Introduction:
As smoking prevalence remains high in Europe (18.4%)¹ with only 4 % of smokers starting older than at the age of 25², many countries are examining tobacco endgame policies which aim to rapidly reduce smoking prevalence to minimal levels. One such policy is raising the tobacco age-of-sale from 18 to 21 years of age, commonly referred to as “Tobacco 21”. The European Respiratory Society (ERS) assessed data on Tobacco 21 + implementation to provide evidence-based conclusions and recommendations to medical and tobacco control community as well as to policy makers.

Material and Methods:
Authors analysed both modelling studies³ on predicted benefits of Tobacco 21 policy and real-world data measuring effects of already implemented Tobacco 21 laws^4,5,6.

Results:
Evidence demonstrates that raising the age-of-sale of tobacco products to 21 years has resulted in decreased youth tobacco prevalence and delayed smoking initiation. In addition, Tobacco 21 has strong public support and there is now mounting evidence for policy makers across Europe to implement this measure into law^7,8,9.

Conclusions:
As more countries press forward with the tobacco endgame agenda, Tobacco 21 is likely to be an important milestone in the journey towards a tobacco-free generation. ERS strongly recommends that governments introduce Tobacco 21 policies.