Protecting the Health of our Young People, and our State’s Future, by Raising the Minimum Sales Age of Tobacco Products from 18 to 21

Op-ed by Karyl T. Rattay, MD, MS, Director, Division of Public Health, Delaware Department of Health and Social Services

It’s a fact that 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.

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 developing early abdominal aortic atherosclerosis, which affects the flow of blood to vital organs; reduced lung growth, which increases the risk of chronic obstructive pulmonary disease (COPD) later in life; and reduced lung function. Adolescent girls and young women who become addicted to nicotine and use tobacco during pregnancy increase the risk of a premature birth or even the death of their child.

An emerging policy intervention to help reduce youth and young adult initiation of, and access to, tobacco products is to increase the legal age for the sale of these products from 18 to 21 years old. These are known as “Tobacco 21 or T21 laws.” Research shows that youth often turn to older friends and classmates as sources of cigarettes. Increasing the tobacco age to 21 in Delaware would reduce the likelihood that a high school student will be able to legally purchase tobacco products for themselves, other students, or underage friends. Adolescents age 15-17 would also have a harder time passing themselves off as 21-year-olds. As many tobacco users between 18 and 21 move from experimental use to regular, daily use, a T21 law would prevent this as well. The Institute of Medicine (IOM) estimates that increasing the age of sale to 21 would decrease long-term tobacco use by about 12 percent. And, it could decrease tobacco-related deaths by 10 percent.

Sen. Bryan Townsend introduced T21 legislation in Delaware last week. SB25, which has the support of Gov. John Carney, additionally imposes a civil penalty for sales to 18- to 21-year-olds, prohibits parents and guardians from purchasing tobacco products for minors, and prohibits individuals under age 21 from entering vapor establishments.

Seven states, including our neighboring states of New Jersey and Virginia, have passed T21 laws. Seventy percent of Delawareans surveyed by the 2017 ATS support a T21 law. A majority of current tobacco product users surveyed also support such a law.

As the Director of the Division of Public Health (DPH) and a board-certified pediatrician, I support SB25 because it is a population-based health initiative that promotes health, prevents disease, averts a lifelong addiction to nicotine and steers Delawareans away from the dangers of tobacco use.

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. Our latest cancer data report lists tobacco use or smoking as risk factors for 16 cancers.

Of particular concern to us here in Delaware is lung cancer. Our most recent cancer statistics indicate lung cancer accounted for 14 percent of all newly diagnosed cancer cases and 30 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.

Additionally, secondhand smoke is a known cause of low birthweight, Sudden Infant Death Syndrome, and lung problems, asthma, and ear infections among children.

Every year, nearly 1,400 adult Delawareans die from smoking-related illnesses, according to Centers for Disease Control and Prevention estimates. The U.S. Surgeon General warns that an estimated 17,000 Delaware youth who are now under age 18, will ultimately die prematurely from smoking-related illnesses if current trends continue.

Despite our great strides in reducing tobacco use, especially reducing youth smoking rates, we still have a long way to go. We are seeing an alarming increase in the use of electronic cigarettes. Although only 6.2 percent of Delaware high school students smoked regular cigarettes in 2017, nearly 20 percent used some type of tobacco product. Also, a 2018 Institute of Medicine 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. We must take innovative actions.

For more than 30 years, Delaware has been a national leader in establishing tobacco prevention interventions that help protect the health of all Delawareans. We all breathe easier in public places and workplaces thanks to the Delaware General Assembly’s passage of the Clean Indoor Air Act. Our legislators created the Delaware Health Fund which helps the state maintain a comprehensive tobacco prevention and cessation program. The creation of the Delaware Cancer Consortium led to a large group of dedicated people who continuously make our cancer prevention, detection, and treatment system work better. The DCC recommends enacting legislation to increase the age to 21 to purchase cigarettes and other tobacco products.

DPH and our health partners have worked hard to save lives and safeguard Delawareans from a diminished quality of life by guiding them toward healthy behaviors. Delaware should join the states that are passing T21 laws – and remain a national leader in protecting the health of our citizens.

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