since the Surgeon General’s first report on smoking 
in 1964. 
(2) The 1964 Surgeon General’s report linked 
cigarette smoking to cancer, and since then, other 
tobacco products, including cigars, cigarillos, roll- 
your-own products, and smokeless tobacco have been 
causally linked to cancer. 
(3) While substantial gains have been made 
since 1964, tobacco use remains the leading prevent-
able cause of death in the United States, responsible 
for more than 480,000 premature deaths each year. 
(4) Tobacco use costs the United States ap-
proximately $175,000,000,000 in direct medical 
costs and $156,000,000,000 in lost productivity 
every year. 
(5) More than 34,000,000 people in the United 
States still smoke, and the tobacco industry con-
tinues to challenge tobacco control measures in 
court, manipulate products to evade existing regula-
tions, introduce new and dangerous tobacco prod-
ucts, and spend billions of dollars on marketing to 
deceive the public and addict more children. 
(6) An estimated 5,600,000 youth aged 17 and 
under are projected to die prematurely from a to-
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bacco-related illness if prevalence rates do not 
change. 
(7) Each day in the United States, more than 
2,000 youth under 18 years of age smoke their first 
cigarette. 
(8) Use of tobacco products in any form is not 
safe, especially during adolescence, as such use can 
lead to nicotine dependence and subsequent tobacco- 
related diseases and death. 
(9) Adolescents are especially vulnerable to the 
effects of nicotine and nicotine addiction and appear 
to show signs of nicotine addiction at lower levels of 
exposure compared to adults. 
(10) Nicotine exposure during adolescence may 
have lasting adverse consequences on brain develop-
ment. According to the Surgeon General, the use of 
products containing nicotine in any form among 
youth, including in electronic cigarettes, is unsafe. 
(11) The likelihood of developing smoking-re-
lated cancers increases with duration of smoking. 
Therefore, smokers that start at younger ages and 
continue to smoke are at higher risk for tobacco-re-
lated disease and death. 
(12) National data show that about 94 percent 
of adult smokers begin smoking before they turn 21. 
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The ages of 18 to 21 are a critical period when 
many smokers move from experimental smoking to 
regular, daily use. 
(13) Three-quarters of adults in the United 
States favor raising the tobacco age of sale to 21 
years, including 7 in 10 smokers. 
(14) In 2018, the Surgeon General issued an 
advisory on the electronic cigarette epidemic among 
youth. Electronic cigarette use among high school 
students in the United States increased 78 percent 
from 2017 to 2018. In 2018, more than 3,600,000 
youth, including 1 in 5 high school students and 1 
in 20 middle school students used electronic ciga-
rettes. 
(15) Electronic cigarettes are the most com-
monly used tobacco product among youth. According 
to the Surgeon General’s 2016 report on electronic 
cigarettes, electronic cigarette use is strongly associ-
ated with the use of other tobacco products among 
youth and young adults. 
(16) The 2015 report of the National Academy 
of Medicine entitled, ‘‘Public Health Implications of 
Raising the Minimum Age of Legal Access to To-
bacco Products’’, concluded that raising the min-
imum legal age of sale of tobacco products nation-
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wide will reduce tobacco initiation, particularly 
among adolescents aged 15 to 17, and will improve 
health across the lifespan and save lives. Specifically, 
the report said that raising the minimum legal age 
of sale of tobacco products nationwide to age 21 
would, over time, lead to a 12-percent decrease in 
smoking prevalence. 
(17) The National Academy of Medicine report 
also predicts that raising the minimum legal age of 
sale of tobacco products nationwide to age 21 would 
result in 223,000 fewer premature deaths, 45,000 
fewer deaths from lung cancer, and 4,200,000 fewer 
years of life lost for those born between 2000 and 
2019. In addition, the report concluded that raising 
the minimum legal age of sale would result in near 
immediate reductions in preterm birth, low birth 
weight, and sudden infant death syndrome. 
(18) Regulating the retail environment, actively 
enforcing laws, and educating retailers are strategies 
that Federal, State, and local governments can take 
to restrict the availability of tobacco products to 
youth. 
(19) Twelve States, the District of Columbia, 
and more than 110 localities in an additional 15 
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States have raised the minimum legal tobacco sale 
age to 21. 
SEC. 3. PROHIBITION AND ENFORCEMENT. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, including any Federal regulation, it shall be 
unlawful to sell a tobacco product to anyone under the 
age of 21 or to sell a tobacco product to anyone under 
30 without verification of age by means of photo identi-
fication. 
(b) AUTHORITY TO ENFORCE.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the 
‘‘Secretary’’) is authorized to enforce the prohibition 
under subsection (a) and shall take necessary action 
to enforce such prohibition, including, as appro-
priate, conducting undercover compliance checks, 
performing retailer inspections, initiating enforce-
ment actions for noncompliance, and taking any 
other measures appropriate to help ensure nation-
wide compliance with such prohibition. 
(2) GUIDANCE.—The Secretary may issue guid-
ance concerning the responsibility of persons subject 
to subsection (a) to ensure compliance with such 
prohibition. 
(c) PENALTIES.— 
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