Friday, June 14, 2019

Common Sense Legislation Would Limit Teen Tobacco Access

Senate Majority Leader Mitch McConnell recently introduced legislation to make 21 the legal age for tobacco sales nationwide.  As he elevated the Tobacco 21 debate to the national stage, McConnell said that stemming teenage vaping was a primary objective.

There is no question that vaping is on the rise among teens, but the Food and Drug Administration and other federal agencies have miscast the situation, labeling it an epidemic to provide a rationale for excessive regulations.  Regardless, McConnell’s championing of Tobacco 21 is appropriate, as it would delegitimize tobacco sales to 18-year-old high school students.  While those youths comprise 16% of all high school students, they account for one-quarter of high school smokers and smoker-vapers.    

FDA survey data shows that more than 90 percent of teens who use tobacco products obtain them from social sources.  The Population Assessment of Tobacco and Health (PATH) survey collects detailed information about teen tobacco use. It reveals that fewer than 10 percent of current teen e-cigarette users – defined broadly as having taken at least one puff in the past 30 days – “bought them myself.” While the FDA and other government agencies target retailers, the vast majority of underage teens get e-cigarettes from their friends and relatives.  These sources can’t be regulated.

The Tobacco 21 debate was reignited recently by a proposed FDA rule requiring retailers to have a separate room for flavored e-cigarette products, accessible only to purchasers of legal age.  This is a nearly impossible requirement for convenience, grocery and drug stores.  The rule might be met by vape and tobacco shops, but that won’t solve the problem. According to a recent study, teens purchased vapor products most frequently online (32%) and from vape (22%) and tobacco (16%) shops.  Convenience, gas and liquor store purchases were less frequent (5.6%), as were grocery, drug and other stores (2.2%).  Thus, the proposed rule would have no impact on the most common sources of teen purchases, but it would likely eliminate vapor sales at stores where teens aren’t buying products.  This would be government regulation at its worst. 

While the FDA obsesses over brick-and-mortar retailers, Congress should immediately address online vapor sales.  The 2009 Prevent All Cigarette Trafficking (PACT) Act required online purchasers of cigarettes and smokeless tobacco products to provide proper identification at the point of delivery.  However, the law doesn’t cover e-cigarettes, an omission that would be corrected by the recently introduced Preventing Online Sales of E-Cigarettes to Children Act

Tackling teen smoking and vaping at the federal level is important.  Passing Tobacco 21 and updating the PACT Act to include e-cigarettes are two easily achievable legislative actions that will be far more successful in decreasing underage teen tobacco use than ill-conceived new restrictions and regulations impacting adult access to e-cigarettes.

Wednesday, June 5, 2019

How Big Is the So-Called Teen Vaping Epidemic?

Federal authorities insist upon the existence of a teen vaping epidemic, based on results of the 2018 National Youth Tobacco Survey (NYTS).  They claim that current (past-30-day) use of e-cigarettes surged 78% in 2018, resulting in over three million high school vapers.  

Federal officials ignore two other 2018 estimates from a commercial online panel that are representative of the U.S. population.   It’s called KnowledgePanel, and it’s a product of the German firm GfK (Growth from Knowledge).  While both of these published studies focus on JUUL use, I will examine only their e-cigarette estimates.

The first KnowledgePanel survey was analyzed by Donna Vallone and colleagues at the Truth Initiative, a rabidly anti-tobacco non-profit organization.  I have previously detailed major technical problems with their Juul results, and noted that the authors refused to respond to my questions in a professional forum.  However, it is unlikely that Dr. Vallone underestimated the prevalence of current e-cigarette use, which she reported as 11% among 15-17 year-olds in 2018.

The second KnowledgePanel survey was analyzed by Neil McKeganey and Christopher Russell at the Centre for Substance Use Research in the U.K.  Under contract with JUUL Labs to research the population impact of e-cigarettes, they recently published a study in the American Journal of Health Behavior reporting that current vaping among 15-17 year-olds in the U.S. was 8.7% in 2018.

The chart above presents the prevalence and population estimates from these three surveys.  In summary, the epidemic of vaping among 15-17 year-olds in 2018 involved either 2.3 million, 1.2 million or 952,000 youths.

Federal officials, politicians and tobacco prohibitionists are calling for drastic measures to curtail a teen vaping epidemic.  Their first priority should be to produce accurate estimates justifying both the existence of such an epidemic and any remedial program.

Thursday, May 30, 2019

Tackling Tobacco 21 Objections

In his recent commentary, Ramesh Ponnuru asserts that “there’s no…justification [unlike alcohol] for raising the age to buy tobacco products” from 18 to 21.  While more thoughtful than some opponents, Ponnuru echoes a familiar refrain: “If you’re old enough to vote, serve on a jury, marry or fight in a war, you should be considered old enough to light up, too.”

The logic of this argument quickly fails under examination.

While one may cherish voting or marriage, they are still considered privileges that are subject to qualifications.  One of these is age, which is not permanently set in stone but determined by historical and cultural customs.  For example, the Preventing Tobacco Addiction Foundation notes that “For 600 years of English common law and throughout most of U.S. legal history, the age of 21 was regarded as the age of full adult status.”  Serving on a jury is required by law (Title 28, U.S. Code, Sections 1861-1878), and as such, the current age of 18 years is subject to revision. 

The most common objection to both Alcohol and Tobacco 21 contrasts eligibility for military service at age 18 with prohibition of drinking or smoking.  This argument is meaningful only if military service is compulsory, a policy that ended in 1973.  Eighteen-year-old men and women may choose to join the armed forces, but that choice is unrelated to the privilege of being able to purchase and consume alcohol or tobacco, unless society decides otherwise.

Fourteen states have raised the age of tobacco sales to 21 years, and there are bipartisan bills in the U.S. Congress that would make Tobacco 21 the law of the land. 
In his commentary, Ponnuru enumerates the reasons for Tobacco 21: delay or reduce tobacco uptake; reduce smoking-related health effects, medical care and insurance costs; and achieve other so-called paternalistic objectives.  But Ponnuru omits the most direct and compelling reason to enact Tobacco 21: to delegitimize tobacco sales to 18-year-old high school students.  In 2018, 16% of all high school students could legally purchase tobacco, and they accounted for one-quarter of high school smokers and smoker-vapers (here).  Government survey data confirms that legal buyers – not manufacturers or retailers – are the primary source for tobacco products used by underage high schoolers (here).

Complaints about paternalism as the rationale for Tobacco 21 are irrelevant.  Tobacco 21 simply provides the best opportunity to defeat the informal black market that supplies tobacco products to the nation’s underage high school students. 

Ponnuru objects that Tobacco 21 advocates “don’t provide any good reason to treat young adults as though they were minors.”  But there is one very good reason: to be treated as an adult, one must act responsibly with respect to children.  Those high schoolers who are the primary suppliers of tobacco to their underage friends are clearly acting irresponsibly.  This is a compelling justification for Tobacco 21.