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Health policy advocates push for federal “Tobacco 21” law

iStock_teen smokingScience and common sense tell us that the teenage brain is more vulnerable to peer pressure and susceptible to nicotine addiction than at any other stage of development.

That’s why California legislators recently voted to raise the legal age to buy cigarettes and tobacco products from 18 to 21. If Gov. Jerry Brown signs the bill, California will become the second state, after Hawaii, to raise the age limit on the unhealthy products.

Michelle Mello, PhD, MD, a Stanford professor of law and of health research and policy, and colleagues from Harvard University and Baylor College of Medicine argue in this New England Journal of Medicine article that there is new evidence to suggest these laws are effective, have great public support and have minimal economic impact in the short term. They write:

The vast majority of smokers begin smoking during adolescence, a period when the brain has heightened susceptibility to nicotine addiction. Nearly everyone who buys cigarettes for minors in the United States is under 21 years of age; raising the sale age prevents high school students from buying tobacco products for their peers.

The authors note an analysis of the effects of one such law adopted in Needham, Mass., revealed a 47 percent reduction in the smoking rate among high school students, along with a reported decline in area retail tobacco purchases. The decreases were significantly greater than those in 16 comparison communities without Tobacco 21 laws.

Two national public opinion studies published in 2015 found that 70 to 75 percent of Americans — including a majority of current smokers — support raising the minimum purchase age to 21.

The authors themselves conducted a national survey of 1,125 American adults regarding their attitudes toward various public health laws. “We found that three in four Americans support the adoption of a federal Tobacco 21 law,” they write. “Majority support extends across all major socio-demographic groups, including 68.3 percent support among young adults 18 to 24 years of age.”

Opponents of the federal and state bills — namely tobacco interests, convenience store owners and e-cigarette manufacturers — say that states should not be in the business of policing public choice. Store owners contend raising the age limit would hurt sales, as snacks and soft drinks are typically ancillary purchases with cigarettes.

And some veterans’ organizations and Republican legislators have said it is wrong to take away the decision on whether to smoke from young people who are nevertheless old enough to marry, vote and join the military.

But Mello and her coauthors, Stephanie Morain, PhD, and Jonathan Winickoff, MD, say the long-term benefits of raising the age limit far surpass the near-term economic concerns, which they believe are overstated.

Research indicates that in the short term, raising the tobacco-purchasing age to 21 would result in a 2 to 3 percent annual decrease in total tobacco sales.

Over the longer term, the revenue loss from decreased smoking prevalence will be substantial. But allowing future generations to become addicted to nicotine in order to preserve tobacco revenue fails the red-face test as an argument against Tobacco 21...

We believe the time has come to expand this effective, broadly supported approach to a much greater share of the population.

Previously: The battle against big tobacco hits the classroom, Raising the age for tobacco access would benefit health, say new Institute of Medicine report and How e-cigarettes are sparking a new wave of tobacco marketing
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