Raising the National Tobacco Age to 21 Would Save Lives, Reduce Health Costs

By Shauna Rust |

Last week, the city of Chicago joined Cleveland, Boston, Hawaii, New York City, Kansas City, and more than 100 U.S. localities in a public health feat—raising the tobacco age to 21. Chicago has taken a stand against Big Tobacco with this legislation, and the creation of a tobacco-free generation is now within reach.

Since the 1964 Surgeon General’s report revealed the health hazards of smoking, awareness of the deadly toll of tobacco use has become widespread. Yet more than 480,000 Americans still die each year due to illnesses caused by tobacco use. A groundbreaking study by the Institute of Medicine found that raising the smoking age to 21 could prevent hundreds of thousands of premature deaths. Given that tobacco use remains the leading cause of preventable death in the U.S., we need to raise the national tobacco age to 21 in order to save lives and reduce healthcare costs.

The main impetus for raising the tobacco age is the fact that most adult smokers, 95 percent, begin smoking before the age of 21. Research has found that almost 9 out of 10 current smokers first tried smoking before the age of 18, but that the age range of 18–21 is a critical transition period when young people are most likely to become daily smokers. In fact, only 46 percent of adult smokers become regular smokers before the age of 18, while 80 percent become regular smokers before the age of 21, according to results from the 2013 National Survey on Drug Use and Health. Therefore, delaying the age of initiation with tobacco products by increasing the legal minimum age could have a profound effect on smoking rates.

In addition, it is also important to delay or prevent tobacco use among youth due to the addictive effects of nicotine, which has been found to adversely affect brain development and be particularly harmful to young people. The United States Institute of Medicine (IOM) concluded that raising the minimum age for the sale of tobacco products to 21 could reduce the number of young people who start smoking and save lives. The IOM report found that increasing the national tobacco age to 21 could reduce the smoking rate by 12 percent and reduce smoking-related deaths by 10 percent. With this higher tobacco age, there would be 223,000 fewer premature deaths and 4.2 million fewer years of life lost.

Raising the tobacco age to 21 would also help prevent youth from obtaining tobacco products from peers or older students. As the Campaign for Tobacco-Free Kids points out, most youth are obtaining their cigarettes and tobacco products from social sources rather than direct retailer purchases. In fact, 82 percent of adolescent smokers obtain their cigarettes from others, mostly friends or peers. By raising the national tobacco age to 21, many of these social sources could be cut off, since high school–aged youth are less likely to go to school with, work with, or be friends with people over the age of 21. Similarly, when U.S. states raised the drinking age from 18 to 21 in the 1980s, youth alcohol usage, binge drinking, and alcohol-related car crashes decreased, according to a report from the National Highway Traffic Safety Administration. Raising the tobacco age could make acquiring tobacco products more difficult for underage youth and delay or prevent smoking and tobacco use.

Lastly, there is broad public support for raising the national tobacco age to 21, given the well-known health risks of smoking and its addictive properties. A study by the CDC found that 75 percent of adults are in favor of raising the tobacco age to 21, including 70 percent of current smokers and 65 percent of people ages 18–24.

Policymakers should raise the national tobacco age to 21 given this widespread public support as well as the economic imperatives for reducing tobacco use. Currently, tobacco use costs the U.S. $170 billion in annual health care expenditures, and the direct and indirect losses to the American economy due to tobacco use total $330 billion annually. Lastly, given that tobacco will kill 5.6 million American children alive today, we have a moral imperative to do more to protect future generations from the deadly impact of tobacco. Following the example of Chicago and hundreds of U.S. localities, Congress should raise the national tobacco age to 21 in order to save lives, reduce health care costs, and reduce the likelihood of tobacco use for generations to come.

Shauna Rust is a senior at UNC Chapel Hill and is Roosevelt's Emerging Fellow in Health Care.