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CANCER MARCH 1, 2018 1 W hen Rob Crane, MD, launched the Preventing Tobacco Addiction Foundation 20 years ago on the heels of his father’s death from lung cancer, passing any type of legislation to combat tobacco use among youth was a daunting prospect. “The tobacco industry was much too strong, so the issue remained dormant for quite some time,” says Dr. Crane, a clinical professor with the department of family medicine at The Ohio State University in Columbus. However, that scenario has begun to change, and municipalities and states across the country have started to pass legislation that raises the tobacco purchase age from 18 to 21 years. Known as Tobacco 21, this law is the foundation’s main focus. In June 2015, Hawaii became the first state to raise the age at which one can purchase tobacco products, followed by California in May 2016. Since then, New Jersey, Maine, and Oregon all have raised their legal tobacco purchase age, and legislation currently is pending in other states, including Massachusetts, Illinois, New York, Washington, Vermont, and Minnesota. “I expect about a half dozen more states will raise the age within the next year,” Dr. Crane says. Approximately 290 local jurisdictions, from small towns and mid-size cities to larger metropolises such as New York City, St. Louis, Boston, Columbus, Cleveland, and San Francisco, have raised the legal tobacco purchase age from 18 to 21 years. In fact, Dr. Crane estimates that the law now pertains to approximately 25% of the US population.