KX News: Less Students Smoking Cigarettes, More Students Smoking E-Cigarettes

By Alicia Ewen
North Dakota kids smoke cigarettes less than they used to…far less.
But they are dabbling in some other risky behaviors.
The state asked high school students across the state about their habits. It found that fewer kids smoke.
In fact, 80% of kids said they hadn’t smoked or used smokeless tobacco in the previous month.
Only 3% of high school students say they smoke cigarettes daily.
For the first time though electronic cigarette use was surveyed.
22% of students surveyed say they tried an e-cigarette in the month before they took the survey…
“That’s another misconception, that kids think they are safer than traditional smoking but really there are still chemicals in these vaping products that will harm your body. There hasn’t been as much research done on them as we should have so I’ll be really excited to see what comes out in the next couple of years about these vaping products,” says Hannah Rexine, CHS student and member of the tobacco policy board.
Rexine is the only youth member on the state tobacco policy board. She’s a senior at Century High School in Bismarck.
http://www.kxnet.com/story/30467318/less-students-smoking-cigarettes-more-students-smoking-e-cigarettes

Bismarck Tribune: E-cigarettes more popular than tobacco among teens, survey finds

By Amy R. Sisk, Bismarck Tribune
Although tobacco use is down among North Dakota’s teenagers, nearly double the number of youngsters are using e-cigarettes, according to a survey of students.
The 2015 Youth Risk Behavior Survey shows that 12 percent of high school students statewide reported smoking at least once in the month before the survey. That’s down from 22 percent in 2005.
Meanwhile, 22 percent of students report having used an e-cigarette in the past month.
The statistics come from a survey overseen by the U.S. Centers for Disease Control and Prevention given to middle school and high school students in every state. In North Dakota, the Department of Public Instruction and the Department of Health administer it to 10,000 high school students.
The prevalence of e-cigarettes marks an area of concern for school and health officials who spoke Monday at a news conference at the state Capitol in Bismarck. E-cigarettes convert nicotine liquid into aerosols that are inhaled, said Jeanne Prom, director of the North Dakota Center for Tobacco Prevention and Control Policy.
Hannah Rexine, a senior at Century High School, said she and her friends became aware of the vaping devices two or three years ago when they began to grow in popularity.
“E-cigarettes are becoming more popular because kids think they are more safe than an actual cigarette,” she said.
Rexine, who sits on the board of directors for the tobacco prevention center, said not enough research has been done to verify that claim.
Prom said using nicotine at a young age causes lasting harm to the brain.
“Nicotine is one of the most highly addictive drugs,” she said. “A curious experiment with an e-cigarette could lead kids into an addiction into any form of nicotine.”
Teens often buy e-cigarettes off the Internet or from friends and don’t know the nicotine content, Rexine said.
E-cigarettes come in a variety of flavors. Some believe the product can help them quit smoking.
“It’s all these rumors going around,” Rexine said.
The Students Against Destructive Decisions group at Century has educated freshmen during orientation each of the past two years about the risks associated with e-cigarettes.
The state and local governments have also jumped on board to combat the popularity of the vaping devices.
Prom said the 2015 North Dakota Legislature passed a bill prohibiting youth from using e-cigarettes and vendors from selling them to minors. Bismarck also approved an ordinance that requires stores selling the products to have a tobacco license and place the items behind the counter.
Though the percentage of teens smoking traditional cigarettes has dropped, Prom said there’s still work to do.
She said 42 percent of the state’s K-12 students attend a school that has a comprehensive policy banning tobacco. She aims to bring that number up to 100 percent by working with county public health units and school districts. Money from North Dakota’s settlement with tobacco companies in the 1990s is funding that effort.
In addition to cigarette use, the survey asks about a number of issues affecting teens, including suicide, drinking, drug use and diet.
State Superintendent Kirsten Baesler outlined efforts to address mental health issues.
The percentage of North Dakota high school students who report having attempted suicide in the past year is 9 percent. The number of students who felt sad or hopeless daily for two or more weeks in the past year is climbing from 20 percent in 2005 to 27 percent this year, according to the survey.
“We need to work to change those numbers,” Baesler said.
She said DPI is preparing training for teachers to identify early signs of mental health issues. She said the 2015 Legislature passed a bill requiring such training annually for high school and middle school administrators, teachers and instructional staff.
She said another new law requires that new teachers receive mental health training before they receive their teaching license.
http://bismarcktribune.com/news/local/education/e-cigarettes-more-popular-than-tobacco-among-teens-survey-finds/article_513c5759-69a0-5f26-8452-d296bca6b03f.html

