Will it make a difference?
Within the past month, a new law went into place raising the minimum age to purchase any tobacco product to 21. This has the support of many groups, including several large tobacco companies. Why is this law so important? Will it help curb the growing nicotine addiction problem among our youth? Why are tobacco companies supporting it?
As of last month, it’s now a violation of federal law to sell tobacco to anyone under the age of 21. The law was included in the federal year-end legislative package. It passed by both houses of Congress and President Trump signed the bill on December 20, 2019. The Food and Drug Administration (FDA) placed a statement on their website that said “it is now illegal for a retailer to sell any tobacco product — including cigarettes, cigars and e-cigarettes — to anyone under 21. FDA will provide additional details on this issue as they become available.” The Family Smoking Prevention and Tobacco Control Act of 2009 brought all tobacco products under the jurisdiction of the FDA, but prohibited them from raising the minimum legal age of sale above the age of 18, which had been the law since the 1990s. This new restriction on tobacco sales has had support of a bipartisan mix of senators. In a related action, FDA approved for sale two low-nicotine cigarettes, Moonlight and Moonlight Menthol. The brands contain between 0.2 to 0.7 milligrams of nicotine per cigarette. When compared to conventional cigarettes, which have an average of 10 to 14 milligrams of nicotine, this is a huge improvement. The FDA did stress that these new products differ from conventional cigarettes only in their level of nicotine. Otherwise, they pose the same health risks. The FDA approved these products in response to their July 2017 announcement saying they would eventually require all cigarettes sold in the United States to decrease their nicotine content to nonaddictive levels, but under pressure from the tobacco industry, the proposal was dropped from its regulatory agenda. While there are several other low-nicotine cigarettes on the market, these don’t have FDA approval because they were present before current tobacco control regulations took effect.
The concept of having the age restriction of being 21 or older to purchase tobacco isn’t a new idea. The increase in the federal age limit comes after a number of new laws at the state and local levels. In the late 19th and early 20th centuries in many cities and states across the nation began to increase their legal sales age for tobacco products, including e-cigarettes. The first to raise it to 21 was Needham, Massachusetts in 2005. Several studies conducted after the law went into effect in Needham showed that the past 30-day cigarette smoking among youth was cut by almost 50% and frequent smoking in youth dropped by 62%. In 2013, the first large city, New York City, changed the minimum age to buy tobacco products to 21. Overall, 19 states, including Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, Utah, Vermont, Virginia and Washington, have passed legislature that raises the minimum age to purchase tobacco to 21. In addition, Washington, DC and more than 500 cities and towns have done the same.
This new law is incredibly important because tobacco remains the number one cause of preventable death and disease in our country with nearly 500,000 premature deaths a year. According to the Center for Disease Control (CDC), the rate of cigarette smoking has declined from it’s 42% peak in the 1960s to 14%, but this means there are still 34 million smokers in the US. One surprising statistic from a federal survey released in December 2019 was that almost 1 in 3 high school students reported using tobacco recently. While e-cigarettes were the most popular product, students also reported smoking cigars, cigarettes or other tobacco products. Most people who use tobacco start before age 18 and nearly all start before 26. Currently, every day over 3,200 youths smoke their first cigarette and another 2,100 youth and young adult occasional smokers convert to daily smokers. In 2014, the US Department of Health and Human Services (HHS) stated that around 5.6 million people under 18 will eventually die prematurely from a smoking-related disease if usage patterns don’t change. A report from the National Academy of Medicine (formerly the Institute of Medicine) released in March 2015 found that if the minimum age to buy tobacco was 21, then 223,000 deaths among people born between 2000 and 2019 could be prevented, which would mean that by the time today’s teenagers were adults and smoking-related deaths would decrease by 10%. This would include reducing lung cancer deaths, which the nation’s leading cancer killer, by 50,000 people. The report also stated that tobacco use would decrease by 12% and smoking initiation will be reduced by 25% for 15-17-year-olds and 15% for 18-20-year-olds. Several surveys show that the age of initiation is increasing from 12-17-year-olds to 15-21-year-olds. One study found that 50% people who try cigarettes in college were still smoking four years later. Often smokers who are 18 and 19 years old are suppliers for younger kids who rely on friends, classmates and peers to buy tobacco products. The raising of tobacco purchase age to 21 is an important step in increasing the age gap between kids and those who can legally buy tobacco will help keep tobacco out of the high school environment. One study concluded that increasing the age of purchase reduced youth smoking rates more than a 100% when compared to a tax increase on tobacco. This has an impact not only on overall smoking prevalence, but prevalence of other tobacco products as well.
