White Paper: Tobacco 21: Raising the Age of use of Tobacco Products to 21
White Paper on
TOBACCO 21: RAISING THE AGE OF USE OF TOBACCO PRODUCTS TO 21
White Paper Summary
Tobacco usage in not a new problem in the United States, and in fact seems to be an ever increasing problem in the nation despite knowledge of the harmful effects. With the new ideas of vapes and e-cigarettes marketed as a safe alternative to cigarettes, tobacco use has increased steadily with consumers not knowing the long-term effects of such products.
Implementing new tobacco laws and taxes on tobacco products while restricting the advertisements from big tobacco companies has influenced the sales and consumption of such products. The 18 states and cities that have raised the minimum age have decreased the number of adolescents using tobacco while also decreasing the amount of tobacco products sold. This will in turn, decrease medical costs as less people will be hospitalized for lung or heart conditions related to long term smoking habits.
The effects of using tobacco at a younger age involve affecting the synapses that our brain makes when we learn something new. This ‘re-wiring’ effect can be detrimental to the adolescent’s ability to learn at the same pace as their peers. It can also cause the adolescent to want to experiment further with different drugs and alcohol as their impulse control is lessened.
To further augment policies in place that are limiting tobacco consumption and reduce substance abuse, the Prevention Alliance of Tennessee recommends the following actions:
1. Raising the minimum age to purchase tobacco and vapor products to 21 in Tennessee. 2. Remove flavorings such as candies, fruits, and mint from e-cigarette and vape products.
Tobacco
Tobacco products are any type of product derived from the tobacco plant to consume in some shape or form. Some examples are cigarettes, cigars, pipes, vapes, e-cigarettes, hookahs, chew or snuff, and heated tobacco products (HTPs). The problem with the use of tobacco products is that they contain nicotine, a highly addictive substance, along with chemicals known to cause cancer or be harmful to the body. It is a common misconception that vapes or e-cigarettes use water vapor instead of these harmful chemicals to deliver the tobacco, but they typically contain ultrafine particles, diacetyl for flavoring which has been linked to serious lung disease, volatile organic compounds, and heavy metals such as tin, lead, or nickel.1 The variety of flavors, mostly fruity or candy, in these e-cigarettes is a major concern for use in today’s youth and are the primary reason these adolescents begin using the e-cigarettes.
1 “Quick Facts on the Risks of E-Cigarettes for Kids, Teens, and Young Adults.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, March 11, 2019.
https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids Teens-and-Young-Adults.html.
Nicotine
Nicotine is the primary active ingredient in tobacco/vape products. It is also the reason why many people who begin to use tobacco/vape products cannot stop using it or have multiple failed attempts at trying to stop the use of tobacco products. Nicotine gets into the body and stimulates epinephrine release, also known as adrenaline, in turn stimulating the central nervous system. This activates the same reward system that cocaine and heroine activate which is the brain’s reward system increasing the level of dopamine.2 This reinforces this behavior as good and making the body ‘happy’. Although nicotine causes addiction in users and is the main reason that people use tobacco products. It is not necessarily the component that causes harmful effects on the body.
During adolescence nicotine exposure does not affect the body the same way it does in adults. In adults, high exposures to nicotine causes an aversive effect, similar to when eating foods that one does not like. This doesn’t occur with adolescents and high nicotine exposure. They also experience fewer physical symptoms of withdrawal.3
Effects on the body/brain
The use of tobacco products shows an increase in lung diseases such as lung cancer, chronic bronchitis, pneumonia, and emphysema. It increases the risk of heart disease, stroke, heart attacks, other cancers especially mouth cancers, leukemia, cataracts, type 2 diabetes mellitus.4 These chemicals with the effect of nicotine can also alter pathways in the brain. Every time something new is learned, new synapses are built in the brain, usually quickly in younger people. Nicotine changes the way these synapses are formed in an adolescent’s brain especially since they are not done with development until the age of 25. Research has proven that those who do not use tobacco products by the age of 25 are unlikely to become a user. These changes in the brain can affect the attention span, ability to learn quickly, mood, and impulse control. This can also increase their chances of trying or experimenting with drugs and alcohol.
Current Research on Tobacco
It has been shown in research and reporting that the majority of current smokers or tobacco users started before the age of 18.5 These earlier use rates are associated with decreased rates of smoking cessation. Increasing the age to purchase has been shown to decrease the usage of
2 National Institute on Drug Abuse. “Cigarettes and Other Tobacco Products.” NIDA: Advancing Addiction Science. NIH, October 2019. https://www.drugabuse.gov/publications/drugfacts/cigarettes-other-tobacco-products. 3 Dwyer, Jennifer B., Susan C. Mcquown, and Frances M. Leslie. “The Dynamic Effects of Nicotine on the Developing Brain.” Pharmacology & Therapeutics 122, no. 2 (2009): 125–39.
https://doi.org/10.1016/j.pharmthera.2009.02.003.