WebMD: E-Cigarette Use Highest Among Young Adults: Report

Almost 4 percent of all adult Americans use them, new survey shows

WebMD News from HealthDay

By Alan Mozes, HealthDay Reporter

WEDNESDAY, Oct. 28, 2015 (HealthDay News) — In a first-of-its-kind look at electronic cigarettes, a new U.S. government study reports that nearly 13 percent of American adults have tried e-cigarettes at least once and almost 4 percent use them.

According to the 2014 National Health Interview Survey by the U.S. Centers for Disease Control and Prevention, the popularity of e-cigarettes rose slightly among men (about 14 percent) and dipped among women (about 11 percent).

But the most dramatic usage differences break along age lines, the poll of nearly 37,000 adults found. Almost 22 percent of Americans between the ages of 18 and 24 said they had tried the battery-powered aerosol nicotine-delivery device, while usage among those 65 and older was less than 4 percent.

Current users also tend to be younger, the report noted, with more than 5 percent of those 18 to 24 saying they now use e-cigarettes, compared with just over 1 percent of those 65 and older.

And among never-smokers, the usage was also highest among the 18-to-24 age group.

The report found that e-cigarette popularity is greatest among white and Native American adults, with nearly 5 and 11 percent, respectively, now using them. Only about 2 percent of blacks and Hispanics use them.

E-cigs also seem to curry much more favor among those who now smoke traditional cigarettes, or those who only recently kicked the habit: About 48 percent of current smokers have tried an e-cigarette and one in six currently use them. About 55 percent of those who stopped smoking just in the last year have tried them, and 22 percent said they currently use them.

By contrast, only about 3 percent of never-smoking adults said they’ve tried an e-cigarette, and less than half of 1 percent said they use them now. Among young (aged 18 to 24) never-smokers, however, almost 10 percent said they’ve tried one out.

So what’s driving the numbers?

“We really can’t answer that question,” said study co-author Charlotte Schoenborn, a statistician with the U.S. National Center for Health Statistics in the CDC’s division of health interview statistics. “This was the first year that the NCHS has even asked these questions. So we can only speculate as to why, as we watch to see how the trends unfold over time.”

Schoenborn and her colleague Renee Gindi outline their findings in the CDC’s October NCHS report released Oct. 28.
Erika Sward, assistant vice president for national advocacy with the American Lung Association, suggested that the CDC data will end up becoming a “very useful and much needed benchmark” for monitoring e-cigarettes.
“Electronic cigarettes are really the wild, wild West,” Sward said. “There’s absolutely no federal oversight of e-cigarettes, even though the FDA [U.S. Food and Drug Administration] has not found any e-cig to be safe or effective in helping smokers quit. And to our knowledge, no e-cigarette company has even applied to the FDA for approval as a smoking cessation product.”
But many manufacturers market the devices that way anyway, she said.
“So the real take-away message is that the people who are most likely to use e-cigs are our most vulnerable adults: the young, current smokers, and those who have recently quit or are trying to quit,” she said.
Sward added, “So just as we’re seeing traditional cigarette use decline — after years of FDA regulation and state smoke-free policies and taxation — we’re now seeing the tobacco industry continue its narrative of aggressively marketing e-cigarettes to younger people in the hopes of developing a whole new lifelong user.
“And until we act,” she said, “troubling studies like this one suggest that we’re on a path to a real public health crisis that will undo much of the progress that has been made to reduce tobacco use in the U.S.”
The report comes on the heels of a recommendation by the nation’s leading pediatricians group to raise the minimum age for purchasing tobacco products and e-cigarettes to 21 across the United States.
The new policy recommendation by the American Academy of Pediatrics, released Oct. 26, also called for the FDA to regulate e-cigarettes the same way it regulates other tobacco products.
http://www.webmd.com/smoking-cessation/news/20151028/e-cigarette-use-highest-among-young-adults-us-report-finds

