susan-keown_
Susan Keown was a staff editor and writer at Fred Hutchinson Cancer Center from 2014-2022 who has written about health and research topics for a variety of research institutions. Find her on Twitter @sejkeown.
In a long-sought victory for public health activists, the federal government has raised the legal age to purchase tobacco or vaping products throughout the U.S. The new age-of-sale provisions are part of the federal 2020 appropriations agreement, signed by President Donald Trump on Friday, which funds the government through the remainder of the fiscal year.
“Raising the minimum age of tobacco sales from 18 to 21 is a historic victory for the tobacco-control community and for our nation,” said Fred Hutchinson Cancer Research Center tobacco-cessation researcher Dr. Jonathan Bricker, who has been an advocate for Tobacco 21 (as such minimum age-of-sale laws are known).
The new nationwide Tobacco 21 measure continues momentum that began with localities and states across the U.S. earlier in the decade. More than 500 U.S. jurisdictions, including 19 states have already enacted their own versions, including Fred Hutch’s home state of Washington last April. Bipartisan Tobacco 21 bills were introduced in both the U.S. House and Senate in the spring.
“My past research and that of my colleagues have shown there is significant tobacco use uptake and relapse in between ages 18 and 21. This new national law will help reverse that trend, thereby preventing more young people from starting or restarting tobacco use and developing addiction,” Bricker said.
Here’s more on the science that shows why this change in the law will have such a big impact.
Why Tobacco 21 nationwide will save lives
In a 2015 report commissioned by the U.S. Food and Drug Administration, the Institute of Medicine (now the National Academy of Medicine) concluded that a national Tobacco 21 law would reduce adult smoking prevalence by 12% and eventually prevent 223,000 of today’s youth from dying earlier than they would otherwise from all of the illnesses caused by tobacco use.
This will have ripple effects throughout the population, too, the Academy reported. Just one example: Because fewer parents would smoke, a nationwide Tobacco 21 law would cause substantial improvements in infant health, with hundreds of thousands fewer babies over the next century born too early or too small — both of which increase the risk of lifelong health consequences — and thousands fewer dying of sudden infant death syndrome.
Why would keeping people from tobacco-related products for just three additional years of their young lives have such a huge effect? Because of how nicotine addiction works in younger people.
Research cited in the Academy's report shows that almost all adults who have ever smoked daily first tried a cigarette before age 19. And the younger people are when they try tobacco, the stronger their addiction is likely to be and the more they will smoke as adults. That’s because humans’ brains are still developing into their mid-20s, gaining the skills to make wise long-term decisions and resist the pleasure signals that addictive substances send.
The Academy reported that the majority of underage tobacco users get their cigarettes, vaping products or chewing tobacco from family and friends. So, Tobacco 21 takes legal tobacco and vaping products out of high schools and thus out of most teens’ social circles.
In the past decade, a sense of alarm has grown across the country about the latest form of nicotine consumption, especially in teens: vaping. High schoolers’ use of e-cigarettes doubled between 2017 and 2019, with more than one in four high school seniors having vaped a nicotine product in the past month, according to a 2019 study. Jurisdictions that have enacted Tobacco 21 laws have frequently cited concerns over youth vaping as a driver of the change.
It’s true that e-cigarettes contain much lower levels of cancer-causing substances than traditional cigarettes. But they do pack a huge punch of addictive nicotine. (One pod of the popular vaping product Juul contains as much nicotine as at least 26 cigarettes, found a recent study.) Thus, young vapers become dependent on nicotine, often without realizing it.
And then, we now know, many switch to combustible cigarettes — exposing themselves with each puff to more than 250 known poisons. A 2017 review of the research found that people who ever vaped before the age of 30 are three-and-a-half times more likely than abstainers to eventually smoke cigarettes.
As Tobacco 21 comes full circle, public health looks to new goals
Tobacco 21 laws in the U.S. are not new. According to a 2016 review in the American Journal of Public Health, jurisdictions across the U.S. began implementing them in the 1880s out of a concern for public health, especially of children. By 1920, people under age 21 could not legally purchase tobacco in at least 14 U.S. states. But these requirements began to loosen across the country in the second half of the 20th century as the tobacco industry lobbied heavily against laws it saw as an existential threat.
“This law is a big step toward the ultimate goal: a nation that is completely free of all tobacco products."
— Dr. Jonathan Bricker, smoking-cessation researcher
Health care advocates have been fighting for years to bring Tobacco 21 laws back. Now, with last week’s historic success, they can focus their efforts on the next goals.
Last month, Bricker’s Fred Hutch colleague, lung cancer immunologist Dr. McGarry Houghton, testified in front of the Washington state senate’s Health & Long-Term Care Committee about the science of vaping risks. Washington state placed a temporary emergency ban of flavored vaping products in September as an epidemic of vaping-related lung injuries swept the country. State legislators in Washington, as in several other states, are now considering a permanent ban on most flavored products, which younger people are more likely to use.
Advocates argue that restricting the sale of fruit- and candy-flavored products would be another step toward preventing nicotine addiction in young people, while keeping open the option of vaping for recovering smokers who use e-cigs to help them avoid combustible cigarettes.
An important note: E-cigs have not been proved to be safe and effective for this purpose, and none are FDA-approved smoking-cessation devices. Learning how to best help nicotine users break the drug’s powerful hold altogether is critical, Bricker said.
“This law is a big step toward the ultimate goal: a nation that is completely free of all tobacco products,” said Bricker, who is developing research-based tools, such as smartphone apps, to help nicotine users recover from their addictions. “To get there, we need to increase federal funding for tobacco control research. Such funding will support the development and testing of new ways to help people stop all forms of tobacco use, including flavored vaping devices and cigarettes.
“Proven-effective treatments have the potential to reach millions of Americans of all ages. When combined with this age-21-for-sales law, these new programs will get us to near zero tobacco use,” he said.
Do you need help quitting tobacco or e-cigarettes? These evidence-based resources are available to you, free of charge:
- The Washington state Department of Health provides access to self-help quitting tools.
- Smokefree.gov contains information, strategies and tools to help you quit.
- Dial 1-800-QUIT-NOW to talk with trained quit-smoking counselors.
- The nonprofit Truth Initiative offers self-help resources for young people who want to quit vaping.
