Towns are limiting tobacco sales to those over age 21, to help those younger from becoming addicted to cigarettes, as this writer did at age 17. A Westwood pediatrician, Dr. Lester Hartman today sent me a brochure about his efforts.
This is the pretty version of the brochure ==> T21 – handbook3 Below is the content of the brochure in a less pretty format.
TOBACCO21
TM
Cigarette sales to those under 21 account for only 2.12% of total sales. But, because 90% of smokers start by
the age of 21, these are the very sales that help lead to 9 out of every 10 new smokers. This means that the impact on
1
Just 2% of tobacco sales help produce 90% of new smokers.
Only 10% of smokers start at the age of 21 or older.2 If the current smoking rate is about 20%,3 then by simple
math, if someone reaches the age of 21 as a non-smoker, that individual has only a 2% chance of becoming a
smoker (.1 X.2 = .02=2%).
Raising the minimum tobacco sales age to 21 can reduce smoking rates to single digits.
In 2005, Needham, MA voted to raise and enforce theminimum tobacco sales age of 21. In 2006, before full
enforcement, the town had a youth smoking rate of 13% compared with 15% in the surrounding communities. By
2010, the youth smoking rate in Needham was down to 6.7% while the surrounding communities’ rate only
decreased to 12.4%. The percent decline in youth smoking in Needham was nearly triple that of its neighbors.4
This strategy is already working.
Since most students do not reach twenty-one years of age while still enrolled in high school, increasing the legal
age of sale would greatly reduce the number of students who could purchase tobacco products. By decreasing
the number of eligible buyers in high school, this action will help reduce youth smoking by decreasing the
access of students to tobacco products.
Many people who purchase for distribution to minors are between the ages of 18 and 20.5
A national age 21 law for alcohol sales resulted in reduced alcohol consumption among youth, decreased alcohol
dependence, and has led to dramatic reductions in drunk driving fatalities.6,7 At the time, some critics of the policy
argued that because 18 year-olds can vote and enlist in the military, they should be allowed to be sold alcohol.
Despite these arguments, the increase in the minimum sales age for alcoholic beverages has saved tens of
thousands of lives of young drivers, their passengers, and others on the road. 8
A similar strategy was highly successful in addressing alcohol sales.
1
2This is a conservative estimate. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey, 2008. Analysis by the American Lung
Association, Research and Program Services Division using SPSS software.
3 CDC. Morbidity and Mortality Weekly Report. “Current Cigarette Smoking. Among Adults — United States, 2011.” November 9, 2012. 61(44);889-894.
4
5 Difranza JR, Wellman RJ, Mermelstein R, et al. The natural history and diagnosis of nicotine addiction. Current Reviews in Pediatrics. 2011;7(2):88-96.
6 Wagenaar AC. Minimum drinking age and alcohol availability to youth: Issues and research needs. In: Hilton ME, Bloss G, eds. Economics and the Prevention of Alcohol-Related Problems. National
Institute on Alcohol Abuse and Alcoholism (NIAAA) Research Monograph No. 25, NIH Pub. No. 93-3513. Bethesda, MD: NIAAA; 1993:175-200.
7 DeJong W, Blanchette J. “Case Closed: Research Evidence on the Positive Public Health Impact of the Age 21 Minimum Legal Drinking Age in the United States.” J. Stud. Alcohol Drugs, Supplement
17, 108-115, 2014.
8 NHTSA’s National Center for Statistics and Analysis, March 2005. “Calculating Lives Saved Due to Minimum Drinking Age Laws.” Washington, DC, U.S., DOT.
Nearly 90% of smokers started smoking by age 20.1
mature and neurobiologically mature.2
vulnerable.2
THE SCIENCE OF BRAIN WIRING
From neuroscience experiments, we know that the frontal lobe – the seat of human judgment – is not fully wired
until age 25. 3 This is why some describe the period from 18-25 years as emerging into adulthood.2 During this
critical period, the brain remains especially vulnerable to tobacco addiction.4
Delaying the age of initiation of nicotine significantly prevents a lifetime of addiction.
99% of lifetime smokers started smoking before the age of 26.2
.4 ,5
The tobacco industry knew all of this as early as 1982:
“If a man has never smoked by age 18, the odds are three-to-one he never will. By age 21, the odds are
twenty-to-one.” -RjReynolds, 19826
Brain health is public health
1 SAMHSA. Calculated based on the data in the 2011 National Survey on Drug Use and Health.
2 The Surgeon General Report. 2012. “Preventing Youth Tobacco Use.” http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/factsheet.html.
3 Crews et al, Adolescent Cortical Development: A Critical Period of vulnerability for addiction; Pharmacol Biochem Beh, 2007, pages 189-199.
4 Morales et al, Cigarette Exposure, Dependence & Craving are Related to Insula Thickness in Young Adult Smokers; Nature/Neuropsychopharmacology, 2014, pages 1-7
5U.S. Department of Health and Human Services. “The Health Consequences of Smoking —50 Years of Progress: A Report of the Surgeon General.” Atlanta, GA: U.S.
Smoking and Health, 2014.