USA Today: DOT bans e-cigarettes in checked luggage

Harriet Baskas, Special for USA TODAY
Under a new federal rule announced Monday by the Department of Transportation, airline passengers and crewmembers will no longer be able to pack battery-powered portable electronic smoking devices such as e-cigarettes, e-cigars, e-pipes, personal vaporizers and any sort of electronic nicotine delivery system, in checked luggage.
“We know from recent incidents that e-cigarettes in checked bags can catch fire during transport,” Transportation Secretary Anthony Foxx said in statement announcing the new federal rule. “Fire hazards in flight are particularly dangerous. Banning e-cigarettes from checked bags is a prudent safety measure.”
The DOT cites a U.S. Fire Administration report listing more than two dozen e-cigarette-related explosions and fires that have taken place since 2009, including some that involved e-cigarettes that were in checked luggage on airplanes.
According to the DOT, on Aug. 9, 2014, at Boston’s Logan Airport, an e-cigarette that was in a passenger’s checked bag in the cargo hold of a passenger plane caused a fire that forced the evacuation of the aircraft. And on Jan. 4, 2015, at Los Angeles International Airport, a checked bag that arrived late and missed its connecting flight caught on fire when an e-cigarette inside the bag overheated.
Under the new rule, passengers may continue to put e-cigarettes in their carry-on bags (or in their pockets), but they cannot use the e-cigs or charge them during a flight.
Although the DOT has said in the past that its rule banning the smoking of tobacco products on passenger flights extends to electronic cigarettes, the DOT is now also proposing to amend the rule to name e-cigarettes in the ruling.
According to the Associated Press, the ruling banning e-cigarettes from checked luggage should go into effect within two weeks.
Harriet Baskas is a Seattle-based airports and aviation writer and USA TODAY Travel’s “At the Airport” columnist. She occasionally contributes to Ben Mutzabaugh’s Today in the Sky blog. Follow her at twitter.com/hbaskas.
http://www.usatoday.com/story/travel/flights/todayinthesky/2015/10/27/electronic-cigarette-checked-luggage-ban/74670944/

NPR: Poll: Most Americans Support FDA Regulation Of E-Cigarettes

Poll: "Do you believe e-cigarettes should be regulated by the FDA like tobacco products?"
A majority of Americans say electronic cigarettes should be regulated by the Food and Drug Administration the same way the agency handles cigarettes containing tobacco, according to results from the latest NPR-Truven Health Analytics Health Poll.
Overall, 57 percent of people said the FDA should regulate e-cigarettes like tobacco products. The proportion of people in favor of regulation rose with age and education. Nearly, two-thirds of people with college degrees or graduate degrees supported regulation compared with 48 percent with high school diplomas or less.
The Food and Drug Administration proposed regulations for e-cigarettes in April 2014. Since then the agency has collected comments and held workshops on the public health issues raised by the products.
The agency sent its e-cigarette regulations to the White House on Oct. 19 for a required review, agency spokesman Michael Felberbaum tells Shots. The Office of Management and Budget has to pore over major regulations before they can be into effect.
Some of the key parts of the proposal included a ban on the sale of e-cigarettes to minors, a requirement that the products carry warnings they contain nicotine and disclosure of ingredients by manufacturers.
How much the FDA may have changed the regulations since they were first proposed isn’t clear because the agency doesn’t publicly release what it sends to the White House for sign-off. The White House can further tweak the rules, too.
We may find out fairly soon, though. There is a 90-day timetable for OMB review. The White House can extend the review to allow for more back and forth on the rules.
In the meantime, plenty of Americans have tried e-cigarettes. The NPR-Truven Health poll found that a quarter of respondents had vaped at least once. About a quarter of the respondents said they are current tobacco users.
E-Cigarette Use vs. Tobacco Use
What’s drawing people to e-cigarettes? The most common reasons given from those who have tried them were: to help stop smoking cigarettes (27 percent), as a healthier alternative to tobacco (26 percent) and curiosity (24 percent).
Among people who have tried e-cigarettes, half continue to use them. But 40 percent of current vapers said they have concerns about the health effects.
What was your primary reason for trying e-cigarettes?
“Electronic cigarettes have exploded in popularity in just a few short years, but we still know very little about the health risks associated with the technology,” said Dr. Michael Taylor, chief medical officer at Truven Health Analytics. “With our data showing a 50 percent adoption rate among those who have tried e-cigarettes, it’s reasonable to expect that usage will continue to grow, even as traditional cigarette smoking declines. This is clearly an area that will require a great deal more research.”
More than 3,000 people were surveyed about e-cigarettes during the first half of August. The responses came from households contacted by cellphone, land line and the Internet. The margin of error is plus or minus 1.8 percentage points.
You can find the questions and full results of the latest poll here. For previous polls, click here.
http://www.npr.org/sections/health-shots/2015/10/27/452244929/poll-most-americans-support-fda-regulation-of-e-cigarettes

