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.  

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.

The American Cancer Society: For and Against Tobacco 21

My op-ed about Virginia’s adoption of Tobacco 21 was published in the Richmond Times-Dispatch (available at Richmond.com here and below).  As I have documented before (here), the American Cancer Society is out of touch with American smokers and their need for reasonable and rational ways to quit.  Further evidence is seen in the Society’s U-turn from supporting to opposing Tobacco 21 in Virginia (below) and Utah (here).  The Society complained in both states that “the devil’s in the details,” but there are no details: states simply want to move the legal age for tobacco sales from 18 to 21.  The Society should advocate for the health, and respect the rights, of American teens and smokers.
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Virginia has raised the minimum age for buying all nicotine products, including e-cigarettes, from 18 to 21. The bill had widespread support from state medical societies and Gov. Ralph Northam, a pediatric neurologist; and it is part of a national trend in which states are responding to the growing number of adolescents choosing to vape. But some in the public health community tried to make the perfect the enemy of the good by standing in the way of a sensible regulation that has the potential to curtail teen nicotine use, without making it harder for adult smokers to access healthier alternatives.

It’s true there has been an increase in teen vaping — a problem exacerbated, in part, by older students legally buying tobacco products and selling them to their younger classmates. Raising the age from 18 to 21 will delegitimize tobacco sales to 18-year-olds and potentially disrupt high school “black markets.” Eighteen-year-olds make up 14 percent of all American high school students, but they account for one-quarter of high school smokers and smoker-vapers. Legal buyers — not manufacturers and retailers — are the primary source for tobacco products used by underage high schoolers. So Virginia’s Tobacco 21 law could make a big impact in limiting access to youth.

The problem comes from the growing contingent of “anti-tobacco” activists who won’t be happy until there is simply no tobacco — or nicotine — for sale at all. Specifically, the American Cancer Society needs to start acknowledging scientific facts and abandon its “tobacco-prohibition” stance. The society opposed the sensible Tobacco 21 bill in the Virginia legislature, despite the fact that the ACS’s lobbying arm, the Cancer Action Network (CAN), endorses Tobacco 21 at the national level. CAN spokesman Brian Donohue insists, “the devil is in the details.”

Similarly, the American Heart Association also supports Tobacco 21 in theory, but has been critical of the Virginia legislation. AHA spokesperson Ashley Bell said — somewhat incoherently — that youth access laws “may not be strong enough to support the current age … are not strong enough to support the enforcement of raising the age.” ACS-CAN’s Donohue added that Tobacco 21 “is a great goal, but it’s backwards.”

The only thing backwards is the public health community’s flip-flopping on support for Tobacco 21. ACS-CAN is critical of the bill’s focus on youth — rather than retailers — and is insisting additional changes ought to be made such as the elimination of fines for teen buyers (currently $100 for the first violation, $250 after that), and increased fines for retailers (currently set at $500 for the first violation and up to $2,500 subsequently). But the reality is, they don’t intend to settle halfway because they want the complete elimination of nicotine and tobacco products.

Efforts to stem the use of tobacco and vaping products through Tobacco 21 laws — like the one signed into law in Virginia — are growing. Hawaii, California, New Jersey, Oregon, Maine, and Massachusetts have already raised the purchase age to 21, and Alabama, Alaska, and Utah bumped it to 19. The leadership at organizations like ACS-CAN and the AHA know that the FDA punishes retailers who sell tobacco to anyone under 18. E-cigarette companies have implemented stringent age verification systems online to support these measures.

No tobacco product is perfectly safe, but vaping is considered 95 percent safer than smoking. E-cigarettes not only provide a safer alternative for adult smokers; but, as the New England Journal of Medicine just confirmed, they are used more often by smokers, and they are more effective than medicinal nicotine in helping smokers quit.

Each year more than 16 million Americans live with, and almost half a million die from, smoking-attributable illnesses; the total economic cost is more than $300 billion. We can’t afford to let politics interfere with sensible policies.

Kudos to Governor Northam for ignoring tobacco policy u-turners in order to remove legal tobacco consumers from Virginia high schools.