The Institute of Medicine (IOM) recently released a report detailing the public health implications of raising the minimum legal sale age to 21. The minimum legal sale age (MLSA) prohibits retailers from selling tobacco products to anyone under that age. In most places across the country, that age is set at 18. Four states (Alaska, Alabama, New Jersey, and Utah) have a minimum age of 19. However, momentum is building across the country to raise the MLSA to 21 to prevent more youth from initiating tobacco use. To date, over 50 cities in 7 states have enacting policies raising the MLSA to 21. State-wide initiatives to raise the age to 21 have been proposed in California, Hawaii, Massachusetts, Rhode Island, Utah, Vermont, and Washington.
At the request of the US FDA, the IOM committee of experts reviewed existing literature on tobacco use initiation, developmental biology and psychology, and tobacco policy, as well as national youth access laws. The resultant report predicts the likely public health outcomes of raising the MLSA for tobacco products to 19 years, 21 years, and 25 years.
The report suggests that smoking prevalence overall will drop significantly between 2015 and 2100 due to previously instituted tobacco control policies even with the MLSA at the status quo. However, they project that smoking prevalence would drop by an additional 12% if the MLSA were raised to 21, compared to only an additional 3% if the MLSA were raised to 19. If the MLSA were raised to 21 now, it could prevent 223,000 premature deaths, 50,000 deaths from lung cancer, and 4.2 million years of life lost.