摘要：The majority of tobacco use emerges in individuals before they reach 21 years of age, and many adult distributors of tobacco to youths are young adults aged between 18 and 20 years. Raising the tobacco sales minimum age to 21 years across the United States would decrease tobacco retailer and industry sales by approximately 2% but could contribute to a substantial reduction in the prevalence of youths’ tobacco use and dependency by limiting access. Recent research has highlighted the susceptibility of the young adult brain to rapid nicotine addiction. 1,2 While individuals are still experimenting with tobacco use and before they are aware of their own level of addiction, they first want, then crave, then need cigarettes, at which point they are unable to quit. 1 Individuals who begin smoking at a young age are more likely to become addicted, progress to daily smoking, become heavier tobacco users as adults, and have difficulty quitting. 3,4 The US Surgeon General has expressed concern about the potential long-term cognitive effects of exposure to nicotine during brain development with the potential for lasting adverse consequences. 5 For many years, public health strategies focused on preventing the onset of nicotine addiction by relying on the strict enforcement of laws that prevent the sale of tobacco to minors younger than 18 years. Indeed, successful efforts to limit tobacco access of minors by disrupting the sale of tobacco to minors have made an important contribution toward reductions in the prevalence of tobacco use among minors. 6 A factor that might limit the impact of preventing the sale of tobacco to minors is the fact that, in most communities, 18- to 20-year-olds who can legally purchase cigarettes provide them to younger friends and family members. 7 The majority (59%) of 18- and 19-year-olds have been asked by someone younger than 18 years to buy cigarettes for them. 8 Also, high-school students are less likely to have 21-year-old adults than 18- to 20-year-old adults in their social circles, suggesting reduced opportunities to access tobacco from older buyers. 9 Inhibiting this well-established distribution cycle provides one rationale for increasing the legal age for tobacco sales to 21 years. Another rationale stems from the 2012 Surgeon General’s report finding that almost 90% of smokers in the United States began smoking before the age of 21 years. 4,10 The report concludes that if young people can remain free of tobacco, most will never start to smoke. Currently, people who reach the age of 21 years as a nonsmoker have a minimal chance of ever becoming a smoker. For these reasons, there is interest in extending the benefits of restricting tobacco sales to individuals younger than 21 years.
