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Starting in January, Washington State will limit sales of tobacco and steam-based products – including electronic cigarettes – to people 21 years of age and older. Democratic governor Jay Inslee signed the law last week.
"This bill today will save thousands of lives in the state of Washington," Inslee said, citing statistics on the number of smoking-related deaths.
Washington is not the first state to raise the minimum age to buy tobacco. Several other states have passed laws setting the legal age at 21, including California, Oregon, Maine, Massachusetts, New Jersey and Hawaii. In addition to Washington, a few other states have adopted this policy this year, including Illinois, Maryland and New York. Dozens of cities have also adopted it.
The idea is to prevent teenagers from trying to smoke, so that they never start smoking.
Research suggests that it can work. According to government surveys, about 95% of daily smokers first tried cigarettes before turning 21 years old.
According to a 2015 report by the Institute of Medicine, raising the legal age of tobacco to 21 years would reduce cigarette consumption among 15-17 year olds by about 25%. The same report used simulations to determine that increasing the age of smoking to 21 years could reduce overall smoking rates by 12%.
Part of this simulation and modeling is, however, reinforced by the actual field experience. Here is what has happened so far in a few places that have beaten Washington in power by limiting tobacco sales to 21 years and older.
In Massachusetts, a strict application helps
In 2005, Needham (Mass.) Became the first US city to raise the age of tobacco to 21 years. Four years after the implementation of this policy, Needham has recorded a 47% drop in smoking rates among college students, to a 2014 article published in the American Journal of Public Health.
Neighboring communities that did not ban tobacco sales to those under 21 did not achieve the same results.
"Almost nothing in public health works so well," said Dr. Jonathan Winickoff, a professor at Harvard Medical School and lead author of the study.
Winickoff said that part of the secret of Needham's success lay in the strict application of the law. For the policy to work, especially young people aged 18 and 19 must be prevented from accessing tobacco, he said. This is because these older teens are the most likely to distribute cigarettes or other tobacco products to their younger friends, especially if they are still in the same school.
"If retailers sell to people under the age of 21, the law is relaxed," Winickoff said.
In Needham, the first retailers sold tobacco to someone under the age of 21. They were fined and their license to sell tobacco was suspended for a week. These penalties increased with subsequent offenses.
Winickoff stated that Needham's regulators were not obliged to go to revoke a retailer's license permanently. After a few stores had their licenses suspended, "everyone cleaned up his act and stopped selling to children, "he said.
Here in Washington, Inslee's law last week does not specify the penalties that retailers will face if they break the new law. The Alcohol and Cannabis Commission will clarify these details through a regulatory process in the coming months, a spokesman said.
High compliance in California
California law has been in effect since June 2016 only. However, even in this short time, raising the age of tobacco to 21 seems to have reduced the ability of adolescents to buy tobacco easily.
A recent assessment of the new law examined what happened when California regulators sent teenage lures to buy tobacco as part of compliance checks. After the law of 21 years and older came into force, the number of offenses involving retailers selling teenagers under 18 years of age decreased by about 45%.
"Seeing the reduction in youth sales or violations of the law – this is definitely a big benefit," said Jeffrey Hardesty, head of the research program at the Institute for Global Tobacco Control, which is part of the Johns Hopkins Bloomberg School of Public Health.
It's too early to know how much the law has changed teen smoking rates, Hardesty said. As the California figures suggest, any reduction in youth tobacco sales should generate at least some short-term benefits, he said.
These could include fewer hospitalizations, fewer premature births, fewer babies with low birth weight and fewer cases of sudden infant death syndrome, he said.
Promising data in Hawaii, but more is needed
Hawaii's law came into effect about six months earlier than California's in early 2016.
New data from the survey on the risk behavior of young people in the state show a decline in the rate of smoking among teenagers after the law comes into force. Between 2015 and 2017, the proportion of high school students who smoke decreased from 9.7% to 8.1%. That's more than double the decrease recorded from 2013 to 2015.
New York City, which raised the age of tobacco to 21 in 2014, also reported a decrease in youth use in surveys. Yet further study did not reveal that these reductions were superior to those in other cities.
The New York City study concluded that "the impact in New York may only materialize after a longer period of time" or that the policy may have a greater impact in countries where Tobacco tax rates are lower. (At the present time, national and local taxes on a pack of cigarettes in New York rise to $ 5.85, nearly double what Washington imposes.)
Cathy Callaway, Director of US Campaigns at the Cancer Action Network of the American Cancer Society of the American Cancer Society, said that data on the public health benefits of raising one's age Smoking will become clearer over time. His organization, however, urged more states to adopt this policy on the basis of research already available.
"I think we need more science," Callaway said. "And certainly, having more laws passed this year will help build that science base."
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