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Wahpeton Daily News: Study: More nicotine found in smokeless tobacco

By Carrie McDermott • Daily News

Users of smokeless tobacco are exposed to equal or higher levels of nicotine and NNK, a cancer-causing chemical in tobacco products, than cigarette smokers, according to a study from the federal government.
Researchers from the Food and Drug Administration and the Centers for Disease Control and Prevention say more data is needed on the toxic components of smokeless tobacco products and the health of those who use them.
In the study, researchers analyzed information from more than 23,000 participants in national health surveys between 1999 and 2012. They looked for markers used to measure the addictive stimulant nicotine and cancer-causing NNK from blood and urine samples. They found the level of cotinine, the marker for nicotine exposure, to be .043 nanograms/milliliter in nonsmokers compared to 180 ng/ml among smokeless tobacco users, about 131 ng/ml in cigarette users and 184 ng/ml among people who used both smokeless tobacco and cigarettes.

Jason McCoy, tobacco prevention coordinator at PartnerSHIP 4 Health in Moorhead, Minnesota, said he’s eager to get this surprising information out to the public.
“We know that in rural parts of the state, one in 10 young white men, basically high school boys, are using Snus and chewing tobacco, thinking it’s less dangerous than smoking,” he said.
He said the only difference is when they use chewing tobacco, they aren’t affecting others with secondhand smoke.
“The individual is potentially damaging themselves more,” he said. “It’s surprising.”
And many young smokeless tobacco users are choosing flavored products, which make it more attractive.
“This ties into other research we have that shows flavored tobacco is viewed, in self reports by teens, as less addictive than regular tobacco,” McCoy said. “On the other end, we know the flavoring makes it more addictive. The part of the brain that ties into the flavor of the product, similar to why you may like Coke over Pepsi, it’s the same triggering mechanism that happens. The flavor gets assigned in your brain along with the nicotine.”
McCoy works with four counties — Becker, Clay, Otter Tail and Wilkin — and gets reports showing that often high school athletes know they don’t want to smoke because of the smell, so they choose smokeless tobacco, also thinking it won’t affect their athletic performance.
“We know that short term, it’s going to cause gum disease and tooth decay, long term, possible mouth, throat and stomach cancers,” he said. “It’s every bit as dangerous as cigarettes.”
He said he’s been told by teachers that students are taking the Ice Breakers mints and filling those containers with Snus, so they can surreptitiously carry the smokeless tobacco around with them.
“When they open it up, it just looks like they’re getting a mint,” he said.
About 3.6 percent of Minnesotans regularly use smokeless tobacco, according to the latest Minnesota Adult Tobacco survey.
For those wanting to quit their nicotine use, the state of Minnesota offers QUITPLAN which provides proven methods of quitting successfully. The program offers phone counseling and nicotine replacement tools at no cost. To find out more, visit www.quitplan.com or call 1-888-354-7526.
http://www.wahpetondailynews.com/news/study-more-nicotine-found-in-smokeless-tobacco/article_a81d5b36-9a9f-11e5-9849-3facbacf33f9.html

Healthline News: Teen E-Cigarette Use Linked to Breathing Problems

A study of adolescents in Hong Kong found respiratory issues were 30 percent more likely in vapers than non-vapers.
Written by Roberta Alexander

E-cigarettes and vaporizers, widely touted as a way to quit smoking, remain controversial. For every supporter who sees them as useful, there is a health expert suggesting that these products are dangerous in their own way.
A new study out of Hong Kong is not likely to settle the issue any time soon.
Researchers looked at the respiratory health of Chinese adolescents, both those who use e-cigarettes and those who do not. The results, published in JAMA Pediatrics, have raised concerns about the impact of e-cigarettes on the health of minors.

Ecig Teen
Indeed, one of the authors of the study, Daniel Ho, Ph.D., of the University of Hong Kong, said in a press release, “E-cigarettes are certainly not harmless and serious health problems of long-term use will probably emerge with time.”
Ho is an associate professor in the School of Public Health whose main research interests are in adolescent health in relation to tobacco, alcohol, and obesity.
He and fellow researchers found that adolescents who use e-cigarettes were approximately 30 percent more likely to report respiratory symptoms than adolescents who do not use them.

