Age Restrictions on Smoking, Drinking and Driving

State legislatures have been lobbied in a coordinated effort, called Tobacco 21 (here), to raise the minimum age for tobacco sales from 18 to 21 years.  Hawaii, California and the District of Columbia have adopted the higher age limit, but numerous city and county ordinances have been passed.

As an advocate of tobacco harm reduction, I strongly oppose any tobacco use by teenagers.  However, I am unconvinced that implementing a smoking ban for those under 21 is an effective strategy.

One of the arguments for Tobacco 21 is that the same age limit has reduced teenage drinking.  The National Minimum Drinking Age Act was passed in 1984.  By 1988, all states prohibited alcohol purchase by those under 21.  The impact on underage drinking is debatable.  It has been on the decline for many years, but rates remain disturbingly high (here). 

The chart above shows past-month (i.e., current) cigarette smoking, marijuana use, alcohol consumption and binge drinking (5 or more drinks on one occasion) among 16-17, 18-20 and 21-25 year olds in the 2014 National Survey on Drug Use and Health.  Despite almost 30 years of Alcohol 21 across the county, nearly a quarter of 16-17 year-olds and 44% of 18-20 year-olds were currently drinking, compared with 11% and 24% who were smoking.  In addition, a majority of drinkers were binging.  In 2014, recreational marijuana wasn’t legal for anyone, yet 15% of 16-17 year-olds and 21% of 18-20 year-olds were using that drug. 

We can also compare these figures with those from 10 years earlier.  Here are the changes in current use from 2004:

Percentage Change From 2004 to 2014 in Prevalence of Youth and Young Adults Who Currently Smoke, Toke, Drink or Binge Drink
Age (yrs)	Smoke	Toke(%)	Drink	Binge Drink
16-17	-51	+6	-28	-41
18-20	-36	+17	-14	-23
21-25	-25	+25	+4	-1

With Alcohol 21 in force for almost 30 years, drinking and binge drinking declined moderately among 16-17 year olds.  But smoking saw the steepest declines in all age groups, even in the absence of a ban for 18-20 year-olds.

Alcohol 21 and Tobacco 21 laws are promoted to save lives.  In the case of smoking, the lives saved are far in the future, as smoking generally takes a toll in advanced age.  With alcohol, the lives saved are primarily from traffic accidents.  With or without alcohol, traffic accidents are the number one killer of youth and young adults (age 16-24 years), with about 7,000 deaths each year (here).  Legislators seeking immediate life-saving impact should consider further age-restricted driving licenses. 

The Truth About Traffic: Putting Fatalities in Context

In my lectures, I often provide context about the risks associated with use of tobacco products by comparing those behaviors with the use of automobiles.  Putting risk in context is important, as can be demonstrated by focusing on traffic safety data alone.

The U.S. National Highway Traffic Safety Administration (NHTSA) recently reported that there were 35,092 traffic fatalities in 2015 – a small increase from the previous year (here).  Some media reports treated the incremental change as if it demonstrated a growing epidemic.  National Public Radio headlined their story, “Largest increase in decades” (here), and CBS called it the “Largest increase in a half century” (here).  Transportation Secretary Anthony Foxx said in a press release (here), “…far too many people are killed on our nation's roads every year…we're issuing a call to action and asking researchers, safety experts, data scientists, and the public to analyze the fatality data and help find ways to prevent these tragedies.” 

Reducing carnage is certainly a worthy goal, but NHTSA ought to kill the hype and present traffic fatality statistics in a meaningful fashion.  In past years, NHTSA framed fatality rates based on population (e.g., deaths per 100,000 residents) or on vehicle miles traveled (see Table 2 of last year’s report here).  Those rates are more meaningful than press release hyperbole such as, “2,348 more people died in traffic crashes compared to previous year.” (here) 

This year’s NHTSA report downplayed the miles traveled rate and omitted the population rate.  Fortunately, using Census Bureau data, one can calculate the latter.  The chart shows both rates since 2005.

Traffic fatality rates, after falling almost continuously for several decades, have been stable since around 2009.  The small 2014/2015 uptick to 11 deaths per 100,000 population or 1 billion miles traveled is not an increase of epidemic proportions.

The risk of traveling by automobile in the U.S. remains very small.