LA Times: First-time tobacco users lured by flavorings, report says

Melissa Healy, Contact Reporter
A majority of adolescents who are puffing, vaping or chewing a tobacco product for the first time prefer one with flavor, suggesting that fruity, tangy, spicy or minty flavorings add a powerful allure to the uninitiated.
In a nationwide survey of U.S. children ages 12 to 17, the Food and Drug Administration’s Center for Tobacco Products has found that among those trying a hookah, electronic cigarette, cigar or regular cigarette for the first time, 89%, 81%, 65% and 50%, respectively, chose to try their tobacco product with an added flavoring.
In the United States, the marketing of flavored cigarettes — with the exception of menthol — is prohibited. But a wide range of flavorings is used in tobacco that is vaped, smoked in hookahs, chewed or dissolved in the mouth.
When adolescents were asked about their use of a tobacco product over the last 30 days, large majorities underscored that flavorings continued to play a role in their enjoyment of tobacco products. Asked about their tobacco use in the preceding month, 89% among hookah users said they had used flavored tobacco, compared with 85% of e-cigarette users, 72% of  users of any cigar type, and 60% of cigarette smokers.
The results were published Monday in the Journal of the American Medical Assn.
The study offers new insights into what factors pave the way for an estimated 3,200 American kids each day to try tobacco for the first time. A lifetime tobacco habit is overwhelmingly started in the teen and young adult years, and federal regulators have been keen to blunt smoking’s appeal to first-time users.
Since 2009, the FDA has had sweeping powers to regulate tobacco products in the interest of the public’s health. New evidence that flavorings play a key role in easing a would-be tobacco user’s introduction to the product is sure to spark renewed debate over outlawing flavorings.
“Consistent with national school-based estimates, this study confirms widespread appeal of flavored products among youth tobacco users,” the authors write. “In addition to continued proven tobacco control and prevention strategies, efforts to decrease use of flavored tobacco products among youth should be considered.”
http://www.latimes.com/science/sciencenow/la-sci-sn-first-time-tobacco-flavorings-20151026-story.html

CNN: Raise smoking age to 21 and regulate e-cigs, pediatricians urge

By Jen Christensen and Joseph Netto

(CNN) Most people who smoke started in their teens. While the number of kids trying tobacco for the first time has declined since the 1970s, there are still new smokers every year and kids’ doctors want to do something about it.

The American Academy of Pediatrics (AAP) came out with a strong new policy statement that urges policymakers to raise the minimum age people could buy nicotine products, be they cigarettes or e-cigarettes, to 21.

The public health benefits of barring people under age 21 from buying these products could be tremendous, including “4.2 million fewer years of life lost” among the next generation of American adults, according to a report released in March by the Institute of Medicine.

Setting a new minimum age nationwide, that study estimated, would result in nearly a quarter-million fewer premature deaths and 50,000 fewer deaths from lung cancer among people born between 2000 and 2019. Teenagers, especially those between ages 15 and 17, are most vulnerable to becoming addicted at a time when their brains are still developing.

