We Need Tobacco 21 Legislation Now

Who knew that candy apple, bubble gum, cherry cola, marshmallow, orange soda, s’mores, chocolate, and taffy were literally so addictive? Every one of those flavors – and thousands more! – are available in e-cigarettes today. Tobacco and e-cigarette use – seductively called vaping – are increasingly sucking our youth into a lifetime quicksand of addiction with health and financial costs certain to follow.

A coalition of many partners, including the American Cancer Society Cancer Action Network, American Heart Association, American Lung Association in Texas, Texas Medical Association, Texas Hospital Association, and numerous health systems throughout the state, have come together as Texas 21 to save lives by preventing tobacco use. One simple legislative change that Texas 21 supports can impact hundreds of thousands of lives down the line: raising the age to buy tobacco products to 21.

Almost all smokers start before age 21. In Texas alone, more than 10,000 kids become daily smokers every year. Lest you think raising the age to buy tobacco products to 21 is a radical idea, six states have already done so, as well as hundreds of cities across the country (including San Antonio in 2018). In fact, more than a quarter of the nation is covered by such T21 legislation.

My home county – Angelina County in deep East Texas – has the dubious distinction of ranking dead last in Texas for health behaviors according to the Robert Wood Johnson Foundation (accessible online at www.countyhealthrankings.org). Our higher than average adult smoking rate is a major factor in that determination. If we are to change the health behaviors of an entire county, we must address some factors more globally. Smoking is one of them.

Raising the smoking age to 21 will not have a big economic impact on retailers, as only 2% of US cigarette sales go to those under age 21. But the long-term impact on our taxes, of which too much goes to smoking-caused healthcare, will be significant. In Texas, Medicaid costs caused by smoking amount to almost $2 billion annually. Total annual healthcare costs in Texas directly caused by smoking reach nearly $9 billion. If fewer kids start smoking, we will – over time – see a significant decrease in smoking-related expenditures. Not to mention that our kids will enjoy longer and healthier lives.

Our children are so vulnerable to influence when they are in their early teens. On average, kids in the US try smoking for the first time even before they are 14 years old. They get their first cigarettes from older teens. Most high school seniors can legally buy cigarettes even before they graduate high school, because the legal age to purchase currently is 18. This gives younger teens easy access to nicotine and tobacco though their peers.

States and cities that have enacted T21 legislation have seen a significant drop in youth smoking initiation. The Institute of Medicine (now the Health and Medicine Division of the National Academy of Medicine) notes that raising the tobacco sale age will not only significantly reduce the number of adolescents and young adults who start smoking, it will reduce smoking-caused deaths and immediately improve the health of adolescents, young adults and young mothers who would be deterred from smoking, as well as their children.

It’s not just about cigarette smoking, though. E-cigarettes must be included in any T21 legislation. The tobacco industry, seeing overall declines in US smoking rates, cleverly (and sinisterly) purchased e-cigarette companies and began refining and marketing these nicotine delivery systems to our kids. Vaping became mainstream.

The power of the tobacco industry to addict people to nicotine is evident in the fact that e-cigarette company Juul – in which tobacco giant Altria owns a large stake – has grown quickly to be worth as much as $38 billion by some estimates. Juul’s annual revenue is said to be $2 billion. Addicting teens with flavors like mango, creme brulee, and mint has resulted in more kids using electronic cigarettes than regular cigarettes. In fact, e-cigarette use among youth is now considered to be an epidemic.

Juul and other vaping devices are not toys. Evidence continues to build that for young people, using e-cigarettes increases the likelihood of smoking cigarettes. Some of the chemicals in e-cigarettes are harmful as well. And the effects of nicotine on developing brains are not fully known. Especially worrisome is evidence that nicotine can cause impaired brain development, especially of the prefrontal cortex, which affects judgement and impulse control. To flavor a highly addictive chemical and sell it to children is not only sinister and dangerous; it is appallingly profitable for the very tobacco companies who have been driving up our healthcare costs killing us with cancer, heart disease, COPD, and many other illnesses for decades.

What can we do right now? Polls show nearly 70 percent of voters across party lines favor T21 legislation. Over half of voters strongly favor it. Sen. Joan Huffman and physician Rep. John Zerwas have introduced Senate Bill 338 and House Bill 749 — both of which include e-cigarettes — to protect kids from tobacco addiction and save lives by raising the tobacco age in the state to 21. This something we can all agree on. Let’s pass T21 legislation in Texas this session.

