A new age for tobacco — raising the age to 21 is a smart move

A new age for tobacco — raising the age to 21 is a smart move
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We are encouraged to see that members of Congress on both sides of the aisle are getting serious about raising the minimum age to 21 years old to purchase tobacco products, including e-cigarettes. This will build on the momentum of several state and territorial legislatures that are working towards banning the sale and use of cigarettes to people under 21.

Why does age matter? We know that increasing the age at which young people can purchase tobacco products is emerging as a promising, commonsense strategy. This, combined with raising the price of tobacco products, will decrease the likelihood that a young person becomes addicted to nicotine. Twelve states, one territory and the District of Columbia have used similar policy strategies to decrease youth tobacco use in their jurisdictions, with over 30 percent of the nation now living in a jurisdiction with a state-wide tobacco 21 law.


Nevertheless, tobacco use remains the leading preventable cause of death and disease in the United States, killing more than 480,000 Americans and costing the nation about $170 billion in healthcare expenses each year. Tobacco use raises the risk of multiple forms of cancer, heart disease, emphysema, limb amputations and many other health conditions that diminish quality and years of life. Tobacco use is especially high among those with substance use disorders and mental illness, as well as a major contributor to high rates of prematurity in infants and premature death in adults.

The best way to quit smoking is to never start in the first place — and that is exactly what commonsense public health policy proposals, such as raising the minimum purchasing age to 21, aim to do. Stop the addiction before it begins: prevent it. State and territorial public health is on the frontlines of these interventions.

Over the past three decades, state and territorial public health agencies have led efforts to end youth smoking and promote adult tobacco cessation by implementing evidence-based practices, including banning smoking in public places, restricting youth access to tobacco products through price increases and social messaging. We have seen the most progress when these policies are coupled with robust enforcement and adequate funding for comprehensive tobacco cessation education.

However, we must do more, as nearly 2 in 10 U.S. adults still use tobacco products and the rising use of e-cigarettes is a growing concern that might be undermining our progress in combustible tobacco use cessation.

It is good policy to set the minimum age to purchase tobacco products at 21 years. Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellHawley expects McConnell's final impeachment resolution to give White House defense ability to motion to dismiss Democrats file brief against Trump, 'the Framers' worst nightmare' Iran resolution supporters fear impeachment will put it on back burner MORE, who represents one of the last American states to grow tobacco, pitched the idea of increasing the minimum age last week but has yet to release the text of the legislation. Other members of Congress, including Reps. Frank Pallone (D-N.J.) and Donna ShalalaDonna Edna ShalalaOvernight Health Care: Kansas leaders reach deal to expand Medicaid | California to launch own prescription drug label | Dem senator offers bill banning e-cigarette flavors A solemn impeachment day on Capitol Hill Overnight Health Care — Presented by That's Medicaid — House panel unveils rival fix for surprise medical bills | Democrats punt vote on youth vaping bill | Pelosi drug bill poised for passage after deal with progressives MORE (D-Fla.), have introduced similar legislation. Sen. Brian SchatzBrian Emanuel SchatzOvernight Defense: Book says Trump called military leaders 'dopes and babies' | House reinvites Pompeo for Iran hearing | Dems urge Esper to reject border wall funding request Senate Dems urge Esper to oppose shifting Pentagon money to border wall Sanders defends vote against USMCA: 'Not a single damn mention' of climate change MORE (D-Hawaii) and Todd YoungTodd Christopher YoungIran resolution supporters fear impeachment will put it on back burner Senate GOP's campaign arm hauls in million in 2019 Sens. Kaine, Lee: 'We should not be at war with Iran unless Congress authorizes it' MORE (R-Ind.) and Reps. Diana DeGetteDiana Louise DeGetteLawmaker calls for hearing into MLB cheating scandal Overnight Health Care: Big Pharma looks to stem losses after trade deal defeat | House panel to examine federal marijuana policies | House GOP reopens investigation into opioid manufacturers Lawmakers express alarm over rise in cocaine overdose deaths MORE (D-Colo.) and Chris StewartChristopher (Chris) Douglas StewartGOP lawmaker offering bill protecting LGBTQ rights with religious exemptions House GOP wants Senate Republicans to do more on impeachment How House Republicans have stayed unified on impeachment MORE (R-Utah) may soon introduce a bill that proposes to raise the age to 21 as well.

In other words, consensus is building. States and territories have long been at the forefront for this sort of legislation. It is time, now, as the youth e-cigarette epidemic continues to gain steam, to make 21 years old the law of the land.

The Association of State and Territorial Health Officials (ASTHO) strongly encourages all of the various legislative proposals discussed above to achieve the common goal of preventing and ending youth tobacco use. We applaud the leadership of both parties for pushing this vital public health solution forward. Bipartisanship is in short supply these days; let’s harness this momentum to reach an agreement that could truly end the scourge of youth tobacco use in our lifetime.

Michael Fraser, Ph.D., MS, is chief executive officer of the Association of State and Territorial Health Officials (ASTHO), the national nonprofit organization representing the public health agencies of the United States, the U.S. territories and the District of Columbia. Marcus Plescia, M.D., is the chief medical officer of ASTHO.