Momentum is growing for a nationwide movement to raise the legal age of tobacco purchase from 18 to 21. Experts say the widespread and worrisome teen vaping epidemic is a major catalyst—but so is support from e-cigarette and tobacco companies, which has some health groups feeling uneasy.
On June 7, Texas joined about a dozen other states in enacting so-called Tobacco 21 policies; even more cities and counties have raised their legal buying ages, and a string of national retailers have instituted corporate policies that echo these legislative efforts. In Texas, the law will raise the purchasing age for all tobacco products, including e-cigarettes, starting in September. Senate Majority Leader Mitch McConnell recently proposed similar legislation at the federal level, and specifically cited “epidemic levels” of teen e-cigarette use as a primary motivator for his bill.
McConnell’s reasoning is familiar. “The nationwide increasing prevalence of vaping has helped policymakers and legislators across the country to really sharpen their focus on tobacco as a whole, and to look more closely at vaping,” says Dr. Peter Pisters, president of Texas’ MD Anderson Cancer Center.
On the surface, it appears to be a silver lining to a public-health disaster. But many health groups are wary of the fact that tobacco and vaping companies, such as Altria and Juul, have thrown their weight behind these policies. Lobbying from Big Tobacco and Big Vape has helped Tobacco 21 legislation pass in nine states this year, but, as detailed in a May 23 report from investigative journalism nonprofit the Center for Public Integrity, health groups oppose some of these proposed laws because they would preempt stricter policies, or include such weak enforcement mechanisms or so many exceptions as to make them largely ineffective. (Texas’ law, for example, includes an exception for military members.)
Jeffrey Hardesty, research program manager at Johns Hopkins University’s Institute for Global Tobacco Control, says he’s skeptical of the tobacco industry’s sudden support for Tobacco 21, noting that it “does not make amends for decades of obituaries.” But even still, he says the laws are a good idea at their core.
“Any teen using any type of tobacco product or e-cigarette raises their harm from zero to a level that is unacceptable,” Hardesty says. “Any law that can help get these products out of the hands of young adults and minors is necessary.”
Tobacco 21 laws are meant not only to keep young adults from buying tobacco themselves, but also to prevent use among younger teenagers, who research shows often get cigarettes from older classmates or siblings. These kids, the logic goes, may be less likely to know someone who is 21 than 18. Curtailing tobacco use at younger ages is considered critical, since some 95% of smokers start before they’re 21.
Young, developing brains are uniquely susceptible to the addictive properties of nicotine, potentially affecting development and setting teens up for a lifelong habit, Pisters says. If fewer kids have access, “We’ll be in a position to avoid lifetime nicotine addiction and the scourges associated with a series of [smoking-associated] diseases that are often fatal,” like cancer, heart disease and lung disease.
In addition to saving lives, reducing rates of those conditions would likely cut health care costs and narrow “the socioeconomic gap in these diseases, since we know that smoking rates are higher among folks at the lower end of the socioeconomic ladder,” says Catherine Cubbin, a faculty research associate at the University of Texas at Austin’s Population Research Center.
Tobacco 21 laws are fairly common in liberal strongholds like Massachusetts, California and New York, and early data out of these areas suggest they do suppress sales. (Few other countries have enacted similar laws, though Singapore plans to by 2021.) But it’s noteworthy that notoriously conservative Texas and McConnell, a Republican senator from tobacco-rich Kentucky, are getting behind these policies. The prevalence of vaping, and the companies behind it, seem largely to thank—or blame—for that shift.
As of the latest federal estimates, about 21% of high school students said they used e-cigarettes, which typically deliver nicotine. (Unlike traditional cigarettes, which work by tobacco combustion, they heat and vaporize a nicotine-packed liquid.) Health experts worry these young people will get hooked on nicotine at a time when teen smoking rates are at historic lows, and gravitate toward other tobacco products. Research has shown that teenagers who vape are more likely than their peers to graduate to other tobacco products. And though e-cigarettes produce fewer of the known carcinogens in cigarettes, preliminary research suggests they’re not without health risks of their own.
That’s why the Food and Drug Administration in March proposed new restrictions on the sale of flavored e-cigarettes, which are thought to be especially appealing to minors. Tobacco 21 efforts, in theory, could also go a long way toward keeping e-cigs out of the hands of adolescents, but it’s not entirely clear why vaping companies support policies that would hurt their bottom lines.
Juul’s co-founder Adam Bowen told TIME in April—a few weeks before North Carolina Attorney General Josh Stein filed a lawsuit alleging that the company’s marketing targeted minors—that the company is “more than willing to take any cut in sales or revenue to do the right thing and prevent underage use.” The company’s founders have also said they cannot achieve their goal of giving adult smokers an alternative to cigarettes if use among adolescents—and, presumably, the extra regulations and restrictions that come with it—continues unchecked.
Tobacco-control advocates, however, aren’t so sure their motivations are pure. “The tobacco companies are masters at proposing or supporting bills that look good on the surface but often include provisions that are harmful to public health,” Campaign for Tobacco-Free Kids Spokesman Vince Willmore told the Center for Public Integrity. “This is more a PR strategy than a serious effort to prevent youth use.”
Hardesty agrees that Big Tobacco’s involvement “has the markings of corporate social responsibility.” Nonetheless, he says grouping vapes and traditional cigarettes under the same regulatory umbrella is a smart strategy for improving public health.
“If you’re only applying legislation to e-cigarettes…you could drive people back to a potentially more harmful product,” Hardesty says. A blanket restriction, however, should theoretically drive down tobacco use across the board.
“Many factors decide whether or not a teen or young adult decides to start smoking or vaping,” Hardesty says. “A well-crafted bill raising the minimum age has the potential to save lives, but it’s not a silver bullet”—especially if it’s passed as a PR play.
Write to Jamie Ducharme at [email protected].