The study, conducted at the request of the U.S. Food and Drug Administration, studied the predicted benefits of raising the minimum legal age for buying tobacco products — currently 18 in most states — to 19, 21, and 25 years. The greatest health benefits would actually come from raising the legal age even higher to 25, at which point the report estimates the prevalence of smokers among today’s teens, when they become adults, would decline by 16%.

The number of people who would not smoke if the age limit was raised to 21 is still significant. It’s estimated smoking rates would fall to 12%.

Even though fewer teenagers are using tobacco than ever before, more than half of current smokers say they started smoking before they were 18, studies show. And the number of teens who tried e-cigarettes and hookahs tripled in one year. The AAP policy statement urges the U.S. Federal Food and Drug Administration to regulate e-cigarettes and other electronic nicotine delivery systems the same as other tobacco products.

Chris Hansen of the American Cancer Society’s Cancer Action Network praised the study when it came out in March, saying “powerful interventions are needed to keep youth from lifelong addictions to these deadly products.”

The American Academy of Pediatrics issued a statement calling the report “a crucial contribution to the debate on tobacco access for young people.”

“There is no safe way to use tobacco,” said Dr. Sandra G. Hassink, the academy’s president.

The FDA cannot raise the age limit nationwide. The minimum age in four states is 19, and in several local jurisdictions including New York City have raised the legal age to 21.

Historically, the tobacco industry has called for “responsible” consumption of tobacco products.

Companies should create more child-resistant packaging to keep curious kids from drinking the liquid nicotine used in e-cigarettes, the AAP policy statement also said. In 2014, there were more than 3,000 e-cigarette calls to U.S. poison centers. As little as half a teaspoon can kill an average-size toddler, according to the AAP. Liquid nicotine is extremely toxic when ingested on its own.

“Tobacco is unique among consumer products in that it severely injures and kills when used exactly as intended,” states the AAP policy statement. “Protecting children from tobacco products is one of the most important things that a society can do to protect children’s health.”

http://www.cnn.com/2015/10/26/health/raise-minimum-smoking-age/

Patient-centered care helps patients overcome mental illness and tobacco use

By Chizimuzo Okoli, Contributing columnist, Lexington Herald-Leader

People diagnosed with chronic mental illness will die an average of 10 years earlier than those without mental illness.
A number of social and biological factors contribute to early mortality, but 40 percent of people with a mental health condition also practice one of the most preventable health risk behaviors — smoking.
A study from the National Institutes of Mental Health found that people with a mental illness smoke nearly half of all cigarettes in America. The Journal of the American Medical Association provided evidence that people with severe mental illness are at a higher risk of cardiovascular death. Depression is three times higher in smokers than in non-smokers, and an estimated 70 to 85 percent of people with schizophrenia are tobacco users.
Evidence supports a bi-directional relationship between tobacco use and depression. For some patients, smoking can alleviate pre-existing symptoms of depression and anxiety by releasing dopamine, a source of pleasure, in the brain. But evidence also suggests that smoking causes depression and other forms of psychosis, and some people with decreased dopamine levels are genetically predisposed to tobacco use and dependence.
Health care providers must address the patient’s tobacco use, a chronic addictive condition, in conjunction with the mental illness to preserve health. To accomplish this, we must:
Treat both conditions at once
Some evidence-based pharmacological methods are dually effective in treating tobacco use and mental illness. For one, bupropion hydrochloride has proven successful in reducing depression and serving as a smoking cessation aid.
Acknowledge the mental health effects of quitting
The decision to quit smoking benefits the patient in the long term, but nicotine withdrawal might exacerbate or lead to depressive symptoms. Patients must communicate with a health care provider about any side effects associated with quitting, such as depression. Patients can also participate in group therapies or meet with a counselor to mitigate the negative effects of quitting smoking.
Ensure that intervention is patient-centered
When patients give up smoking, they’re letting go of a coping mechanism or a companion. The patient should remain the central focus in any intervention, and providers should act with empathy and understanding, because quitting is a process requiring perseverance. A patient-centered plan should incorporate aids to quit smoking as well as mental health support and accessible resources.

