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Should you be 21 to buy tobacco?

Public health experts ponder how raising the minimum legal age to buy tobacco to 21 could help reduce smoking rates.

If you smoke, odds are you started before you turned 25 or even cast your first vote. About 90 percent of all people who smoke daily said they took their first puff before age 19 — and almost all regular smokers report that they took up the habit before age 26.

Now there’s a movement to raise the minimum legal age to buy tobacco from 18 to 21.

Four states have already inched up the age to 19, and some municipalities — most notably New York City — have gone all the way to 21.

A recent report from the Institute of Medicine, while shying away from making any specific recommendations, notes that preventing those younger than 21 from buying tobacco would result in a 12 percent decrease in tobacco use. Setting the bar at 19 would lead to only a 3 percent decrease, and going up to 25 would result in a 16 percent decrease.

So public health advocates are zeroing in on 21 as the sweet spot.

“From the report, it was the biggest bang for the buck,” said Dr. Richard Feldman, director of medical education and residency training at Franciscan St. Francis Health and the former state health commissioner.

But no one, including the statistics, says that this step alone will help dramatically reduce smoking in the United States. About 18 percent of the population still smokes. In Indiana, that number is even higher, closer to 22 percent, according to the Indiana State Department of Health.

Each day, more than 3,200 people younger than 18 light up for the first time, government statistics show; more than 700 of those go on to develop a daily habit, government studies show.

Few would dispute that smoking carries serious health risks. Smoking contributes to about 1 in 5 deaths in the United States, according to the Centers for Disease Control and Prevention, leading to about 480,000 deaths annually, including those from secondhand smoke.

Reducing the number of people who smoke, then, will require a number of dramatic steps, many of which focus on youths, experts say.

“The feeling … is that we need game changers,” said Dr. Stephen Jay, a professor of medicine and public health and past founding chair of the IU Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis.

Such game changers in Indiana include funding to create a comprehensive statewide tobacco program; the state now spends less than 10 percent of what the federal government recommends it allocate to fighting tobacco use, Jay said. Other proposed initiatives include widespread bans on smoking in public places, access to cessation programs and higher tobacco taxes.

In Indiana, where the tobacco tax is $1 per pack, which is significantly lower than in any neighboring state except Kentucky, Hoosiers for a Healthier Indiana — a coalition of groups including the American Heart Association, the American Lung Association and a number of hospitals — is advocating that the state increase the tobacco tax by $1.

In addition to raising more revenue for tobacco prevention and cessation programs, higher taxes go a long way to keeping youths from adopting the habit, according to Hoosiers for a Healthier Indiana. A 10 percent increase in tobacco price would reduce smoking among kids by 5 to 15 percent, compared with 3 to 7 percent in adults.

Raising the minimum tobacco age likely would make it harder for 18- to 21-year-olds to buy cigarettes and for their younger siblings and friends to start smoking before reaching the legal age, experts say. Older teens who can legally purchase tobacco products often supply younger youths.

Preventing younger people from buying cigarettes makes sense as the brain does not fully develop until the early 20s, Jay says.

“Are these young people really good decision makers? Can they make these life-and-death decisions? Some can, and many can’t,” Jay said. “So society has to decide where the line is. … By the time you get to 25, your brain is fully mature. New smokers don’t appear at the 25-, 26-, 27-year-old mark at anything close to younger ages.”

Teen smokers don’t have a particularly active lobby, but a common argument is that once someone is old enough to serve in the military and vote, he or she should be considered old enough to choose whether to smoke.

Advocates such as Feldman have little patience for this argument. He would like to see all tobacco sales to people born after a certain date banned. That way, older people who are addicted would have legal access to tobacco, but younger people would not.

“Look, this is the only legal product that kills its users,” Feldman said. “The legal age is 21 for alcohol. Why shouldn’t it be for tobacco? Tobacco is much more dangerous than alcohol.”

But advocates agree that raising the minimum legal age alone would not be the answer.

“It’s just one other thing we can use in our arsenal to reduce tobacco use in Indiana,” said Danielle Patterson, government relations director for the American Heart Association.

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