A well-established, if unevenly implemented, strategy to reduce young people’s access to tobacco products is to establish a minimum age of sale policy. Around the world, the minimum age to buy cigarettes or other tobacco products varies, primarily according to each country’s age of majority. Comoros and Sao Tome & Principe set their official minimum age of sale at just 16 years old, while Sri Lanka sets theirs at 25 years old. Still, 22 countries report having no minimum age of sale in place. As countries attempt to curb the devastating consequences of youth smoking, more and more places are raising the minimum age of sale for tobacco to the increasingly popular age of 21.

Minimum Legal Age of Sale of Tobacco Products

Measured in Years

0 refers to countries without a minimum age of sale

In the U.S., such policies started at the local level. Beginning with Needham, Massachusetts, in 2003, individual localities and states passed laws at different times, initially creating a patchwork of policies that was followed by a national law passed in December 2019. Singapore, on the other hand, is taking a phased approach by raising the age of sale first from age 19 to 20 in 2020 and then from age 20 to 21 in 2021, gradually increasing the minimum age of sale for youth born after a certain date as they age. Whether it is more or less effective than other Tobacco 21 policy designs — as these policies are known — remains to be determined.

Research shows most adult smokers started using tobacco as teenagers, and that those who do are more likely to die from a tobacco-related disease. Tobacco 21 laws are an effective tobacco use prevention strategy that makes it harder for young people to access tobacco products or start smoking ­at a time when their brains may be particularly vulnerable to the effects of nicotine.

These policies don’t just inhibit 18 or 19-year-olds from smoking. Tobacco 21 policies can also prevent smoking uptake in younger teens by limiting the number of people in their peer group who can legally purchase cigarettes or other tobacco products for them. While 16-year-olds might have 18- or 19-year-old friends who could buy them cigarettes, they are less likely to have friends in their 20s who would be willing to do the same. Such a policy effectively also means there will no longer be any high school students who can legally buy cigarettes.

Evidence for Tobacco 21 Policies

Research done on the effectiveness of tobacco 21 policies shows that they are effective at curtailing youth smoking. One analysis found that tobacco 21 policies covering an entire metropolitan statistical area could lower smoking rates among 18 to 20-year-olds in that area by 3.1 percentage points. Research done in Hawaii found the state’s tobacco 21 law led to a 4.4 percent drop in cigarette sales and a drop in the market share of menthol products, which are preferred by teens and young adults.

Data out of Needham, Massachusetts showed that smoking among teenagers dropped significantly — from 13% to 7% — after the law was enacted, demonstrating a greater decrease than was seen in comparison communities without tobacco 21 policies. Similarly, one study found that tobacco 21 laws reduced the odds of smoking by 39% among 18 to 20-year-olds who had ever tried smoking or electronic cigarettes. The relationship was particularly strong among study participants whose friends smoked or used e-cigarettes at age 16.

In 2015, the U.S. Institute of Medicine (now called the National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division) published a report on the public health implications of raising the minimum age of sale for tobacco products to 21. Modeling in the report suggested such policies could prevent an estimated 249,000 premature deaths for those born in the U.S. between the years 2000 and 2019.

Like other tobacco control policies, the effectiveness of tobacco 21 policies relies heavily on their enforcement. A population-based prospective cohort survey conducted in Southern California, for example, found negligible differences in cigarette use before and after the state’s tobacco 21 policy went into effect. The majority of 18-19-year-old cigarette or e-cigarette users surveyed reported no retailers had refused to sell them tobacco products, despite them being under the legal age of sale. Study authors theorized this non-compliance among retailers could be due to a lack of trust in regulatory agencies, infrequent compliance checks by law enforcement, or lack of knowledge about changes to the legal minimum age of sale.

Key Considerations for Tobacco 21 Policies

While the evidence supporting tobacco 21 laws is encouraging, it’s crucial such policies adhere to best practices and be well defined, strictly enforced, and used in conjunction with other effective strategies aimed at preventing youth tobacco use.

Policymakers considering or evaluating tobacco 21 policies should use clear, broad definitions for what constitutes tobacco products — including not just cigarettes or cigars, but also e-cigarette and e-liquids, water pipe , and smokeless tobacco — so as not to provide loopholes that would lessen the effectiveness of the policy.

Likewise, laws should specify who will enforce the policy and how and when it will be enforced. Tobacco 21 policies should target retailers rather than individual tobacco users by imposing penalties or revoking retail licenses for retailers selling to those under age 21.

Lastly, despite strong evidence for raising the minimum age of sale to 21, such policies alone are insufficient to eliminate youth tobacco use. They should be implemented alongside other effective prevention strategies, such as tobacco taxes that raise the price of products, smoke-free laws that create smoke-free places and change social norms, and prohibitions on point-of-sale advertising.

By Melissa Maitin-Shepard and Robyn Correll-Carlyle

Cover Image Credit: KXLY.com