Dr. Chizimuzo Okoli is an assistant professor in the UK College of Nursing.

http://www.kentucky.com/2015/10/24/4103534/patient-centered-care-helps-patients.html

The Hill: FDA sends e-cigarette regs to White House for review

By Lydia Wheeler
The Food and Drug Administration (FDA) has sent its final rule to regulate additional tobacco products, including electronic cigarettes and cigars, for White House review.
The rule, which was first proposed more than a year ago, was sent to the White House Office of Management and Budget’s Office of Information and Regulatory Affairs on Monday, but it could be weeks before the rule is actually released.
FDA spokesman Michael Felberbaum said the Office of Management and Budget is required to review all significant regulatory actions and has 90 calendar days to do so.
“However, this timeframe can be extended to allow for additional interagency discussion,” he said. “At this time, the FDA cannot provide any further comment until the final rule is published.”
The American Lung Association is hoping for an expedited review.
“We remain deeply troubled that it’s taken 18 months from the time the proposal was released to now,” said Erika Sward, the group’s assistant vice president of national advocacy. “We need to move forward in protecting kids and public heath.”
Sward said the lung association is hoping the final rule will give FDA the authority to truly regulate all tobacco products. Under the proposed rule, she said, there was a loophole for certain “premium” cigars.
“There’s no such thing as a safe tobacco product and certainly not a safe cigar,” she said. “FDA needs to have the basic authority over all tobacco products to make sure kids aren’t buying them and warning labels are required.”
http://thehill.com/regulation/pending-regs/257920-fdas-tobacco-deeming-rule-under-final-review

Stateline: Should the Smoking Age Be 21? Some Legislators Say Yes

By Jenni Bergal, Stateline | Pew Charitable Trust
While a growing number of states have turned their attention to marijuana legalization, another proposal has been quietly catching fire among some legislators—raising the legal age to buy cigarettes.
This summer, Hawaii became the first state to approve increasing the smoking age from 18 to 21 starting Jan 1. A similar measure passed the California Senate, but stalled in the Assembly. And nearly a dozen other states have considered bills this year to boost the legal age for buying tobacco products.
“It really is about good public health,” said Democratic Hawaii state Sen. Rosalyn Baker, who sponsored the legislation. “If you can keep individuals from beginning to smoke until they’re at least 21, then you have a much greater chance of them never becoming lifelong smokers.”
Supporters say hiking the legal age to 21 not only will save lives but will cut medical costs for states. But opponents say it would hurt small businesses, reduce tax revenue and violate the personal freedom of young adults who are legally able to vote and join the military.
Measures to raise the smoking age to 21 also were introduced this year in Massachusetts, New York, Oregon, Rhode Island, Utah, Vermont, Washington and the District of Columbia, according to the Preventing Tobacco Addiction Foundation, an advocacy group aimed at keeping young people from starting to smoke. Iowa and Texas considered measures to increase the legal age to 19. None of those bills passed. And just last week, a Pennsylvania legislator introduced a bill to up the minimum age there to 21.

