Pushing the tobacco age to 21 is good, but it’s not enough

It is universally acknowledged that smoking leads to premature disease and death. Yet, 1 billion people worldwide, including 38 million adults in the U.S. continue to smoke. It’s not because they are oblivious to the dangers of smoking, but because their addiction smothers all prudent consideration of the adverse health effects of tobacco use. Most people become addicted to nicotine when they are teenagers. That’s why it’s imperative that we do all that we can to deter early nicotine addiction in youth. Initiatives to raise the national sales age for tobacco products to 21 deserve serious consideration by the Congress. 

“Tobacco 21” proposals are a significant step in the right direction. Nicotine addiction fundamentally threatens the development in young people’s brains that is necessary for executive function, memory and emotional regulation. 

It rewires the developing brain, sensitizing it to other drugs and increases the likelihood of lifelong nicotine addiction and future substance abuse. Hence, the public health benefits of deterring early nicotine addiction are likely to be substantial. A report by the National Academy of Medicine found that a national Tobacco 21 policy would curb tobacco use by 12 percent, resulting in 223,000 fewer premature deaths and 4.2 million fewer years of life lost for those born between 2000 and 2019. 

The proposals are timely. Decades of relentless work by public health advocates have caused youth smoking rates to plummet, but with the introduction of e-cigarettes, nicotine addiction has surged dramatically in just a few years. Recent reports suggest that as many as 21 percent of high school students and 5 percent of middle school students, or more than 3.6 million children, are using e-cigarettes. Alarmed by the very real possibility of creating a new generation that is addicted to nicotine, several states have already enacted Tobacco 21 laws. It is time for the Congress to do the same.

Opponents — in their attempts to sow fear and hobble Tobacco 21 efforts — have said that these initiatives show too much government overreach.

No one in our society can secure the rights promised by our nation’s founding documents without good health — we cannot be free without first being healthy. All governments seemingly have the responsibility to safeguard the health of their citizens, especially children. That is why 180 governmental organizations around the world have pledged to increase their tobacco sales age as part of the Framework Convention on Tobacco Control. 

The U.S., one of few outlier countries that has not signed the FCTC, should reassert its leadership role in combatting tobacco use by becoming one of the first countries to prohibit tobacco sales to those under age 21.  

Increasing the tobacco sales age to 21 nationally would signal our country’s commitment to protect our nation’s youth, but our efforts cannot end there. We must also ensure Tobacco 21 bills include effective enforcement, and that they not penalize youth and adolescents. 

Weak Tobacco 21 laws can benefit the tobacco industry’s bottom line by gutting restrictions on sales to youth, creating carve outs for certain products and prohibiting communities from enacting other effective tobacco control policies. We must not let that happen.

Effective tobacco control requires a comprehensive approach at the federal, state and community levels. We must support not only Tobacco 21, but also other necessary policies including strong FDA regulation of tobacco manufacturing and marketing; prohibition of all flavored tobacco products,; comprehensive clean indoor air laws; and funding for cessation and prevention programs and increased tobacco taxes. To minimize the future burden of heart disease, cancer and other life-threatening conditions caused by tobacco, the National Institutes of Health should undertake a large and comprehensive evaluation of the long-term health effects of e-cigarettes and other nicotine delivery devices.

Nancy Brown is chief executive of the American Heart Association. Aruni Bhatnagar, Ph.D., is a professor of medicine at the University of Louisville and co-director of the American Heart Association Tobacco Regulation and Addiction Center.