This Report to Congress describes how the Substance Abuse and Mental Health Services Administration (SAMHSA) is implementing the Synar legislation, a section of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act of 1992 (P.L. 102-321), which mandates the reduction of tobacco sales to minors. It also presents findings from State efforts to enforce related laws and regulations.

An estimated 57 million Americans currently smoke, putting themselves at risk of serious health problems, such as cancer, heart disease, and high blood pressure. Each year, over 430,000 deaths nationwide are attributable to smoking-related diseases, making tobacco use the leading preventable cause of death and disease in the United States. Total spending by the Department of Health and Human Services (HHS) to prevent tobacco use and dependence is estimated at $900 million for fiscal year 2001. Tobacco use, and the resulting nicotine addiction, begins predominantly in childhood and adolescence. Every day, about 3,000 young people become regular smokers. It is estimated that one-third of these youth will die from smoking-related diseases. In addition to long-term health consequences, these youth are at risk for numerous early consequences, such as a general decrease in physical fitness, early development of artery disease, and a slower rate of lung growth. If children and adolescents can be prevented from using tobacco products, however, they are likely to remain tobacco-free for the rest of their lives. In 1992, the Congress enacted legislation, referred to as the Synar amendment, to reduce the sale and distribution of tobacco products to individuals under the age of 18. HHS' Substance Abuse and Mental Health Services Administration (SAMHSA) is responsible for promulgating regulations and overseeing states' compliance with the Synar requirements. Synar and its regulation require states and territories to have and enforce laws that prohibit tobacco sales to minors, conduct random inspections of tobacco retail or distribution outlets to estimate the level of compliance with Synar requirements, and report the results of these efforts to the Secretary of HHS.

Tobacco use by adolescents and young adults poses serious concerns. Nearly all adults who have ever smoked daily first tried a cigarette before 26 years of age. Current cigarette use among adults is highest among persons aged 21 to 25 years. The parts of the brain most responsible for cognitive and psychosocial maturity continue to develop and change through young adulthood, and adolescent brains are uniquely vulnerable to the effects of nicotine. At the request of the U.S. Food and Drug Administration, Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products considers the likely public health impact of raising the minimum age for purchasing tobacco products. The report reviews the existing literature on tobacco use patterns, developmental biology and psychology, health effects of tobacco use, and the current landscape regarding youth access laws, including minimum age laws and their enforcement. Based on this literature, the report makes conclusions about the likely effect of raising the minimum age to 19, 21, and 25 years on tobacco use initiation. The report also quantifies the accompanying public health outcomes based on findings from two tobacco use simulation models. According to the report, raising the minimum age of legal access to tobacco products, particularly to ages 21 and 25, will lead to substantial reductions in tobacco use, improve the health of Americans across the lifespan, and save lives. Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products will be a valuable reference for federal policy makers and state and local health departments and legislators.