It’s important to note that the National Academy of Medicine’s 2015 study was published before Juul and other nicotine e-cigarettes caught on with teenagers. According to the CDC, e-cigarette use among high schoolers increased by 78% and among middle schoolers by 48% between 2017 and 2018. The latest report from the federal survey, Monitoring the Future, discovered that 25% of 12th graders, 20% of 10th graders and nearly 10% of 8th graders reported vaping nicotine in the past month. As a result, this has driven up the overall increases in youth tobacco use. As of this month, the CDC says that of the 15.6 million high school kids in the country, nearly 5 million reported using some kind of tobacco product with more than 4 million saying they used e-cigarettes. According to the HHS, of the high school students who used e-cigarettes, about 28% used them between 20 to 30 days in a month, around 19% reported using them between 6 to 19 days in a month and just over 46% used them 1 to 5 days in the last month. The bottom line is the past progress in reducing youth uses of tobacco products has been erased. Many experts are calling vaping the health epidemic of America’s youth. Not only is there a rise in levels of youth vaping, there’s a mysterious outbreak of vaping-related lung injuries. Per the CDC, vaping-related lung injuries have surpassed more than 2,500 cases nationwide and 54 people have died. One thing for sure is that teens like flavored e-cigarettes and many cite this as the key reason for their use. So, as long as flavored e-cigarettes remain available, rest assured that kids will find a way to get them. This is why some states have imposed bans on sales of flavored e-cigarettes. Unfortunately, the vaping industry has been challenging many of these in court. The good news is that as of January 2, the Trump Administration banned the sale of flavored e-cigarettes other than tobacco and menthol. The FDA announced a warning to companies that if they don’t stop manufacturing, distributing and selling the now-unauthorized flavors within 30 days, they risk FDA enforcement. Juul controls about 75% of the American e-cigarette market has halted the sales of both its popular mint-flavored products and fruit-flavored e-cigarettes.
There is a significant amount of evidence that demonstrates that nicotine use during adolescence and young adulthood has long term influence on brain development. Since your brain continues developing until your 25, this is very impactful. Also, it can make it more difficult to quit using tobacco later in life because teens are especially susceptible to nicotine addiction. The American Lung Association (ALA) states that young people are more likely to develop a respiratory illness from smoking compared to an adult. Additionally, the number and severity of those illnesses is higher. Not only does smoking at a young age affect your brain, put it has the potential to stunt lung growth and function. The ALA’s data shows that 87% of adults who have ever smoked on a daily basis tried their first cigarette by the time they were 18 and 95% tried their first cigarette by the time they were 21. The ALA further states that more than 2,500 people under 18 will try their first cigarette every day, 400 of whom will go on to become habitual smokers and 50% of them will die from their habit.
What is surprising to many is that new law received the backing of many companies in the tobacco and e-cigarette industry. The two most well know companies who supported the law were Juul and Altria. This support is a complete reversal of the stance they’ve taken for decades. It’s easy to see why they’ve changed their minds. It’s hard to design a marketing campaign where the “intended” target are people who are 21 and still get 12-year-olds to start smoking. This is why tobacco companies preemptively lobby for bills that are weak or don’t spell out effective enforcement mechanisms as a way to keep doing what they’re doing without actual rules. Also, this is part of a business campaign to help soften the public backlash against the marketing that they already did directed at minors. By doing this the industry can say that they’ve done something already, so they don’t need to do anything else. So, the new law might not bring about meaningful change, but will lead to the tobacco companies to claim that the youth e-cigarette problem is solved even though it could continue to get worse. Another issue is the bipartisan support of the bill in Congress. While this might seem like a good thing, it’s important to understand the reasons for the support. The Republican side of the Senate was represented by Mitch McConnell, who definitely seems like he wouldn’t be a supporter of the new law because he has long been seen as a friend to the tobacco industry. However, it shouldn’t be shocking that the National Public Radio’s (NPR) Embedded podcast discovered that currently employed as lobbyists by the vaping and tobacco companies are McConnell’s former policy adviser, his former policy director and his former chief of staff.
These are the reasons health advocates aren’t enthusiastically celebrating the change because they worry it may help the tobacco companies fend off further sweeping regulations. They also wonder how strictly any laws will be enforced because the FDA has jurisdiction over any laws governing the tobacco industry and many health advocates question about how aggressive they’ll be at doing their job. The major concern is that the law will do little to keep tobacco products out of the hands of kids if it’s not enforced. Besides raising the minimum purchase age and getting rid of flavors, there are many evidence-based measures suggested by health advocates to help decrease tobacco use among, not only, youth, but the general population. The first suggest is increasing the price of tobacco products by imposing tobacco taxes. Numerous studies show that for every 10% increase in price, youth tobacco use decreases by 7% and overall tobacco consumption decreases by 4%. Two other suggestions include bans on coupon redemptions and creating minimum price floors for tobacco products. Also, continuing to establish smoke- and tobacco-free environments will help to reduce secondhand smoke exposure and contribute to those who work in tobacco-free environments smoking fewer cigarettes. By fully funding tobacco control programs at state and local level, it’ll provide for more quit-smoking services and programs to prevent youth and young adults from starting smoking in the first place. Another important tool is using mass media campaigns targeted at youths to encourage nonsmokers to not start smoking and current tobacco users to quit. It’s critical to denormalization the use of tobacco by reducing youth exposure to tobacco use in movies and other media. In addition, youths shouldn’t bear the burden of purchase, use or possession laws. The responsibility for enforcing minimum age of sale laws lies squarely on the retailer. As part of eliminating flavors, online sales of tobacco products should be banned.
Many of us forget that tobacco is not the first product to be restricted to the age 21 and older. Since the 1980s, the sale of alcohol has been restricted, in most states, to individuals over 21. Once the national law went into effect, it resulted in reduced alcohol consumption among youth, decreased alcohol dependence and has led to a dramatic reduction in drunk driving fatalities. It’s projected that there will be similar effects in the tobacco industry, but the results surrounding the age increase likely won’t be observed for at least 30 years. Regardless of how long it takes, this new law is an important component of a comprehensive public health approach to reducing tobacco use in general, but especially among teens and young adults.