Medicaid and indigent care issue brief: youth access to tobacco.

Tobacco use is the single leading preventable cause of death in the United States. Annually, tobacco causes more than 430,000 deaths and costs the nation approximately $50 billion - $73 billion in medical expenses alone. Smoking among American adolescents increased 78 percent between 1988 and 1996. Each day, more than 6,000 youth under age 18 try their first cigarette, and more than 3,000 become daily smokers. State legislatures currently are pursuing a wide range of legislative proposals that are designed to limit youth access to tobacco products and to ensure that their state laws comply with current federal requirements. State laws vary in their approach, and are unevenly enforced. Until recently, current laws did not penalize minors for using or possessing tobacco; instead, punishment focused on retailers. These punishments, however, have proved ineffective because retailers rarely are prosecuted for breaking these laws. This document will highlight legislative approaches since 1992, the year the federal Synar Amendment was enacted.