The Truth about Big Tobacco

There was some big, big news recently that you probably haven’t heard. After years of legal wrangling, the tobacco industry has not only been found guilty of fraud, conspiracy, and racketeering, but they have been ordered to run television and newspaper ads admitting the truth that they fought so hard to suppress for decades.

Let’s go back to the beginning. It was more than 50 years ago, in 1964, when Luther Terry, the 9th Surgeon General of the United States, issued a landmark report linking smoking to lung cancer and a host of other diseases. Since that time, Big Tobacco lied, deceived, and in every way engaged in a no-holds-barred battle against every attempt to regulate or curtail the sale of tobacco products. In the meantime, tens of millions of U.S. citizens have died prematurely from tobacco use.

In 1999, the Department of Justice took on Philip Morris and other tobacco giants under the Racketeer Influenced and Corrupt Organizations Act (RICO), alleging that the tobacco companies had engaged in a decades-long conspiracy to (1) mislead the public about the risks of smoking; (2) mislead the public about the danger of secondhand smoke; (3) misrepresent the addictiveness of nicotine; (4) manipulate the nicotine delivery of cigarettes; (5) deceptively market cigarettes characterized as “light” or “low tar,” while knowing that those cigarettes were at least as hazardous as full flavored cigarettes; (6) target the youth market; and (7) not produce safer cigarettes.

Seven years later, in 2006, Federal District Court Judge Judy Kessler ruled that Philip Morris and other tobacco companies engaged in fraud, conspiracy and racketeering – all to deliberately deceive the American public about the health risks of smoking and secondhand smoke. Her ruling noted that Big Tobacco had “marketed and sold their lethal product with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success exacted.” Judge Kessler ordered that these companies admit their guilt publically by running newspaper and television ads detailing their deception.

It took eleven more years – and a lengthy appeal process – for Big Tobacco to finally agree to any sort of public mea culpa about the health effects of smoking and their role in addicting hundreds of millions of people. Their watered-down admissions of guilt (known in legal parlance as “corrective statements”) will appear in about 50 newspapers and for a year on major television networks. One startlingly honest (and obvious) fact that must be publicized is that Altria, R.J. Reynolds Tobacco, Lorillard, and Philip Morris USA intentionally designed cigarettes to make them more addictive.

Think about that. At a time when we rightly are criticizing pharmaceutical companies for how they market pain medications (which actually have a therapeutic use), we still give a pass to the companies that market the most addictive, useless, and deadly product around. At least Big Tobacco now must admit publically that “More people die every year from smoking than from murder, AIDS, suicide, drugs, car crashes, and alcohol combined.”

Other statements you may see are, “Many smokers switch to low tar and light cigarettes rather than quitting because they think low tar and light cigarettes are less harmful. They are not,” and “There is no safe level of exposure to secondhand smoke.” Sadly, we have known all of this for years. No, decades.

These ads started on November 26, but I have yet to see one myself. I wonder if anyone who needs to see them will see them. Major newspapers and even television are not the way our vulnerable youth consume media these days. I am sure Big Tobacco is counting on that.

In the meantime, tobacco sales continue at a brisk pace. A Wall Street Journal article in April of this year noted that revenues for U.S. tobacco companies hit $117 billion in 2016, up from $78 billion in 2001, despite lawsuits, rising taxes and declining smoking rates. Americans spent more than $90 billion on cigarettes in retail stores last year.

Stores that sell tobacco products today are complicit in the very deception that Big Tobacco is guilty of. The retail markup of tobacco products, according to the Wall Street Journal, is 17%, higher than that on groceries. No wonder grocery and convenience store chains put tobacco products front and center in their stores – or even out in front of their stores. Easy money. Dirty money.

The conservative/libertarian argument about supply and demand and “personal choice” is, pardon the pun, smoke and mirrors when people are knowingly addicted to the product in question. Cigarettes are not sugar water. I don’t mind companies making a profit – even obscene profits – as long as it isn’t by addicting us and killing us.

If nothing else comes from this mea culpa – these “corrective statements” – I hope tobacco and related products become so regulated and so taxed that not only is it not possible to become addicted, but it is too expensive for our youth to even consider starting. Nothing short of a world without tobacco will do. Perhaps that is a pipe dream, but our kids are worth it.