Over the past 50 years, tobacco control in the United States has led to an estimated 8 million fewer premature deaths. However, tobacco use continues to significantly affect public health, and more than 40 million Americans still smoke.
In 2009, the Family Smoking Prevention and Tobacco Control Act granted the U.S. Food and Drug Administration broad authorities over tobacco products, though it prohibited FDA from establishing a nationwide minimum age of legal access (MLA). It also directed FDA to convene a panel of experts to conduct a study on the public health implications of raising the MLA above 18 years of age.
At FDA's request, an Academies committee conducted this study, which found that raising the minimum age for purchasing tobacco products to 21 likely would have a substantial impact on reducing the initiation of tobacco use -- defined as having smoked 100 cigarettes -- even more than raising it to 19 would. The added effect of raising the minimum age beyond age 21 to age 25 would probably be considerably smaller. Underage users rely primarily on social sources -- friends and relatives -- to get tobacco. Between ages 15 and 17, mobility increases with driving privileges, and social networks and potential sources of tobacco start to increase as some adolescents take on part-time jobs with co-workers who may be over the MLA. Therefore, increasing the MLA only to 19 may not change social sources substantially, but raising the MLA to 21 is likely to have a considerable impact on initiation for this age group.
If the MLA were raised now, by 2100 there would be approximately a 3 percent decrease in smoking prevalence for an MLA of 19, a 12 percent decrease for an MLA of 21, and a 16 percent decrease for an MLA of 25, the report says. In terms of direct health effects, if the MLA were raised now to age 21 nationwide, there would be approximately 249,000 fewer premature deaths, 45,000 fewer deaths from lung cancer, and 4.2 million fewer years of life lost among the cohort of people born between 2000 and 2019.
Another recent Academies study requested by the FDA looks at a different aspect of the tobacco trade -- understanding the U.S. illicit tobacco market and what we can learn from other countries' efforts to decrease illicit sales.
Currently, the U.S. illicit tobacco market consists primarily of bootlegging from Native American reservations and low-tax states, such as Virginia, to high-tax states, such as New York, where illicit sales may constitute as much as 45 percent of all tobacco sales. Bootlegging is the legal purchase of cigarettes in one jurisdiction and their resale in another, without the payment of applicable taxes or duties in the jurisdictions where they are resold.
Other countries' adoption of comprehensive interventions show that it is possible to reduce the size of the illicit tobacco market through tobacco-specific enforcement resources and collaboration across jurisdictions. For example, Spain reduced the illicit share of its market from 15 percent in 1995 to 2 percent in 2001 through licensing and control measures, enforcement efforts, and legal agreements.
In order to better understand the nature of the tobacco market in the U.S. and the ways it may evolve in the future, additional research and data are needed across a broad range of areas, such as an examination of how smokers respond to the permanent loss of specific product features they previously found desirable, and the relationship between e-cigarette use and the use of conventional tobacco products.
-- Dana Korsen