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Health Advice
by Dr. Weiss

Aug 15, 2016
Tobacco 21” laws are a tool to reduce access by young people to cigarettes and e-cigarettes. These laws prohibit selling tobacco products to anyone under age 21.
The vast majority of smokers begin smoking during adolescence when the brain has a heightened susceptibility to nicotine addiction, according to a recent New England Journal of Medicine Perspective. Middle school and high school students typically gain access to cigarettes from older adolescents who are also under 21. Raising the age to buy tobacco to 21 will make access more difficult for those younger students. Areas around the nation which have adopted Tobacco 21 laws experienced a 47% reduction in the smoking rate among high school students. If access to tobacco were limited, the Institute of Medicine (IOM) predicts an overall 12% decrease in tobacco use with a 20 to 30% decrease among teens 15 to 17. The IOM also estimates a dramatic decrease in premature deaths of 249,000 from lung disease and 45,000 from lung cancer. There would be an estimated 4.2 million fewer lost quality adjusted life years (QALY) among those born between 2010 and 2019. As these children reach the child-bearing years, the benefits multiply with fewer premature births and low-birth-weight babies. These children of non-smoking parents would be less likely to become addicted to tobacco. The encouraging news is that 70 to 75% of Americans, including current smokers, favor raising the minimum purchasing age to 21. Interestingly even the 18 to 24 year old age group had a 68% rate of support. There is also general agreement between survey respondents who identify themselves as Republicans or Democrats, 76% and 80%, respectively. This is not a political issue but rather a health issue. The near term economic harm to small business is minimal, based on an estimated 2-to-3% total decrease in tobacco sales. Long term the revenue loss from decrease smoking will be substantial but will be far less than the savings in healthcare costs and misery associated with lung diseases. Particularly for young people who are so easily influenced and impressionable, making the healthier choice the easier choice clearly makes economic sense and is the right thing to do. CVS Pharmacy’s decision to no longer sell tobacco products—which they did a couple of years ago—is a model for all responsible corporations. Science shows that this “denormalizing” process is a critical step in tobacco use prevention and also encourages adults to stop smoking. Eliminating tobacco sales in pharmacies has long been advocated by health professionals, including the majority of pharmacists, the American Medical Association, American Heart Association and American Cancer Society. Existing Tobacco 21 laws protect more than 16 million of 320 million Americans. Having a nationwide standard would prevent adolescents from jumping from a restricted area to a non-restricted region. The coalition of tobacco retailers and manufacturers will emphasize the sanctity of personal liberty and create unfounded fear of further personal restriction. None of which is true, but nonetheless it will be a rallying cry for those profiting by addicting adolescents. The greater good for impressionable adolescents is to at least postpone access to tobacco to age 21. That will help these youngsters live longer, happier, and healthier lives.