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USA Today Editorial Board: Raise cigarette sales age and see: Our view

The Editorial Board

When California lawmakers voted this month to raise the legal age to buy cigarettes from 18 to 21, they joined Hawaii and more than 100 localities in seeking a new way to prevent vulnerable teenagers from getting hooked.

Almost everyone who smokes started by age 18, research shows. The tobacco industry, among the world’s slickest marketers, has known and used that fact to its benefit for decades. “Raising the legal minimum age for cigarette purchaser to 21 could gut our key young adult market (17-20) where we sell about 25 billion cigarettes,” a Phillip Morris report noted in 1986.

This suggests that raising the age is worth a try. Gov. Jerry Brown, D-Calif., ought to sign the measure, and careful study is warranted to find out to what degree the change  affects teen smoking.

Parents and public health advocates shouldn’t get their hopes too high. Teenage behavior is unpredictable and resourceful; many teens use fake IDs to buy alcohol and no doubt would do the same for tobacco. But unless a few states make the change, the value can’t be calculated. Right now, all but five states set the legal purchase age at 18. In Alabama, Alaska, New Jersey and Utah, it is 19. Hawaii went to 21 on Jan. 1.

Although smoking rates among high school seniors have fallen drastically, from 33.5% in 1995 to 11.4% last year, that still leaves millions of adolescents addicted and vulnerable in later years to cancer, heart disease and premature death. Raising taxes, running anti-smoking ad campaigns, and making smoking less cool  have worked, but more is needed.

Last year, the respected Institute of Medicine projected that if the legal age were raised to 21, by the time today’s teenagers became adults smoking prevalence would be cut by 12%. The greatest impact, the IOM found, would likely be among teens 15 to 17. Meanwhile, other avenues of getting cigarettes are drying up: Vending machines have all but vanished, and less than 10% of stores sell illegally to minors.

Plenty of reasons exist to try to cut further into youth smoking. Nicotine exposure during adolescence is likely to adversely affect cognitive function and development. Adolescents are more prone to addiction than adults because parts of the brain most responsible for decision-making, impulse control and susceptibility to peer pressure are still developing. As for the health effects, the risks for smoking-related illness rise not only with the number of cigarettes smoked per day but also with the number of years a person smokes.

The most persistent argument against raising the age is that at 18, people have the right to marry, to vote and to serve in the military, so they should be able to choose to smoke. But society does set 21 as the age for another dangerous activity, drinking alcohol — a change that has prevented about 900 drunken driving deaths per year. Smoking is the public’s business, too: Everyone helps pick up the tab for the enormous health care costs of tobacco-related illnesses.

In Finland, daily smoking dropped significantly among 14- to 16-year-olds after the legal age was raised from 16 to 18 and enforcement was bolstered. There’s no comparable research in the United States, which is precisely the point. Given the tobacco industry’s success in getting young people hooked, teenagers deserve to find out whether the U.S. has been missing a powerful tool to save their lives.

USA TODAY’s editorial opinions are decided by its Editorial Board, separate from the news staff. Most editorials are coupled with an opposing view — a unique USA TODAY feature.

http://www.usatoday.com/story/opinion/2016/03/21/cigarettes-21-sales-age-california-hawaii-editorials-debates/81730332/

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/

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

HealthlineNews: Is 18 Too Young to Buy Tobacco Products? Some States Think So.

California is on the verge of joining other states in raising the minimum age to purchase tobacco, sparking more debate about what privileges and responsibilities fall on young adults.

How old should you be to purchase tobacco?

Some legislative leaders in the United States apparently think 18 is too young.

On Friday, Hawaii’s governor signed a bill raising the minimum age to buy tobacco to 21. The law takes effect next year.

Four states — Alabama, Alaska, New Jersey, and Utah — have raised the minimum age to buy tobacco to 19, while some local municipalities have raised it to 21.

And, earlier this month, the California State Senate overwhelmingly voted to increase the age at which a person can buy tobacco products from 18 to 21. The bill still needs Assembly approval and the governor’s signature.

The goal is to further limit access to tobacco products to young smokers. The move is backed by several health groups, including the American Cancer Society and the California Medical Association.

Dr. Jack Jacoub, an oncologist and director of thoracic oncology at the Memorial Care Cancer Institute at Orange Coast Memorial Medical Center in Fountain Valley, California, says with decades of data available, it’s clear the age increase is a sound move to prevent people from starting lifelong habits.

“It’s still a risk factor for a host of different cancers, not just lung cancer,” he said. “If you separate the legal aspect of it, it makes the most sense to raise the minimum age to 21.”

A Measure Aimed at Delaying the Start

A study by the Institute of Medicine (IOM) published in March found that increasing the minimum legal age to 21 would likely prevent or delay when people would begin smoking, specifically children aged 15 to 17.

About 90 percent of smokers now start before 19 years old, so the argument is the 21-year minimum would reduce teens’ access to tobacco because it’s unlikely they would be in the same social circle as people old enough to purchase tobacco.

