Back to Latest

The Tobacco 21 Legislation Is Projected to Reduce Smoking-related Disease and Health Care Costs

Preventing early access to tobacco could reduce initiation and addiction to nicotine, subsequently saving billions in tobacco-related costs

New York, NY – The vast majority of adult tobacco users reportedly started for the first time in their early adolescent years. Throughout adolescence, brain development is an enduring process, making these youth particularly susceptible to the effects of nicotine. There is little doubt that peer pressure among fellow teens plays a large part in early exposure to tobacco. However, an equally large part is due to the shocking ease of access for young, vulnerable teens to obtain tobacco products.

According to a research study led by Dr. Joseph DiFranza, MD, of the Department of Family Medicine and Community Health at the University of Massachusetts, 89% of youths within 10 Massachusetts communities buy their cigarettes from a store. Tobacco 21 is a legislation that aims to combat these trends, and reduce the risk of teens and young adults developing an addiction to tobacco by raising the minimum legal age of sale (MLA) to 21. As reported by the United States Institute of Medicine (IOM), raising the MLA from 18 to 21 years would lead to a projected decrease in initiation among adolescent youth, resulting in lowered tobacco-related morbidity and mortality rates. Not only does the Tobacco 21 legislation prevent individuals ages 18-20 from purchasing tobacco products, but it may potentially reduce cigarette exposure to those under age 18 as well. According to a number of paper surveys and focus group discussions conducted by Dr. DiFranza, teenagers between ages 18 and 20 act as a major gateway to tobacco products for youth in their early to mid-teens. Therefore, fortifying the barrier to entry for obtaining cigarettes will effectively restrict access for younger groups indirectly.

Every year, the costs for tobacco-related health care in the United States approximate to an alarming $170 billion, with further economic losses due to smoke-related lost productivity in the form of smoking breaks and cigarette-related sick leaves approximating to more than $156 billion. For New Yorkers, these deficits amount to $10.4 billion and $6 billion respectively. With Tobacco 21 having a profound impact on the massive demographic of both the 18-20 age bracket, as well as individuals below the age of 18, the IOM expects this regulation to reduce smoking rate by 12 percent, and reduce smoking-related deaths by 10 percent. These changes are critical to addressing the losses to the American economy caused solely by tobacco-related health issues.

“Increasing the legal age to purchase tobacco from 18 to 21 years would be an important step to reducing the effects of tobacco use on the health care system.” said Marcy Hager, Director of the COE for HSI. “This would ensure that another generation does not have to suffer the high consequences of tobacco use on their generation’s overall health”

For more information about the work of the COE for HSI, visit

About CAI: CAI is a global nonprofit organization dedicated to improving the health and well-being of underserved populations worldwide. Since 1979, CAI has provided customized capacity building services to health and human service organizations in more than 27 countries and in all 50 states. Offering more than 1,500 training programs annually, CAI’s passionate staff works to fulfill its mission: to use the transformative power of education and research to foster a more aware, healthy, compassionate and equitable world. For more information about CAI, visit our website:

About the Center of Excellence for Health Systems Improvement: With funding from the New York State Department of Health, Bureau of Tobacco Control, CAI serves as the Center of Excellence for Health Systems Improvement (COE for HSI) for a Tobacco-Free New York. The COE for HSI promotes large-scale systems and policy changes to support the universal provision of evidence-based tobacco dependence treatment services. The COE for HSI aims to support 10 regional contractors throughout New York State working with health care systems and organizations that serve those populations for which tobacco use prevalence rates have not decreased in recent years – adults with low incomes, less than a high school diploma, and/or serious mental illness. Focused on providing capacity-building assistance services around topics like how to engage and obtain buy-in from leadership to implement the kinds of systems-level changes that will result in identification and intervention with every tobacco user who seeks care, the COE for HSI also will offer materials and resources to support contractors in their regional work. For more information, visit

Tobacco-Free NY