Cities Act First

In almost every state, the legal age to buy tobacco products is 18. Four states—Alabama, Alaska, New Jersey and Utah—have set the minimum at 19.
Anti-tobacco and health care advocates say that hiking the smoking age to 21 is a fairly new approach in their effort to reduce young people’s tobacco use. Until recently, research on the topic has been somewhat limited, they say.
That hasn’t stopped a growing number of local governments from taking action on their own in the last few years. As of late September, at least 94 cities and counties, including New York City, Evanston, Illinois, and Columbia, Missouri, had passed measures raising the smoking age to 21, according to the Campaign for Tobacco-Free Kids, an advocacy group that promotes reducing tobacco use.
One of those communities is Hawaii County, the so-called “Big Island” of Hawaii, where the law changed last year after a grassroots effort by health care advocates, anti-smoking groups and local high school students. That coalition, joined by teens from across Hawaii, continued its fight at the state level, and legislators heard the message, said Sen. Baker, whose bill also included e-cigarettes, battery-powered devices that deliver vaporized nicotine, which have become popular among young people.
Supporters of raising the smoking age to 21 say that a turning point was a March report by the Institute of Medicine, the health arm of the National Academies of Sciences, Engineering and Medicine, which predicted that raising the age to 21 would cut smoking by 12 percent by the time today’s teenagers are adults. It also would result in about 223,000 fewer premature deaths.
The institute’s report also supported health care advocates’ argument that preventing or delaying teens and young adults from experimenting with smoking would stop many of them from ever taking up the habit. About 90 percent of adults who become daily smokers say they started before they were 19, according to the report.
“Raising the age to 21 will keep tobacco out of high schools, where younger kids often get it from older students,” said John Schachter, state communications director for the Campaign for Tobacco-Free Kids. “If you can cut that pipeline off, you’re making great strides.”
California state Sen. Ed Hernandez, a Democrat who sponsored a measure to raise the smoking age, said it’s good public policy.
“If we make it a law to drive with your seatbelt on to protect the consumer, or to require helmets for people on motorcycles, why can’t we raise the smoking age to protect young adults from becoming addicted to tobacco?” he said.
Supporters also point out that 21 became the national legal drinking age after President Ronald Reagan signed legislation in 1984 that forced states to comply or risk losing millions of dollars in federal highway funds. That has resulted in reduced alcohol consumption among young people and fewer alcohol-related crashes, national studies have found.
“President Reagan thought young people were not ready to make this decision to drink or to drink and drive before they turned 21,” said Rob Crane, president of the Preventing Tobacco Addiction Foundation. “Smoking kills more than six times as many people as drinking.”

Personal Choice

Opponents say that raising the smoking age to 21 would have negative consequences for businesses, taxpayers, and 18-year-olds who should be free to make a personal choice about whether they want to smoke.
Smokers’ rights groups, retailers and veterans’ organizations are among those who’ve opposed such legislation.
“If you’re old enough to fight and die for your country at age 18, you ought to be able to make the choice of whether you want to purchase a legal product or not,” said Pete Conaty, a lobbyist for numerous veterans groups who testified against the California bill. “You could enlist in the military, go to six months of training, be sent over to Iraq or Afghanistan and come back at age 19½ to California and not be able to buy a cigarette. It just doesn’t seem fair.”
Opponents say it’s wrong to compare cigarettes with alcohol. “If you smoke one or two cigarettes and get behind the wheel of a car, you’re not driving impaired,” Conaty said.
Opponents also say taxpayers would take a financial hit if the smoking age is raised because it would mean less revenue from cigarette taxes.
In New Jersey, where a bill to hike the smoking age to 21 passed the Senate last year and remains in an Assembly committee, a legislative agency estimated that tax revenue would be reduced by about $19 million a year.
In California, a fiscal analysis by the Senate appropriations committee estimated that raising the age to 21 would cut tobacco and sales tax revenue by $68 million a year. That would be offset by what the analysis said could be “significant” health care cost savings to taxpayers—reaching as much as $2 billion a year.
Stores that sell tobacco products and e-cigarettes also fear the effect. The Hawaii Chamber of Commerce opposed the measure there.  And Bill Dombrowski, president of the California Retailers Association, suggested that raising the smoking age would simply drive young people to the black market.
“If you raise the age, people under 21 will find the cigarettes somewhere else,” he said.

Health Care Savings

Cigarette smoking is the leading cause of preventable death in the U.S. and is responsible for more than 480,000 deaths a year, according to a 2014 U.S. Surgeon General report, which said the direct medical costs of smoking are at least $130 billion a year.
Supporters of the 21 smoking age say that the savings in health care costs, especially through Medicaid, the federal-state health insurance program for the poor and disabled, will far outweigh any loss in tax revenue for states.
Schachter and other advocates say Hawaii’s action, along with that of dozens of cities, will help spark legislation in other states and create a new standard for when young people take their first puff.
“There is momentum on this issue, and I think you’re going to see more and more states and cities moving in that direction,” Schachter said.
http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/10/14/should-the-smoking-age-be-21-some-legislators-say-yes