Texas legislators have proposed bipartisan legislation to raise the state’s minimum legal sale age for tobacco products to 21. Legislators and public health representatives – including our two organizations – came together at the Capitol recently to draw attention to the issue. Evidence and experts strongly suggest this policy would have a sharp impact in preventing children from using tobacco and starting down a path that so often ends with serious illness and premature death.
The challenge is clear.
Tobacco use is the leading preventable cause of death in the United States; 20 percent of all deaths and 30 percent of cancer deaths are linked to tobacco use. Despite great strides in reducing smoking, tobacco use still claims more than 480,000 Americans lives each year.
In Texas alone, tobacco’s annual toll amounts to 28,000 lives, more than $8.8 billion in direct health care expenses and another $8.2 billion in productivity losses.
MD Anderson clinicians are daily witnesses to the devastating impacts of tobacco use, including the suffering of both cancer patients undergoing treatment as well as their families. As an institution devoted to ending cancer, MD Anderson applauds the use of sound evidence to inform policy that protects the public health.
Addressing this preventable public health menace requires a comprehensive strategy that includes policy, education and cessation services, especially to those in the greatest need. That’s where Tobacco 21 comes into play.
Approximately 95 percent of adult smokers began smoking before they were 21. Each day in the U.S., about 2,500 children under 18 smoke their first cigarette — and another 400 become daily smokers.
In Texas, every year about 13,700 children become daily smokers; roughly one-third of them will ultimately die prematurely as a result. All totaled, there are nearly 500,000 Texas youth alive now who are expected to die prematurely from smoking.
Raising the tobacco age to 21 will reduce tobacco use among youth and young adults – age groups when nearly all tobacco use begins and that are heavily targeted by the tobacco industry. In addition, the 18-to-21 age range is a critical time when many experimenting with tobacco products become addicted. If we prevent these young people from ever starting to smoke, then most never will. Raising the age to 21 will also help keep tobacco out of high schools, where younger teens often obtain it from older students.
According to data from the Institute of Medicine report, increasing the tobacco age to 21 across the U.S. would, over time, reduce the smoking rate by an average of 12 percent, with the greatest effect in youth ages 15 to 17. The action would lower smoking-related deaths by an estimated 10 percent and result in 223,000 fewer premature deaths.
The report also states that raising the tobacco age would significantly reduce the number of adolescents and young adults who start smoking and immediately improve the health of adolescents, young adults and young mothers who would be deterred from smoking, as well as their children.
We have made great strides in reducing smoking rates among adults and youth, reaching all-time lows of 15.1 percent and 10.8 percent, respectively. However, without action to prevent our children from becoming addicted, we will continue to fight this winnable battle for the foreseeable future.
California and Hawaii already have enacted statewide laws raising the tobacco age, as have several major U.S. cities – including New York, Chicago, Boston and St. Louis – and at least 220 other localities in 16 states.
As a physician and public health advocate, we urge legislators in Texas to consider these facts. Raising the tobacco age to 21 — together with smoke-free laws and comprehensive prevention and cessation services — will save lives. Our duty is to protect the health of our communities, making it essential we do all we can to reduce tobacco use by our young people.
Dr. Hawk is vice president and division head with Cancer Prevention and Population Sciences at the University of Texas MD Anderson Cancer Center. Lee is executive vice president with the Campaign for Tobacco-Free Kids.