Thousands of Students Studied

More than 45,000 students in Hong Kong participated in the study. Data was collected between 2012 and 2013.
Of the sample population, 1.1 percent of students reported e-cigarette use within the past 30 days. Those students were 30 percent more likely than their peers to report respiratory problems.
The results are suggestive but not definitive. Dr. Norman H. Edelman, senior consultant for scientific affairs for the American Lung Association, found the study intriguing.
“It’s important [but] we need to know if the lungs are injured. It’s not clear if this really affects the lungs. We’re not sure what the symptoms are,” Edelman told Healthline.
He wondered if the young subjects were reporting soreness in their throats, excessive coughing, or difficulty breathing. He would like to see a follow-up study, perhaps in the United States.
“We need to do lung function tests,” he said.
“Whenever you breathe in something, you don’t know what’s in it. Some of the data suggest irritation,” Edelman said. “We don’t know what the negative effects are. This is just a beginning.”
E-cigarettes and vaporizers use liquids that have varying amounts of nicotine or none at all. These liquids are not regulated by the U.S. Food and Drug Administration (FDA), but generally also contain propylene glycol, a suspected lung irritant, and vegetable glycerin.
“While supporters [of e-cigarette use] are optimistic about the potential for harm reduction in the minority of established cigarette smokers, [for] which convincing evidence is lacking, this does not seem to justify the potential harm of renormalizing cigarette smoking, delaying smoking cessation, and escalating to real cigarette smoking, especially among the majority of non-smoking young people,” Edelman said.

E-Cigarettes Gaining in Popularity

The use of e-cigarettes have surpassed the use of conventional cigarettes among young people in the United States.

Mitch Zeller, director of the Center for Tobacco Products at the FDA, called those numbers “astounding and concerning” in an interview earlier this year.
“Nicotine is very harmful to the developing child and adolescent brain,” Zeller said. “Parents should take no comfort in the fact that their kids are using an e-cigarette rather than a burning cigarette because of the presence of nicotine.”
http://www.healthline.com/health-news/teen-e-cigarrette-use-linked-to-breathing-problems-111715#1

Reuters Health: Adolescent e-cigarette use tied to breathing problems

BY ANDREW M. SEAMAN
Adolescents who reported using e-cigarettes were about 30 percent more likely to report respiratory symptoms than those who never used e-cigarettes, in a study from China.
The increased risk of breathing problems – like a cough or phlegm – varied depending on whether or not the adolescents also smoked traditional cigarettes.
“Among never smoking adolescents, e-cigarette users are twice as likely to report respiratory symptoms than non-users,” study author Dr. Daniel Ho, of the University of Hong Kong School of Public Health.
 
“E-cigarettes are certainly not harmless and serious health problems of long-term use will probably emerge with time,” Ho added in an email to Reuters Health.
E-cigarettes deliver nicotine through a vapor, which contains propylene glycol and flavoring chemicals known to be bothersome to the respiratory system, the researchers write in JAMA Pediatrics.
While past research found some short-term respiratory effects in adults after e-cigarette use, the researchers say no study had looked for these effects in adolescents.
The new findings are drawn from data collected between 2012 and 2013 from over 45,000 schoolchildren in Hong Kong with an average age of about 15.
Overall, 1.1 percent of students reported smoking e-cigarettes within the past 30 days, and about 19 percent of all students reported respiratory symptoms.
Students who smoked e-cigarettes were 30 percent more likely to report breathing problems, compared to those who didn’t use the devices.
The difference in breathing problems was most pronounced among students who said they never smoked traditional cigarettes. These students were over twice as likely to report breathing problems as those who didn’t use e-cigarettes.
Students who reported using e-cigarettes and also smoking traditional cigarettes at some point in their lives were at a 40 percent increased risk of breathing problems, compared to those who didn’t use the devices.
While the study can’t prove the devices caused breathing problems among children, the researchers say the findings support the World Health Organization’s recommendation to regulate e-cigarette use among children.
“Other studies have also shown that adolescent e-cigarette users are more likely to initiate cigarette smoking than non-users,” Ho said. “One in two smokers will be killed by tobacco; two in three if started from a young age.”
Parents, he said, can prevent e-cigarette and traditional cigarette use among their children by not using the devices or tobacco, not exposing their children to secondhand smoke and setting strict smoke-free rules at home.
“E-cigarette use is a controversial topic,” Ho said. “While supporters are optimistic about the potential for harm reduction in the minority of established cigarette smokers, (for) which convincing evidence is lacking, this does not seem to justify the potential harm of re-normalizing cigarette smoking, delaying smoking cessation, and escalating to real cigarette smoking, especially among the majority non-smoking young people.”
http://www.reuters.com/article/2015/11/09/us-health-ecigarettes-adolescents-breath-idUSKCN0SY22Y20151109#UoWlC6rr1iRdS4YY.99

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

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/

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