Dr. Richard Feldman: Congress should pass Tobacco 21 legislation now

It appears that Congress will accomplish what the Indiana General Assembly could not: increasing the legal age for the purchase of tobacco products to 21. To date 14 states and 470 localities have passed “Tobacco 21” legislation. This legislation is an important part of the comprehensive effort to prevent youth initiation of a lifelong deadly addiction.

There are two Senate bipartisan bills introduced requiring this age threshold for the purchase of tobacco and vaping products nationwide. Nice to see Congress working together on something. There is also an introduced bipartisan House companion bill.

One bill is authored by Sens. Mitch McConnell, a Republican from Kentucky, and Tim Kaine, a Democrat from Virginia. Both are from tobacco-growing states, which makes the authorship of this bill even more significant. Both senators expressed that the motivation for this bill was twofold: to address the high cancer and other tobacco-related disease rates in their states and to curb the staggering explosion of e-cigarette use nationwide by youth. The bill appropriately does not exempt military personnel (supported by the military) and does not contain any state preemption preventing additional stronger legislation.

Bill critics point to the fact that the measure requires each state to pass supplementary Tobacco 21 laws or risk losing federal substance abuse block grants. State Tobacco 21 laws are apt to contain provisions, aggressively pursued by the tobacco industry, which block other state actions to reduce tobacco and vaping use, benefiting the tobacco industry’s special interests.

The more appealing bipartisan bill, winning the endorsement of many public health groups, is the Tobacco To 21 Act. It was introduced by several senators including Indiana’s Sen. Todd Young. I generally do not agree with Sen. Young’s political perspectives, but I admire him for this move to do the right thing for the health and future well-being of America’s youth. The authors’ stated rationale for the new legislation is like that expressed by Sen. McConnell and Kaine. It’s a simple, clean bill without the state requirement for enacting additional legislation and includes strict and multi-faceted federal enforcement mechanisms.

The tobacco industry (including Juul Labs, the e-cigarette heavyweight) supports Tobacco 21 legislation. This support is clearly not a sincere reflection of industry concern for the health of children. It’s to shield the industry from threatened FDA actions, including additional vaping product restrictions and even product removal from the market because of its past promotion to youth. The industry concurrently works aggressively in states to weaken or defeat tobacco-control measures. And contrary to their recent public statements, it works to preserve sweet-flavored tobacco and vaping products, so appealing to youth and fueling the epidemic of youth vaping. Tellingly, Juul and tobacco giant Altria have not endorsed a Tobacco 21 House bill introduced by two Democrats that includes banning flavored tobacco products.

Tobacco 21 legislation makes sense. Ninety-four percent of individuals begin smoking before age 21, and 90% of individuals who purchase tobacco for minors are under 21. Between the ages of 18 and 21, many young smokers move from experimentation to regular daily use. Youth e-cigarette use has skyrocketed recently without abatement and ultimately could unravel all our progress in tobacco control. This legislation will reduce youth initiation of tobacco and vaping, lower smoking prevalence by 12%, and decrease premature deaths among those born between 2000 and 20019 by 223,000.

Tobacco 21 will be a significant health advancement for youth and a blow against the tobacco industry empire.•

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Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to ibjedit@ibj.com.

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