The U.S. Food and Drug Administration (FDA) doesn’t have the authority to raise the legal smoking age to 21, so it’s an issue that must be dealt with at the state level. The federal government, however, does have a law that withholds federal highway funds to states that don’t have their minimum drinking age at 21.

The town of Needham, Massachusetts, raised its smoking age to 21 in 2005. Over the next decade, teenage rates of smoking dropped from 13 to 7 percent, according to the Education Development Center, which conducted the study.

In California, smoking has been banned in enclosed workspaces since 1995, and smoking in a vehicle with a minor has been illegal since 2008. This was done to prevent exposure to secondhand smoke, but the new proposed law would affect young smokers directly.

“The group where smokers usually start is the highest impact group,” Jacoub said. “I don’t know of anyone who would be against it.”

A handful of trade groups, such as the Cigar Association of America and the California Retailers Association, oppose the change on the grounds that Americans are considered adults under the eyes of the law, so that’s also when they should have the right to make their own decisions.

Personal choice is the crux of the argument the tobacco industry uses when opposing stricter legislation.

This new legislation has lit up an ongoing debate over when a person is considered a legal adult and what that entails.

When Are Americans Adults?

When the federal drinking age was pushed back from 18 to 21 in 1984, it was backed by health concerns, mainly the high rate at which minors were being killed in traffic accidents while under the influence.

Research shows the parts of the brain most responsible for decision-making, impulse control, sensation seeking, and susceptibility to peer pressure are still developing and changing between the ages of 18 and 21. The IOM study notes, “Adolescent brains are uniquely vulnerable to the effects of nicotine.”

Jamie Miller, a political consultant and e-cigarette lobbyist from Florida, likened the California legislation to the change in voting age in 1971 when young men were being drafted to serve in Vietnam.

The thought was that men and women old enough to serve in the armed forces should be able to vote for the people who decide to go to war.

“We’re looking at the unintended consequences of passing laws under public pressure at the moment. I personally believe we, as a society, made a mistake when we changed the Constitution to allow those who are 18 to vote just so we could draft those who are 18,” he said.

Saying he believes the fewer people who have access to addictive substances the better, Miller also says there needs to be some kind of uniformity to when young people are considered adults.

“If the age to drink and smoke is 21, we should change the draft and voting age to 21 as well,” he said. “In other words, full, legal adulthood would be 21.”

http://www.healthline.com/health-news/some-states-think-18-is-too-young-to-buy-tobacco-products-062015#5

Fargo Forum: Anti-tobacco groups eye raising purchasing age to 21 in Minnesota

By Patrick Springer

MOORHEAD – Minnesota tobacco control advocates may propose raising the legal age for buying cigarettes to 21 years old.
Hawaii, New York City and more than 30 municipalities in Massachusetts have raised the legal age for buying tobacco, and the experiment will be closely watched, said Andrea Mowery, vice president of ClearWay Minnesota, a foundation that promotes prevention and cessation of smoking and tobacco use.
ClearWay Minnesota, funded by the state’s share of the 1998 tobacco settlement, will only move ahead with a proposal if a wide consensus of health groups and public health groups agree the approach has merit, Mowery told The Forum editorial board.
“We’re part of a broad coalition,” she said, and listed the American Cancer Society, American Lung Association and American Heart Association as frequent partners. “There’s a very collegial and collaborative process.”
More than 9 of every 10 smokers start before the age of 19 or 20, a reality that is behind the nascent movement to raise the legal age for buying tobacco, Mowery said.
Earlier efforts, which public health officials credit with reducing smoking rates, have centered on raising tobacco taxes and banning smoking in public places.
Teenagers are especially sensitive to price increases spurred by tax increases, which have been shown to be the most effective means to date of curbing youth smoking, Mowery said.
“Youth and young adults are much more sensitive to price,” she said.
Smoking prevalence continues to decline in Minnesota, where the smoking rate stood at 14.4 percent last year, down 35 percent since 1999 and the lowest rate ever recorded, according to the Minnesota Adult Tobacco Survey in 2014.
“So really significant progress,” Mowery said.
The national adult smoking rate is 19 percent. In North Dakota, the adult smoking rate was 21.9 percent in 2011, according to the Centers for Disease Control.
Persistent gaps remain in smoking rates, with those who have less than a high-school education the most likely to smoke, with a rate of 28.6 percent.
Young adult smoking decreased by 6.4 percentage points over the past four years, dropping to 15.3 percent from 21.8 percent, the only noteworthy decline for any age group.
“That is quite a stark departure,” Mowery said.
But that drop coincided with a sharp spike in the use of e-cigarettes, which jumped from a rate of 0.7 percent to 5.9 percent from 2010 to 2014.
The age group most likely to smoke is the 25- to 44-year-old bracket, with a rate of 19.7 percent for men and 18.7 percent for women.
American Indians smoke at a rate that far surpasses the overall population—a rate of 59 percent, quadruple the 14.4 percent overall rate.
“On the whole we’re making good progress,” Mowery said, adding that challenges remain.
http://www.inforum.com/news/3748538-anti-tobacco-groups-eye-raising-purchasing-age-21-minnesota