so without making a direct recommendation on whether or not the MLA should be raised.
The IOM report finds that raising the MLA of tobacco products to 21 will have "a substantially greater impact" than raising it to 19. The effect of raising the MLA to 25 would be considerably smaller, however, say the authors.
Explaining how they arrived at this conclusion, the authors say that it is between the ages of 15 and 17 - when teenagers begin to drive, take on part-time jobs and encounter more people over the MLA who may smoke - when Americans typically first have access to tobacco.
Therefore, raising the MLA may not make enough of a change within social sources to limit tobacco exposure within this age group, whereas a raise to 21 might delay the initiation of smoking. "Initiation of tobacco use" is defined as having smoked 100 cigarettes.
Statistics show that 90% of the people who have ever smoked daily tried their first cigarette before the age of 19, with almost all of the remaining 10% trying their first cigarette by the age of 26. This suggests, say the authors, that if a person is not a regular user of tobacco by the age of 25, it is highly unlikely they ever will become a smoker.
What would the impact on public health be from raising the tobacco MLA?
Illustrating the impact raising the MLA might have on public health if implemented now, the authors say that by 2100 there would be a decrease in smoking prevalence of 3% for an MLA of 19, with a 12% decrease for an MLA of 21, and a 16% decrease for an MLA of 25.
In terms of how raising the MLA to 21 might affect rates of death and disease, the authors estimate that for people born between 2000 and 2019, there would be 249,000 fewer premature deaths, 45,000 fewer deaths from lung cancer and 4.2 million fewer years of life lost.
Also, the report suggests that maternal, fetal and infant outcomes would be significantly improved by raising the MLA to 21. Modeled projections reveal that by 2100, there would be 286,000 fewer preterm births, 438,000 fewer cases of low birth weight and 4,000 fewer cases of sudden infant death among mothers aged 15-49.
Other health benefits conferred by raising the MLA would be more immediate, such as reduced exposure to secondhand smoke.
Committee chair Richard J. Bonnie, Harrison Foundation Professor of Medicine and Law and director of the Institute of Law, Psychiatry, and Public Policy at the University of Virginia in Charlottesville, says of the decision-making process that should inform tobacco MLA policy:
"A balance needs to be struck between the personal interests of young adults in being allowed to make their own choices and society's legitimate concerns about protecting the public health and discouraging young people from making decisions they may later regret, due to their vulnerability to nicotine addiction and immaturity of judgment. These concerns support an underage access restriction, but they do not resolve the policy question about the specific age at which the line should be drawn."
Elsewhere today on Medical News Today, we report on the call from United Nations experts for increased efforts toward a tobacco-free world.