Age 21 For All Nicotine Products: A Logical, Powerful Intervention.
Tobacco use results in over 500,000 American deaths each year,
equivalent to three 747s crashing, killing all aboard, every single day. It
costs us annually over $289 billion. 2800 teenagers try smoking every
day, and unless there is a trajectory change this addiction will
dramatically shorten the lives of 5.6 million children alive today.1 For
years we’ve successfully pursued a strategy of education, countermarketing, increasing taxes and limiting tobacco access to teenagers.
These worked to a degree, obviously not enough, but now money is
tight, “tax” is an epithet and new forms of nicotine like e-cigarettes
threaten our kids. It’s time for a change.
MetroWest (age 18)
Frequent (20 / 30 days)
30 Day Prevalence
15%
Needham (age 21)
13%
10%
8%
4.5%
3.0%
2010
2010
2008
2006
2008
1.5%
2006
5%
6.0%
The Example of Needham: In 2005, Needham,
Massachusetts (population 30,000) raised its sales age
for tobacco to 21. Despite being tightly surrounded
by other Boston suburbs, the effect was powerful.
The MetroWest Health Foundation examined tobacco
use in a survey of 20 suburban high schools. Only
Needham had moved to age 21 and the result was a
48% drop in 30 day prevalence and a 62% drop in
frequent (20/30 day smoking)2, declines nearly triple
those of surrounding communities. If this result can be
widely duplicated, age 21 will become by far the single
most effective tobacco prevention intervention ever
utilized in the US.
Lessons from the Drinking Age: There was a !
lesson hard-won with another troublesome drug,
alcohol. The unpopular, forcible draft of millions of
disenfranchised teenagers brought about the 26th
Amendment giving 18 year-olds the vote. Twenty-five
states also lowered their drinking age to 18. The
immediate effect was disaster on the highways and a
surge in teen alcohol use, alcoholism and other drug
use.
Congress, at the behest of President Reagan
forced all states to raise their age minimum back to 21.
There followed a rapid drop in highway deaths and a
sustained decrease high school drinking, alcoholism and
other drug use. The problem of teen drinking wasn’t
solved but it was clearly and substantially ameliorated.
Alcohol is used differently than tobacco. Alcohol is
used occasionally, and there may be an incentive to
give alcohol to a teen to induce a party atmosphere
or sexual compliance. There is less incentive to buy a
teen a daily pack of cigarettes. Age 21 for nicotine
may work substantially better than did 21 for alcohol.
TOBACCO21.ORG
The top line tracks high-school seniors who had at
least one drink in the previous 30-day period and
re9lectsadropfrom70%to50%. Thebottomline,
more relevant to the daily addiction of cigarettes,
shows a drop in daily use from 6% to 2.5% -down
morethan50%–similartoNeedham.
@TOBACCO21
OVER
The 90% from 2% Phenomenon. Social sources are enormously
important in adolescent initiation of tobacco use and consolidation toward
addiction. 90% of the suppliers of tobacco products to those under age 18
are themselves under age 21.4 Yet only 2% of total dollar cigarette sales go
to those ages 18 to 21.5 Thus this tiny sliver of the total number of
cigarettes sold produce the overwhelming majority of new nicotine addicts
and smokers. This is undoubtably the lever by which age 21 works to reduce
teenage initiation and addiction to nicotine.
Adolescents Have Plastic Brains. A
tsunami of neurologic data now underscores the
vulnerability of the youthful brain. Kids’ astonishing
cognitive gains parallel the rapid modulation of
neuroreceptors that can then be reset for life. The nicotinic-cholinergic receptors
that affect dopamine transport are a case in point. Early high-level nicotine exposure
ramps up these receptors resulting in a brain that feels perpetually starved for the
powerful neurotransmitter dopamine. This leaves kids and the adults they will grow into at risk for depression,
anxiety, irritability and substance abuse and other high risk behaviors, as scores of studies indicate.
E-cigarette use has skyrocketed due to televised sexual and celebrity ads as
well as candy flavors. Seventeen percent of high school seniors smoke highly addictive
e-cigarettes3. Couple this with the the thousands of “vape shops” that have opened in
the last few years4, and you have a recipe for an addiction epidemic. For adolescents
and pregnant women it is the nicotine which does the damage, not the “tars.”
Age 21 Enjoys 75% Popular Support. In July of 2015 the CDC conducted a nationally representative
survey of 4,219 United States citizens investigating support for Tobacco 21. 75% of respondents, and 70% of
current smokers, favored raising the tobacco age to 21.3 The majority of adults in every demographic and
smoking-status category supported increasing the minimum age. Raising the age to 21, it seems, is easy to
understand, straightforward and hugely popular across the board.
Supported by the Institute of Medicine & FDA. In March of 2015 the
prestigious Institute of Medicine released a long-awaited 360 page report
commissioned by the FDA, which detailed the enormous public health benefits that
would result from raising the tobacco age to 21. These include a 25% decline in
smoking initiation by teenagers, and a 12% overall drop in smoking prevalence.
Nearly immediate effects include 16,000 cases of preterm birth and low birth weight
averted in the next 5 years. The report also predicted that for kids alive today, 4.2
million years of life would be saved by virtue of this logical, simple policy change.
A National Movement with Local Roots. Over 130 cities in nine states covering 17 million people
have now enacted strong age 21 protections for all nicotine products, with most of these ordinances enacted
within the last year. Thanks to the dedication of local advocates, Hawaii became the first state in the nation to
raise their tobacco age to 21 in June of 2015. It is important to note that Hawaii's effort began at a local level.
Tobacco lobbyists wield little power with our neighbors, and our local town and city councils.
1
The health consequences of smoking: 50 years of progress. A report of the Surgeon General. U.S. Department of Health and Human Services. 2014.
2 Needham, MA, Public Health Department. http://www.needhamma.gov/DocumentCenter/View/8554
3 King, Brian A. et al. Attitudes Toward Raising the Minimum Age of Sale for Tobacco Among U.S. Adults. American Journal of Preventative Medicine. July 6, 2015.
4 JR, Coleman M. Sources of tobacco for youths in communities with strong enforcement of youth access laws. Tob Control 2001:10:323-8
5 Winickoff JP, Hartman, L, Minimal Retail Impact of Raising Tobacco Sales Age To 21. Am J Public Health, November 2015.