227 FDA contracted with the Institute of Medicine (now known as the National Academy of Medicine), and concluded in a 2015 report that "increasing the minimum age of legal access to tobacco products will likely prevent or delay the initiation of tobacco use by adolescents and young adults." 228 However, the report noted that "the impact on initiation of tobacco use of raising the minimum age of legal access to tobacco products to 21 will likely be substantially higher than raising it to 19, but the added effect of raising the minimum age of legal access beyond age 21 to age 25 will likely be considerably smaller." 229 In FY2020 appropriations, Congress amended the FFDCA to raise the federal minimum age of tobacco product sales to 21
Further, our study benefits from the repeated outcome measures afforded by the PATH Study, as well as explicitly accounting for pack-years of smoking and additional confounders not captured by other studies
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