Smoke, the chief killer--strategies for targeting combustible tobacco use.

are offset to a degree by revenue generated through fines. One barrier to successful implementation of Tobacco 21 laws is the prospect of incomplete compliance by retailers. Compliance with the 18-year minimum has been variable, and interventions to boost compliance have had mixed success.5 Some retailers may prove even more reluctant to comply with Tobacco 21 laws, particularly in challenging economic times, because they further undercut already-reduced sales revenue and lack the perceived moral force of laws that more explicitly aim to protect children. Studies show that the extent to which such access restrictions reduce the prevalence of smoking among young people depends on the vigor with which authorities enforce them.5 Strong incentives for enforcement activities can be provided through mechanisms such as the Synar Amendment, which made a portion of federal block grants from the Substance Abuse and Mental Health Services Administration conditional on states’ willingness to adopt policies to restrict tobacco sales to minors and demonstrate high levels of compliance with these laws. A forthcoming FDA report to Congress on the public health impact of raising the minimum tobacco-sales age could soon place Tobacco 21 legislation on the federal agenda. In the interim, further state and local policy leadership can help to generate effectiveness data to determine whether the policy merits nationwide adoption and what implementation problems should be anticipated. According to a recent Gallup poll, nearly 90% of U.S. adults who smoke report that if they had it to do over again, they would not have started. Helping today’s adolescents avoid that regret requires a comprehensive strategy that includes strong supply-side interventions. We believe that Tobacco 21 laws are a logical next step.