Tobacco 21: prevention of nicotine addiction by increasing the minimum legal access age, US and international experience
Rob Crane 1,2
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Ohio State University, Family Medicine, United States of America
Preventing Tobacco Addiction Foundation, United States of America
Ohio State University, Moritz College of Law, United States of America
Ohio State University, College of Public Health, United States of America
Campaign for Tobacco-Free Kids, United States of America
Publication date: 2018-03-01
Tob. Induc. Dis. 2018;16(Suppl 1):A540
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Background and challenges to implementation:
In accordance with the World Health Organization Framework Convention on Tobacco Control, almost all countries set a minimum legal access age (MLA) for tobacco products. Most countries have established their minimum at age 18, but the MLAs vary from 14 to 21. Although the effectiveness of youth access restrictions has been mixed in the past, emerging evidence indicates the promise of increasing the MLA to 21.

Intervention or response:
So far, over 250 local U.S. jurisdictions and three states—covering 22% of the U.S. population—have raised their MLA to 21. In addition, six countries: Honduras, Kuwait, Samoa, Singapore, Sri Lanka and Uganda have established an MLA of 21, and Japan's access age is 20. Success in enforcing these laws, however, has been variable, and adult smoking rates, especially among men, remain stubbornly high. In addition, tobacco manufacturers and tobacco retailers are increasingly mobilizing to stymie laws raising the MLA to 21

Results and lessons learnt:
In the U.S., the prestigious Institute of Medicine assembled an expert panel to study the potential effects of higher MLAs. This panel compiled an extensive, evidence-based report, published in 2015. It projected that raising the MLA to 21 would prevent 4.2 million years of life lost in youth currently alive today, reduce youth tobacco use rates by 25%, and reduce adult prevalence by 12%, among other health benefits. Based on this report and other evidence, there is considerable interest in the U.S. in raising the MLA to 21.

Conclusions and key recommendations:
The authors, respectively professors of medicine and law, have extensive academic and political experience in youth access issues including MLA 21, policy advocacy, and tobacco control legal issues. This presentation will review best practices for crafting clear and enforceable policy language designed to raise the MLA, and frame the scientific, social, and legal arguments necessary to win public and legislative support.

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