4 National Institute on Drug Abuse. “Cigarettes and Other Tobacco Products.” NIDA: Advancing Addiction Science. NIH, October 2019. https://www.drugabuse.gov/publications/drugfacts/cigarettes-other-tobacco-products. 5 Farber, Harold J., Smita Pakhale, and Enid R. Neptune. “Tobacco 21: An Important Public Policy to Protect Our Youth.” Annals of the American Thoracic Society 13, no. 12 (September 16, 2016): 2115–18. https://doi.org/10.1513/annalsats.201604-253ar.
tobacco by 12% from 18 to 21, and even a 3% decrease by raising the age from 18 to 19.6 The tobacco industry has been known for its marketing tactics to attract the youth and drawing them into to a lifelong nicotine addiction. Recently, there has been more attention drawn to vaping products as “safer” alternatives to smoking cigarettes, but cigarettes kill half a million people prematurely, alone in a year. Even as a safer alternative, that does not indicate these products are safe by any means. Another study found that those using e-cigarettes were more likely to be using combustible cigarettes in a one year follow up.7
Policy Changes
Some larger companies have already raised their selling age to 21 such as Walmart and Walgreens. CVS and Rite-Aid quit selling tobacco products altogether in order promote healthier decisions and prevent use in minors. These changes help with the convenience or spontaneity of tobacco purchases, with less retailers selling tobacco, the more the consumer must look or be conscious of trying to find a retailer to buy from.8 Currently there are 18 states that have already raised the tobacco purchasing age to 21 along including: Virginia, Arkansas, Texas, and Washington, D.C. In addition to raising the age, most states have raised taxes on tobacco products, started having more smoke free environments, banning tobacco advertisements and sponsorships, and are including graphic pictorial warnings on packaging.9 This has been shown to be more effective than text warning, gets the attention of users, and can even encourage quitting in some people realizing the effects of the tobacco products they are using.
6 Bonnie, RJ, K Stratton, and LY Kwan. “Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products.” Committee on the Public Health Implications of Raising the Minimum Age for Purchasing Tobacco Products, July 23, 2015. https://doi.org/10.17226/18997.
7 Farber, Harold J., Smita Pakhale, and Enid R. Neptune. “Tobacco 21: An Important Public Policy to Protect Our Youth.” Annals of the American Thoracic Society 13, no. 12 (September 16, 2016): 2115–18. https://doi.org/10.1513/annalsats.201604-253ar.
8 We Quit Tobacco, Here's What Happened Next.” CVS Health. CVS, September 1, 2015. https://cvshealth.com/thought-leadership/cvs-health-research-institute/we-quit-tobacco-heres-what-happened next.
9 Glynn, T., J. R. Seffrin, O. W. Brawley, N. Grey, and H. Ross. “The Globalization of Tobacco Use: 21 Challenges For The 21st Century.” CA: A Cancer Journal for Clinicians 60, no. 1 (January 2010): 50–61.
https://doi.org/10.3322/caac.20052.
Tobacco companies are even pushing for the legal purchase/consumption age to be raised to 21 in order to minimize the public perception of purposely marketing to youth. Vape and E-cigarette companies have recently been in the media and under fire for marketing to teens. Their advertisements show teens using their products, and their product flavorings directly attract youth. An argument used to not move the legal age to 21 is that individuals who serve in our military should be able to use tobacco products. This argument is not based on science or in the best interest of the health and well-being of our young adults serving our country. Tobacco/vaping products only harm our military, reducing their ability to respond quickly, and increasing overall healthcare costs, due to higher frequency of lung-related infections and illnesses. Usage in the military is associated with dropping out of basic training early and premature discharge from the armed forces.10 It is important to begin with prevention of tobacco/vaping use in order to reduce further health disparities, decrease the costs in treating medical conditions from use of these products, and protecting our nation’s youth and young adults.
The town of Needham, Massachusetts was the first to raise the minimum purchase age to 21 with 16 surrounding counties that did not change the age. Smoking rates in Needham declined as well as sales in the number of cigarettes purchased from stores in Needham. This decline may have been even larger had the surrounding communities raised the minimum age as well. This change occurred in 2005 where the rate of smoking declined to 15% compared to 21% in 2001.11 Raising the minimum age to 21 to buy tobacco/vape products makes it more difficult for those too young to purchase to get them from older peers in high school. This could potentially
10 Farber, Harold J., Smita Pakhale, and Enid R. Neptune. “Tobacco 21: An Important Public Policy to Protect Our Youth.” Annals of the American Thoracic Society 13, no. 12 (September 16, 2016): 2115–18. https://doi.org/10.1513/annalsats.201604-253ar.
11 Kessel Schneider S, Buka SL, Dash K, et al. Tob Control 2016;25:355-359. Doi:10.1136/tobaccocontrol-2014- 052207
decrease the amount of tobacco/vape use in today’s youth by 12%. It could also reduce adolescent smoking/vaping by half in the next 7 years.
Conclusion
Tobacco/vaping is harmful to all users, but adolescents are especially susceptible to effects on the brain, since they are still developing. Tobacco and vape products are typically not sold to adolescents, but they are able to get it from their peers in school, where seniors typically turn 18 before graduating. Adolescents who use nicotine products are at an increased risk for using other substances, such as alcohol and illicit drugs. When stopping the early initiation of tobacco use, adults are less likely to begin using tobacco products, having more impulse control due to a more fully developed brain. If more states raised the age to 21, the effect would be nationwide decreased health care costs and less people addicted to nicotine, alcohol and other drugs.
Authors
Lexie Ferguson, Student Nurse, UT College of Nursing
Karen Pershing, MPH, CPS II, Executive Director, Metro Drug Coalition