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.  

Wednesday, May 22, 2019

Tobacco 21 is Unstoppable, But U-Turns Are Unacceptable

Last week the Inside Sources published my commentary on Tobacco 21.  Read it here or on the Inside Sources website.

Walmart added momentum to the Tobacco 21 movement by announcing on May 8 that it would raise the minimum age for tobacco sales in July.  So far this year the number of T-21 states has doubled to twelve, and Senate Majority Leader Mitch McConnell has called for congressional action to implement the policy across the U.S.

However, everyone is not in favor of curbing underage access, sort of.  Anti-tobacco crusaders who campaigned for years to increase the legal age for tobacco purchases made a sudden U-turn, calling T-21 a Trojan horse for the tobacco industry.

The T-21 turnaround has been seen multiple times in state legislative battles across the country. In fact, it’s clear that some anti-vaping crusaders never really cared about changing age restrictions as a means of keeping e-cigarettes out of the hands of underage users; rather, as soon as there’s an opportunity to enact a T-21 law, they tack to opposition, pushing for even more extensive controls like flavor bans and increased taxes.

Crusaders trade on fear, not facts. The facts tell us that smoking continues to kill nearly 500,000 Americans each year, according to the Centers for Disease Control. E-cigarettes and other non-combustible alternatives may not be perfect, but researchers now consider vaping to be 95 percent safer than smoking. E-cigarettes provide a safer alternative for adult smokers and science shows that e-cigarettes are more effective at helping smokers quit than other nicotine replacement therapies.

Still, there has been a rise in teen vaping. And while e-cigarettes are a better alternative for adult smokers, we don’t want a new generation getting hooked on nicotine unnecessarily. That’s why, just last week a bipartisan Tobacco 21 bill was announced by U.S. Senators Brian Schatz (D-HI), Todd Young (R-IN), Dick Durbin (D-IL), and Mitt Romney (R-Utah).

But this isn’t a partisan issue. Many organizations, such as the American Cancer Society, the American Heart Association, and the Campaign For Tobacco-Free Kids support the new legislation. These groups had originally endorsed Tobacco 21, then opposed it in several states, and now support it again.

Some anti-tobacco crusaders, however, continue to swim against the current, now insisting that Tobacco 21 legislation is a farce. Ohio State Professor Robert Crane, president of the Preventing Tobacco Addiction Foundation, said of the federal Tobacco 21 bill, “the hair on the back of my neck stood up and I said, ‘This is really terrible.’” Ironic, since Dr. Crane’s foundation hosts the Tobacco 21 advocacy website with a long list of major medical organization endorsements.

Prohibitionists ostensibly support Tobacco 21, but they are capitalizing on the visibility McConnell brings to the issue to launch a thinly veiled attack on all safer products, even those still blocked by the FDA. IQOS, Philip Morris International’s new heat-not-burn product, has been available in 45 countries and has decimated cigarette sales in Japan, but the FDA just got around to approving it last week (after two years, or 1 million smoker deaths). We’re still waiting to see if the FDA acknowledges the unanimous findings of its scientific advisory committee and allows PMI to market IQOS as less harmful and likely to reduce risk of disease.

U.S. cigarette sales are declining as the market develops safer, satisfying alternative products.  But this is what is driving crusading prohibitionists crazy. For decades, they invoked burdensome legislation, litigation, taxation and regulation that failed to curtail the annual toll of dead smokers. Now, despite their latest efforts to promote the exaggerated, distorted and even imaginary dangers of e-cigarettes and teen epidemics, vapor products have become the most popular and most effective quitting aids for American smokers. 

The fact is that while smoke routinely kills, tobacco and nicotine rarely do. Instead of supporting safer, smoke-free cigarette substitutes that help smokers step away from the fire, anti-tobacco crusaders promote policies that sustain the cigarette market, and its deadly consequences. 

We have to keep all tobacco products away from underage teens while providing vastly safer smoke-free cigarette substitutes to their parents and grandparents. Tobacco 21 will help accomplish both of these public health priorities.



Thursday, May 16, 2019

The 2018 American Teen Vaping Epidemic, Recalculated


Former FDA Commissioner Scott Gottlieb and other government officials have repeatedly asserted that the U.S. is in the midst of a teen vaping epidemic (example here).  Their claim is based on last year’s National Youth Tobacco Survey, the full contents of which was finally released six weeks ago by the Centers for Disease Control and Prevention.  With that data in hand, I have confirmed some of the assertions made by anti-vapers but easily put the lie to others (here).

Federal officials claim there were over three million high school vapers in 2018.  Let’s take a look at the actual numbers.  Each table below lists the number of high school students who used e-cigarettes 0, 1-5, 6-19 or 20-30 days in the past month, according to whether they were underage or of legal age (18+ years).   

Table 1 shows that 3.13 million high schoolers vaped, with 877,500 using the products 20-30 days in the past month.


Table 1. Number of High School Students in 2018 Who Vaped in the Past Month, According to Age




Days VapedLess than 18 years18+ yearsAll




1-51,303,366200,2641,503,630
6-19602,392150,841753,233
20-30630,490247,000877,490




All2,536,248598,1053,143,353


Next, let’s remove any high school students who ever tried CIGARETTE SMOKING.  As shown in Table 2, that leaves 1.36 million, with 198,000 using the products 20-30 days in the past month.


Table 2. Number of High School Students in 2018 Who Vaped in the Past Month But Never Tried Cigarette Smoking, According to Age




Days VapedLess than 18 years18+ yearsAll




1-5762,02392,035854,058
6-19259,45043,231302,681
20-30151,17647,150198,326




All1,172,649182,4161,355,065


Removing students who ever tried CIGARS, the total drops to 978,000, with 132,500 using the products 20-30 days in the past month (Table 3).


Table 3. Number of High School Students in 2018 Who Vaped in the Past Month But Never Tried Cigarette or Cigar Smoking, According to Age




Days VapedLess than 18 years18+ yearsAll




1-5607,89450,784658,678
6-19163,69922,841186,540
20-30109,12323,392132,515




All880,71697,017977,703


Finally, subtracting students who ever tried SMOKELESS TOBACCO, Table 4 reveals that the vaping epidemic consists of 897,000 individuals, with 116,000 using the products 20-30 days in the past month.  Of those, 95,316 were underage.


Table 3. Number of High School Students in 2018 Who Vaped in the Past Month But Never Tried Cigarette or Cigar Smoking or Smokeless Tobacco, According to Age




Days VapedLess than 18 years18+ yearsAll




1-5572,09147,539619,630
6-19139,88120,942160,823
20-3095,31621,053116,369




All807,28889,534896,822


For comparison, I conducted the same analysis on the 2017 NYTS, which yielded 26,660 underage teens who vaped 20-30 days in the past month but never used other products.  That was less than 0.2% of all high school students. 

It is true that frequent vaping among underage high school teens increased substantially from 26,660 in 2017 to 95,316 in 2018.  These numbers translate into an increase from less than 0.2 to 0.6% of all high school students.

In summary, the oft-cited teen vaping epidemic involves not three million youths, but rather 95,000 underage teens who vaped frequently but never used other tobacco products – or 0.6% of the nation’s 14.8 million high school students.