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working together to implement new approaches to reducing youth access, often achieving significant success and providing the rest of the country with valuable insight and models. As the public's attitudes evolve toward a tobacco-free norm, most American citizens, including many tobacco users, widely favor measures to prohibit youth access to tobacco.4 Yet, our national policy is lagging behind this emerging consensus regarding the public health importance of, and need for, meaningful restrictions on children's access to tobacco products. The time for effective action is at hand. We now know enough to design workable, effective legislation to curtail youth access without unduly burdening access to adults.


A Brief History of the Emergence of Youth Access Measures

The curtailment of sales of tobacco products to minors has a long history in the United States. After the turn of the twentieth century, techniques enabling the mass production of cigarettes and the invention of the portable match contributed to a rapid increase in tobacco consumption. Reformers who associated tobacco use with social problems of the emerging large industrial cities were concerned about tobacco's demoralizing effects on young people. Because of these concerns, many states enacted laws limiting youth access to tobacco. These laws varied widely. Most laws prohibited tobacco sales to persons under 18 or 21, but some statutes did not specify an age. Penalties generally ranged from $0 to $100. Many of these early access laws were more concerned with cigarettes than with other forms of tobacco because the relative mildness of cigarettes was thought to present a special temptation to young people; therefore, lower minimum age limits for purchase, or no limitations at all, were set on the sale of cigars, pipes, and snuff.5 A 1907 judicial decision, which upheld a regulatory distinction between cigarettes and other forms of tobacco, explained: "Before the day of the cigarette, mastery of the tobacco habit was obstructed by agonies of nausea usually sufficient to postpone it to a period of at least reasonable maturity."6 In 1944, another court noted that Tom Sawyer's experience with the "wallop" from a cigar encouraged boys to take up cigarettes instead.7 In part, youth access laws arose out of concerns about the health effects of tobacco use; many people associated tobacco use with heart disease and respiratory ailments. Often, these concerns were moralistic, intertwining the health effects of tobacco with arguments regarding the character of tobacco users.8 In 1937, a federal court found that a local ban on cigarette vending machines was justified to prevent "the evil . . . of the purchase of cigarettes by immature minors."9

Although youth access legislation was adopted throughout the country, it was largely unenforced. The general disregard of these laws may have reflected a national ambivalence about tobacco. The federal government actively supported the tobacco industry, for example by providing free tobacco as a basic

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