Commentary: Raising tobacco sales age to 21 will protect Delaware’s future

Starting Tuesday, the law in Delaware prohibits the sale of tobacco products including cigarettes, cigars, chewing tobacco, JUULs and other vape products to individuals under the age of 21. Additionally, no one under the age of 21 can enter a vape establishment, and parents and guardians of those under 21 cannot purchase tobacco products for them. Some recent media stories interviewed youth who claim that raising the purchase age from 18 to 21 won’t make a difference. The experience of other states and municipalities says otherwise.

When we started the push to change Delaware’s law this spring, just seven states, including our neighboring states of New Jersey and Virginia, had passed Tobacco 21 (T21) laws, along with several municipalities. Now, just months later, according to the Campaign for Tobacco-Free Kids, the total is up to 16 states (including nearby Maryland) and over 470 cities and counties that have made the decision to protect the health of youth in their jurisdictions by limiting their access to tobacco products.

Dr. Karyl Rattay

Preliminary data from cities that enacted similar legislation or ordinances shows some early promise. Chicago implemented its policy in July 2016, and, in 2017, 6 percent of Chicago high school students, an all-time low, reported being current cigarette smokers. Since New York City implemented its Tobacco 21 measures in August of 2014, there was a 29 percent decline in current cigarette smoking among high school students between 2013 and 2015, an 18 percent reduction in ever trying cigarettes and a 13 percent reduction in smoking initiation in the prior 12 months. Following California’s Tobacco 21 law taking effect in June 2016, there was a 45 percent reduction in sales of tobacco products to underage buyers ages 15 to 16.

This is not about taking away personal choice. It is about saving lives and preventing lifelong diseases that can be entirely prevented by making the choice not to start using tobacco in the first place. It’s also about saving millions of dollars every year in health care costs associated with treating tobacco-related diseases. And it’s a policy change supported by Delaware youth themselves, based on the dozens of young people who filled the room when the governor announced the proposed legislation and on the day of the bill signing.

The facts are hard to ignore. Most smokers start using tobacco as youth. Eighty-nine percent of current adult Delaware smokers started before the age of 21; and slightly over 17 percent started between the ages of 18 and 20, according to 2017 Delaware Adult Tobacco Survey (ATS) data.

Research shows that youth often turn to older friends and classmates as sources of tobacco products. Increasing the tobacco age to 21 in Delaware will eliminate opportunities for older high school students to buy tobacco products for themselves or underage friends. Adolescents age 15-17 also will have a harder time passing themselves off as 21-year-olds.

Nicotine addiction keeps young people using tobacco products, which increases the risk of physical damage to their bodies. Exposure to nicotine can have lasting effects on adolescent brain development, and can disrupt the formation of brain circuits that control attention, learning, and susceptibility to addiction. Youth and young adults who use tobacco are also at risk for reduced lung function and lung growth, which increases the risk of chronic obstructive pulmonary disease (COPD) later in life.

While cigarette smoking rates have declined among all age groups, the introduction and promotion of other tobacco products by the tobacco industry has kept overall tobacco use rates among adults relatively level. Although only 6.2 percent of Delaware high school students smoked regular cigarettes in 2017, nearly 20 percent regularly used some type of tobacco product, and nearly 40 percent of Delaware high school students have tried vaping. Also, a 2018 Institute of Medicine (IOM) report indicates young people who begin with e-cigarettes are more likely to transition to combustible cigarette use, and are at risk for suffering associated health burdens.

The toll of tobacco use is staggering. Tobacco use is still the leading cause of preventable death and disability in Delaware and the United States. Just last week we released our latest cancer data report, which lists tobacco use or smoking as risk factors for 16 cancers, including lung cancer. In the report, lung cancer accounted for 19 percent of all newly diagnosed cancer cases and 29 percent of all cancer deaths. An estimated 85 to 90 percent of all lung cancer cases are caused by tobacco use, according to the U.S. Department of Health and Human Services.

IOM, in a 2015 report, estimated that increasing the tobacco sales age to 21 nationwide, could decrease long-term tobacco use by about 12 percent, and, decrease tobacco-related deaths by 10 percent over the next 30 years, which translates into 223,000 fewer premature deaths, 50,000 fewer deaths from lung cancer, and millions of dollars saved in health care costs for tobacco-related illnesses. The Centers for Disease Control and Prevention estimated that tobacco use costs our country about $170 billion annually just for health care, including $532 million per year here in Delaware.

I am so grateful for the leadership at the state, legislative, community and youth that helped pass such a landmark bill. Thanks to all of you, we will save lives.

Karyl T. Rattay, MD, MS, is director of the Division of Public Health, Delaware Department of Health and Social Services.

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