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Since the vast majority of smokers begin smoking before the age of 21, Tobacco 21 laws are able to reduce smoking and other tobacco use among young people and have been shown effective, publicly supported and to have minimal, short-term economic impact.27 A 2015 report by the National Academy of Medicine estimated that if a nationwide Tobacco 21 rule was implemented, it would result in 249,000 fewer premature deaths, 45,000 fewer deaths from lung cancer and 4.2 million fewer lost life-years among Americans born between 2010 and 2019

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