Raise the Smoking Age to 21? Most Kids Fine With That

Study found two-thirds of U.S. teens endorse such a move by states

Monday, June 19, 2017

MONDAY, June 19, 2017 (HealthDay News) -- Nearly two-thirds of U.S. teens support raising the minimum age for purchasing tobacco products to 21 years old, new research finds.

Specifically, kids from 11 to 18 were asked if they supported the Tobacco 21 initiative -- a program through the Preventing Tobacco Addiction Foundation that strives to raise the minimum age for tobacco purchases.

"Current studies have focused on the attitudes of adults, and little is known about how youth nationwide perceive the Tobacco 21 initiative as well as the correlations between these attitudes and smoking behaviors," said study author Hongying Dai. She's an associate professor in the Health Services and Outcomes Research Department at Children's Mercy Hospital in Kansas City, Mo.

The reasons for increasing the age to 21 are largely scientific. Kids are at the greatest risk of becoming smokers, and smokers almost always begin experimenting with cigarettes and other tobacco products before age 18, the researchers said.

"The adolescent brain is still developing, and using tobacco at that age can actually change and alter brain development," explained Bill Blatt. He's the national director of tobacco programs for the American Lung Association.

"You end up with more brain receptors that are looking for nicotine, and the brain structure changes. That's why you become addicted for a lifetime," Blatt said.

Raising the minimum tobacco purchase age to 21 would likely have significant public health benefits. There would be 249,000 fewer premature deaths and 45,000 fewer lung cancer deaths for people born between 2010 and 2019, the researchers said.

The study included more than 17,000 teens and preteens from 185 U.S. schools.

The researchers found that younger adolescents were more likely to support the initiative. Girls were more likely to support raising the minimum age than boys.

According to Blatt, this follows the national trend that younger teens and girls are less likely to use tobacco.

Unsurprisingly, current young tobacco users were less enthusiastic about the initiative. Only 17 percent of teens who currently smoked cigarettes supported Tobacco 21 initiatives. For current e-cigarette users, that number was 31 percent.

About 71 percent of teens who didn't smoke cigarettes or e-cigarettes supported raising the purchase age.

Past research has shown that up to 75 percent of adults favor the higher purchase age for tobacco products, according to the study authors.

In recent years, there has been a continued decline in teen smoking, but alternative tobacco products such as e-cigarettes have sometimes taken the place of cigarette smoking.

Dai said that an initial fast rise in e-cigarette use was due to a lot of advertising and appealing flavors such as candy crush, gummy bears and bubble gum.

Through 2015, e-cigarettes had been gaining in popularity in teens. But, the most recent estimates show a sharp decline in use, from 3 million middle and high school students in 2015 to 2.2 million in 2016, according to the U.S. Centers for Disease Control and Prevention.

In the majority of e-cigarettes, the liquid that is present -- whether flavored or not -- contains nicotine, and users do become addicted, according to Blatt.

He also pointed out that there are often unknown ingredients in the liquid, and even for the known ingredients, researchers don't yet know the effects of inhaling them.

"A lot of people perceive e-cigarettes as being less harmful than regular cigarettes, and some people think they aren't harmful at all," said Blatt. "But we don't have the evidence to support that."

Tobacco 21 would also increase the age on the purchase of e-cigarettes.

Currently, there are at least 215 cities and two states -- California and Hawaii -- that have raised the minimum smoking age from 18 to 21, according to the study.

"This is good evidence for state legislators to understand that there is broad support, even among teens for Tobacco 21 policies," Blatt said. "It's a bit tough when you have a patchwork of policies where you can't buy cigarettes if you are 19 in this county, but you can in the next county. It's much better if you have to be 21 in all counties."

The study was published online June 19 in Pediatrics.

SOURCES: Hongying Dai, Ph.D., associate professor, Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, Mo.; Bill Blatt, national director, tobacco programs, American Lung Association; June 19, 2017, Pediatrics

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