Tobacco 21

Raising the minimum legal sale age for tobacco products to 21 is a promising strategy to save lives and reduce smoking and other tobacco use among youth. A 21 sale age complements other strategies to reduce tobacco use, including higher tobacco taxes, the Clean Indoor Air Act, and well-funded, sustained tobacco prevention and cessation programs such as the Montana Tobacco Use Prevention Program and the Quit Line.

“The base of our business is the high school student.”

Evolving studies of the young adult brain demonstrate a unique predisposition to experimental tobacco use. Initiation as a teen comes with a high probability of addiction, progression to daily smoking, and heavier tobacco use in adulthood. Young people often feel dependent earlier than adults. Low minimum sales age laws exploit the susceptibility to addict teens to tobacco for life, with relatively few exposures. Raising the age of sale to 21 would have a significant effect on current tobacco use rates among youth, decreasing the chances of ever becoming tobacco dependent.

Most teens get tobacco from others, such as friends, rather than purchasing it themselves. High-school students are less likely to have 21-year-olds than 18- to 20-year-olds in their social circles. The majority (59%) of 18- and 19-year-olds have been asked by someone younger than 18 years to buy cigarettes for them. A higher age of purchase reduces opportunities for teens to access tobacco from buyers in their peer group. Within 7 years of raising the age of sale to age 21, tobacco use could be reduced by 55% for 15- to 17-year-old adolescents. 

Needham, Massachusetts was the first town in the country to raise the tobacco sales age to 21 years. Following implementation, the Youth Risk Behavior Surveillance System showed a 47% reduction in Needham high-school smoking rate in the 4 years (2006–2010) after the legislation was implemented. No tobacco retailers have gone out of business in Needham since implementation of the law.

According to the Institute of Medicine, nationally, the potential public health benefits of enacting a Tobacco 21 policy would be remarkable with a 25% drop in youth smoking initiation, a 12% drop in overall smoking rates, and 16,000 cases of preterm birth and low birth weight averted in the first 5 years of the policy, an impact that would be recognized immediately. Their conservative estimate is that if age 21 were adopted throughout the U.S. it would prevent 4.2 million years of life lost to smoking in kids alive today.

The tobacco industry and retailers argue that raising the sales age to 21 years will significantly hurt businesses that depend on tobacco sales.  A small percentage of total tobacco sales (2%) is attributed to those younger than 21 years, yet most lifetime tobacco users start smoking before the age of 21 years.  As we saw in Needham, the retail industry would have plenty of time to adapt to market pressures as a result of lower youth initiation. Action on this critical issue of raising the minimum tobacco sales age to 21 years across the United States has excellent public health and ethical rationale and has minimal implementation costs through existing regulatory frameworks for alcohol sales.

How about in Montana?

Montana has an above national average rate of high school smoking and adult smoking. There are an estimated 19,000 children now under the age 18 who will die early due to smoking, with 900 children becoming daily smokers every year.  The state spends 44.1% of the CDC recommended amount on tobacco prevention, and imposes a tax of $1.70 per pack. Unfortunately, the state law contains preemption language regarding youth access to tobacco; which means local jurisdictions cannot have more stringent rules than the state law.  In order for Tobacco 21 to be a viable option for local governments in Montana, preemption language would need to be altered or removed.  At this point, legislation would need to be passed at the state level; where the tobacco lobby has more power.

For more information on tobacco prevention in Montana, access the latest Montana Tobacco Use Prevention Program Progress Report for July 2014-June 2016.  It is filled with Montana specific successes, challenges, and other possible ways to reduce the impact of tobacco use in our state and communities. 

¹ Lorillard, Memo from executive TL Achey to former Lorillard President Curtis Judge re Newport brand, August 30, 1978, Bates No. TINY0003062.

² HHS. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. , 2014.HHS,Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General, 2012; U.S. Department of Health and Human Services (USDHSS), How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.

³ White, MM, et al. “Facilitating Adolescent Smoking: Who Provides the Cigarettes?” American Journal of Health Promotion, 19(5): 355 – 360, May/June 2005.

Winickoff JP, Hartman L, Chen ML, Gottlieb M, Nabi-Burza E, DiFranza JR. Retail Impact of Raising Tobacco Sales Age to 21 Years. American Journal of Public Health. 2014;104(11):e18-e21. doi:10.2105/AJPH.2014.302174.

5 Ahmad S, Billimek J. Limiting youth access to tobacco: comparing the long-term health impacts of increasing cigarette excise taxes and raising the legal smoking age to 21 in the United States. Health Policy. 2007;80(3):378–391.

6 MetroWest Health Foundation. 2006 and 2010 MetroWest Adolescent Health Surveys. Available at: http://www.mwhealth.org/PublicationsampMedia/Reports/tabid/192/Default.aspx. Accessed July 1, 2013.

7 Winickoff JP, Hartman L, Chen ML, Gottlieb M, Nabi-Burza E, DiFranza JR. Retail Impact of Raising Tobacco Sales Age to 21 Years. American Journal of Public Health. 2014;104(11):e18-e21. doi:10.2105/AJPH.2014.302174.

8 Winickoff JP, Hartman L, Chen ML, Gottlieb M, Nabi-Burza E, DiFranza JR. Retail Impact of Raising Tobacco Sales Age to 21 Years. American Journal of Public Health. 2014;104(11):e18-e21. doi:10.2105/AJPH.2014.302174.

9 Campaign for Tobacco Free Kids. The toll of tobacco in Montana Fact Sheet. Http://www.tobaccofreekids.org/facts_issues/toll_us/montana. Accessed September, 2016.

10 Campaign for Tobacco Free Kids. Broken Promises to our Children Fact Sheet, http://www.tobaccofreekids.org/microsites/statereport2016/montana.html. Accessed September, 2016.