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 McConnellPelosi mum on when House will send impeachment article to Senate Democratic senator: COVID-19 relief is priority over impeachment trial The Hill's Morning Report - Biden asks Congress to expand largest relief response in U.S. history 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 ShalalaBiden's new challenge: Holding Trump accountable Trump, Florida complicate Biden approach to Cuba Florida Rep.-elect Elvira Salazar tests positive for COVID-19 MORE (D-Fla.), have introduced similar legislation. Sen. Brian SchatzBrian Emanuel SchatzFor platform regulation Congress should use a European cheat sheet Senate Democrats rebuke GOP colleagues who say they'll oppose Electoral College results 11 Senate Republicans say they will oppose Electoral College results Wednesday MORE (D-Hawaii) and Todd YoungTodd Christopher Young'I saw my life flash before my eyes': An oral history of the Capitol attack US Chamber of Commerce to stop supporting some lawmakers following the Capitol riots GOP senator confronted by Trump supporters over electoral challenge: 'The law matters' MORE (R-Ind.) and Reps. Diana DeGetteDiana Louise DeGette'I saw my life flash before my eyes': An oral history of the Capitol attack Pelosi names 9 impeachment managers Bipartisan lawmakers call for expedited diabetes research MORE (D-Colo.) and Chris StewartChris StewartREAD: The Republicans who voted to challenge election results House Republicans who didn't sign onto the Texas lawsuit Atlanta Wendy's 911 call the night of Rayshard Brooks's death released 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.