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Ex-Indiana health commissioner: Raise smoking age to 21

Raising the minimum legal age to 21 is not so farfetched and is rapidly gaining momentum. This has already occurred in New York City, Cleveland, Chicago, Kansas City and more than 170 other localities. A number of states, including Alaska, New Jersey, Utah and Alabama have already increased the legal age to 19, and two states, Hawaii and California, have passed legislation to raise the legal age of tobacco sales to 21. Any chance in Indiana? Many would think Indiana would probably be one of the last states to enact such a law, but I anticipate such a measure will actually be considered this legislative session.

The prestigious Institute of Medicine issued a report that concluded that raising the minimum legal age for tobacco sales to 21 would have substantial positive effects on our nation’s health. This would delay or reduce the number of adolescents and young adults who initiate tobacco use and ultimately reduce the prevalence of adult smoking.

Increasing the legal age of purchasing tobacco makes a lot of public health sense:

Eighty percent of smokers begin daily smoking before age 19, and 95 percent initiate smoking by age 21. Four out of five smokers become daily smokers before age 21.

•Between the ages of 18 and 21, many young smokers move from experimentation to regular daily use. It is a critical time of solidifying tobacco addiction.
•A major focus of the tobacco industry is promotion to college-age young adults. The highest prevalence of smoking is between the ages of 21 and 25 years of age.
•Ninety percent of individuals who purchase tobacco for minors are between the ages of 18 and 21.
•According to the IOM, children between the ages of 15 and 17, those most vulnerable to nicotine addiction due to differences in brain physiology, would benefit the greatest by enacting a 21 sale age.
•According to an internal tobacco industry document: “If a man has never smoked by age 18, the odds are three-to-one he never will. By age 24, the odds are 20-to-one.”

Raising the minimum age to 21 would reduce smoking by 12 percent (even much higher percentages in youth) and smoking-related deaths by 10 percent. Almost 250,000 fewer premature deaths and 50,000 fewer deaths from lung cancer among people born between 2000 and 2019 would result.

But what of the argument that if one is old enough to vote and serve in the military, one should be old enough to smoke? One solution has been to exempt active-duty military from the law. But consider these facts: The drinking age is 21 in all states, and tobacco is more dangerous than alcohol. And further, tobacco is also the only legally-available product that kills the consumer when used exactly as intended.

Feldman is an Indianapolis family physician and is a former Indiana state health commissioner. Email him at

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