Eric Lindblom - Institute of Medicine

The Health Implications of Raising
the Minimum Age for Purchasing
Tobacco Products
Eric N. Lindblom
Director, Office of Policy
Center for Tobacco Products, FDA
February 4, 2014
Tobacco Use in the United States
• Leading preventable cause of death in the United States
• At least 480,000 premature deaths yearly from cigarette smoking
and exposure to secondhand smoke;
• 8.6 million Americans have 12.7 million smoking-attributable serious
medical conditions
• Lost productivity and increased direct health care costs from
smoking and exposure to secondhand smoke total more than $289
billion per year.
• Despite significant declines during the past 30 years, cigarette
smoking among adults in the United States remains widespread,
and year-to-year decreases in prevalence have been relatively small
Youth Tobacco Use in the USA
• Due to the slow declines in smoking rates, if we continue
on the current trajectory 5.6 million children alive today
will die prematurely due to smoking
– Nearly 2.4 million (14%) of high school students
report current use
– Every day, more than 3,200 kids under 18 smoke
their first cigarette and more than 700 other youth
under 18 become daily cigarette smokers
– Nearly nine out of ten (87%) of daily adult smokers
tried the first cigarette by 18 years of age
Youth Access
• 14% of high school smokers (less than 18 years
of age) report usually obtaining their own
cigarettes by buying them in a store or gas
station (Youth Risk Behavioral Surveillance
System 2011)
• Half of 8th graders (49.9%) and seven out of ten
10th graders (71.4%) report cigarettes being
fairly easy or very easy to obtain (Monitoring the
Future 2013)
The Tobacco Control Act Gives FDA/CTP
Extensive Authority
• Recognizes FDA as the “primary Federal regulatory
authority with respect to the manufacture, marketing and
distribution of tobacco products”
• Gives FDA authority to directly regulate cigarettes,
smokeless tobacco products, RYO and cigarette tobacco
• Grants FDA authority to put all other products made or
derived from tobacco intended for human consumption
(but not those used for medical treatment of nicotine
addiction) under its active tobacco product jurisdiction.
FDA’s Current Efforts
to Prevent Sales to Youth
Rule issued pursuant to the Tobacco Control Act
prohibits sales of cigarettes, smokeless, RYO to
persons under the age of 18 and requires sellers
to check the age and ID of anyone under the age
of 27.
FDA/CTP Retail Inspections & Enforcement
• Inspection/compliance contracts with 45 states/territories
• Direct FDA inspections in jurisdictions w/o contracts (e.g., NY, FL)
• More than 249,000 inspections of tobacco retailers; 12,600
warning letters and 1160 Civil Money Penalties (as of 1/1/14).
But the Tobacco Control Act Prohibits FDA
From Raising the Minimum Age
No FDA restrictions on the sale and distribution of
tobacco products may “establish a minimum age of
sale of tobacco products to any person older than
18 years of age.” [Sec. 906(d)(3)(ii)]
Instead, the Tobacco Control Act instructs FDA to:
1. Convene an expert panel to conduct a study on the
public health implications of raising the minimum age to
purchase tobacco products; and
2. Not later than 5 years after the date of enactment of this
Act [4/1/15], submit a report to the Congress on the
results of such as study. [Sec. 104]
Project’s Statement of Task:
The Institute of Medicine (IOM) shall establish a committee of
public health, medical and other experts to advise the
FDA/Center for Tobacco Products (CTP) on the likely public
health impact of raising the minimum age for purchasing tobacco
products. The committee shall develop a consensus study based
on their findings, which the CTP will use as a basis for creating
their report to Congress.
The IOM shall:
• Examine existing literature on tobacco use initiation; and
• Use modeling and other methods, as appropriate, to predict
the likely public health outcomes of raising the minimum age
for purchase of tobacco products to 21 years and 25 years.
Task Order with IOM also states that:
• The study will also serve to inform state and local
governments considering raising the minimum age.
• The committee shall obtain input from a wide range of
stakeholders including federal agencies, health care
industry, tobacco industry, academicians, and the public.
* * * * *
To make the report as useful as possible to Congress,
state and local governments, FDA, and the range of
interested stakeholders, the following questions could be
What are the likely different public health impacts
from raising the minimum age to purchase tobacco
In particular, to what extent would raising the
minimum age:
– Reduce (or delay) initiation? Among which
age groups?
– Affect cessation (e.g., among existing
smokers no longer of legal age)?
What different public health benefits would likely come from
raising the minimum age to different levels. For example:
– Would a disproportionate portion of the potential
benefits be secured from raising the minimum age
just to 19 (beyond high school), compared to some
higher age?
– Are there significantly diminishing or increasing
returns from raising the age to higher levels?
– Would phasing in a higher minimum age (e.g., no
current legal smokers affected) significantly reduce
overall benefits?
• Does raising the minimum age in a single town (or single
state) secure significant benefits – or just move sales to
other nearby jurisdictions with lower minimum age laws?
• Minimum age laws typically prohibit tobacco product
sales to persons under a certain age. How does that
approach compare to prohibiting persons under the
stated age from purchasing or possessing tobacco
• To maximize public health benefits from raising the
minimum age, how important are severity of penalties,
and related inspections and enforcement,?
There is not a lot of published research directly on point to help
answer these and other relevant questions. So we encourage
the Committee also to consider:
• What can be learned from the experiences of states and
localities (or other countries) with raised minimum age laws
for tobacco products -- or for other products?
• What do the past U.S. reductions in the minimum age for
alcohol from 21 to 18, and the subsequent return to 21, tell us
that might be relevant regarding the minimum age for tobacco
• Is available research on brain and emotional development
among youth and young adults relevant to whether the
minimum age should be increased to some higher age?
Some Guidelines
• The Committee should identify the research, data and
other evidence used to inform its analysis and
conclusions – and also identify any key research gaps.
• The Committee should clearly identify any cited
references or other information considered by the
Committee that were provided by, or funded by, any
parties that would be directly affected by a change in the
minimum age for purchasing tobacco products, such as
sellers or manufacturers of tobacco products.
Thanks for taking on this interesting
and important project.

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