Most American adults favor raising legal smoking age to 21

Several municipalities have enacted legislative strategies for disrupting the sale of cigarettes to minors as part of an integrated effort to curb youth tobacco use. Of course this is a laudable goal, with vast public health implications. However, it has not always been so clear that a majority of Americans would support this sort of government restriction on commercial trade, or the imposition on free will. A number of arguments have been used to undermine the proposition, including the false equivalence to military service and the non sequitur notion that, since children by definition already obtain their cigarettes illegally, changing the law would have little effect. The report by King and colleagues documents a growing public acceptance of policy proposals for raising the minimum age for purchasing tobacco products to 21. Further, support appears to be independent of the respondent’s smoking status. King’s work adds to the public conversation about this important topic, elevating the legislative priority of the issue and increasing the chance of adoption.

We know a few things that should remain part of the conversation around age-of-sale legislation. First, while the motivation to experiment with tobacco may stem from complex psychosocial influences such as social acceptability bias, adult behavior modeling, and discounted future impact, the motivation to keep smoking comes from the changes that nicotine induces deep inside the survival instinct parts of the brain. During adolescence and early adulthood, developing brains are in a period of very rapid growth and plasticity. It’s during this special time that nicotine exerts its strongest influence, “rewiring” pathways that will influence the outcome of free will decision-making for decades to come. Raising the legal purchase age for tobacco products is not just about teaching our kids healthy habits, it’s about protecting their brains from the chemical exposure that reliably causes the most prevalent compulsive disorder of our time. Second, we know that kids also experiment with alternative forms of tobacco during the run up to smoking. Candy-flavored cigars, electronic cigarettes, and chew tobacco have all become readily available and attractive ways to exert burgeoning adolescent independence. Laws that restrict access to tobacco products should extend to all nicotine delivery devices. Lastly, we know that laws that change the age-of-sale work best when accompanied by strict enforcement. A shift in purchase age to 21 should be accompanied by stricter identification requirements, and stiffer penalties for transgressing merchants. Public education and enforcement campaigns that accompany such legislative action should be carefully tested and specifically designed to avoid overemphasizing the “adult behavior” aspects of tobacco purchases, as there remains some concern that this message could paradoxically encourage experimentation.

Alongside the King report, the CDC has highlighted the anticipated epidemiologic impact of this policy position. Tens of thousands of people could avoid a future lung cancer diagnosis in the U.S. alone. Perhaps just as importantly, future generations might avoid the burdens of treatment, the fear and uncertainty of illness and the guilt that comes along with wishing someone had stopped them from making such a terrible mistake as a child.