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 $170,000,000,000 in direct medical 
costs and $156,000,000,000 in lost productivity 
every year. 
(5) More than 36,000,000 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 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, nearly 2,500 
youth under 18 years of age smoke their first ciga-
rette. 
(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 95 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 people of the United 
States favor raising the tobacco age of sale to 21 
years, including 7 in 10 smokers. 
(14) Each year, nearly 500,000 youth aged 12 
to 17 use smokeless tobacco for the first time, and 
young adults aged 18 to 24 use smokeless products 
at twice the rate of older adults aged 45 to 64. 
(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-
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 
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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, 50,000 
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) Five States, the District of Columbia, and 
more than 230 localities in an additional 13 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 
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unlawful to sell or distribute a tobacco product to anyone 
under the age of 21. 
(b) ENFORCEMENT.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services is authorized to enforce the prohibi-
tion under subsection (a) and shall take necessary 
action to enforce such prohibition, including, as ap-
propriate— 
(A) 
conducting 
undercover 
compliance 
checks, performing retailer inspections, initi-
ating enforcement actions for noncompliance, 
and taking any other measures appropriate to 
help ensure nationwide compliance with such 
prohibition; and 
(B) establishing requirements that retailers 
check identification or use other methods to en-
sure compliance with subsection (a), or issuing 
guidance concerning the responsibility of retail-
ers to ensure such compliance. 
(2) ENFORCEMENT AUTHORITY.—In the case of 
a violation of subsection (a), the Secretary of Health 
and Human Services may apply the penalties under 
section 303 of the Federal Food, Drug, and Cos-
metic Act (21 U.S.C. 333), as though such sub-
section (a) were a regulation promulgated under sec-
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