6 RJ Reynolds. Estimated Change in Industry Trend Following Federal Excise Tax Increase .; 1982. Available at:
http://legacy.library.ucsf.edu/tid/tib23d00;jsessionid=211D4CCF0DBD25F9DC2C9BB025239484.tobacco03
The minimum age of military service does not equal readiness to enlist in a lifetime of smoking.
We will go out of business.
When Needham increased the sales age to 21 in 2005 not a single convenience store went out of business.
Restaurant and bar owners had the same fear when smoking was banned, and this did not happen.1
Tobacco sales to 18-20 year olds are only 2% of retail tobacco sales.2
CVS and Target have decided to stop selling all tobacco products, leaving more tobacco business for
convenience stores.
We make our profits from the ancillary purchases (milk and bread) when people come in to buy cigarettes.
98% of tobacco sales and all associated ancillary purchases will be unaffected.2
18-20 year olds will have more money for other in-store purchases that are not tobacco.
They will just go to other towns and we will lose business.
Lower smoking rates are better for business.
A city or town that creates fewer smokers will have higher socioeconomic status, better health status, better jobs,
and better quality of life for all residents.3
Research has shown a minimal retail impact of raising the sales age to 21.2
In fact, since 2005 in Needham, there is no evidence for youth traveling to other towns to purchase tobacco.
Each town that goes to 21 increases the likelihood that the surrounding towns will also to go to 21.
Small decreases in youth access to retail tobacco are strongly associated with lower tobacco use.
The key point is that youth will quit or use less tobacco, and those who don’t smoke are less likely to start.4,5
We want this to go to the state legislature to make it a level playing field.
The banning of tobacco in bars and restaurants was won on the local level first before it went to the state.
This is a ploy by the Tobacco Industry.
When Utah’s Senator Reid was asked why Tobacco21 didn’t pass at the state level, he explained it to us in
three words: “The Tobacco Lobby.”
1 Hahn, EJ, “Smokefree Legislation: A Review of Health and Economic Outcomes Research,” American Journal of Preventive Medicine 39(6S1):S66-S76, 2010.
2 Winickoff JP, Hartman L, Chen ML, Gottlieb M, Nabi-Burza E, DiFranza JR. Minimal Retail Impact of Raising Tobacco Sales Age to 21. American Journal of Public Health. 2014. In Press.3 2
3 U.S. Department of Health and Human Services. “The Health Consequences of Smoking —50 Years of Progress: A Report of the Surgeon General.” Atlanta, GA: U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
4Scully M, Mcarthy M, Zacher M, Warne C, Wakefield M, White V. Density of tobacco retail outlets near schools and smoking behavior among secondary school students. Aust New
Zealand J Pub Health. 2013;37(6):574-78.
5Henriksen L, Feighery EC, Schleicher NC, Cowling DW, Kline RS, Fortmann SP. Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette
advertising near schools? Prev Med. 2008 Aug;47(2):210-4.
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Big tobacco (RJR and Philip Morris USA) have been working through the retailers.
The arguments you may hear:
What you can’t do until you are 21 years or older:
Buy alcohol
During the Vietnam era, 29 states lowered the alcohol purchase age to 18 and highway death rates
made a significant climb. Raising the sales age back to 21 caused the death rate to drop
significantly.1
Casino gambling
Get a ‘license to carry ‘ gun permit.
Rent a car (must be age 25 – crash rates don’t drop significantly until then)
Rent a hotel room in some hotels.
The argument: If you can go to war and bear arms at 18 you should have the
right to smoke.
The U.S. Army Surgeon General says soldiers who smoke are less combat ready and take
longer to heal.2
Years of studies, including a comprehensive study on 9.3 million military beneficiaries, have
revealed lung cancer mortality rates are double among Veterans.3
Veterans who served to protect our freedom but contracted emphysema from addiction to
the discounted cigarettes in the military have lost their freedom.4
1 DeJong et Blanchette: Case Closed: Research Evidence on the Positive Public health Impact of Age 21 MLDA in the US, Journal of Studies On Alcohol and Drugs/ Supplement
No17.2014 pg108-115
2 http://www.army.mil/standto/archive/issue.php?issue=2012-11-20
3 A Study of Cancer in the Military Beneficiary Population, Guarantor: Raymond Shelton Crawford III, MD MBA, Contributors: Raymond Shelton Crawford III, MD MBA; Julian Wu, MD MPH; Dae Park,
MD; Galen Lane Barbour, MD; Military Medicine, Vol. 172, October 2007
4http://www.iom.edu/~/media/Files/Report%20Files/2009/MilitarySmokingCessation/Combating%20Tobacco%20Military%20for%20web.pdf
Response: The minimum age of military service does not equal readiness to
enlist in a lifetime of smoking.
The U.S. Military is taking steps to ban all tobacco sales on military bases. Easy access to
cigarettes has led to a 33.6% smoking rate among active duty military. 2
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IN FACT:
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NOTES
Contact Us
Jonathan P. Winickoff, MD, MPH Lester Hartman, MD, MPH
jwinickoff@mgh.harvard.edu lester.hartman@childrens.harvard.edu T21_Version 2.0
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