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February 21, 2018

Lawmakers in Alabama are considering increasing the smoking age from 19 to 21. Proponents of the change claim it would help curb smoking rates, but the proposal would also extend the age to “alternative nicotine products,” including e-cigarettes, vaping devices, and smokeless tobacco, thereby disregarding the public health benefits provided by these products. If successful, this effort would not only limit adults’ choices, it would negatively impact the state, which would lose tax revenue provided by these products. Further, it would create an incentive for adults to purchase tobacco, e-cigarettes, and vaping devices in neighboring states, taking even more money away from Alabama’s coffers.


In nearly every other sense, individuals are considered adults at 18. They can serve in war, are tried as adults in courts, and they can accumulate massive debt in contractual agreements, such as student loans, which in 2016 averaged about $30,000. If individuals aged 18–20 can join the military and be tried as an adult in court, shouldn’t they be permitted to choose to use tobacco products?


Increasing the tobacco age limit has not proven effective in deterring consumption. The National Institute on Drug Abuse noted 58 percent of high school seniors reported consuming alcohol in 2015, and 35 percent reported using marijuana. Both of these substances are illegal for persons aged 21 and under to use in every state, yet their illegality does not indicate a connection between lower consumption rates and age restrictions.


Regarding tobacco use, the Centers for Disease Control and Prevention reports nearly 90 percent of tobacco users started by age 18. Research also shows underage youth rely on “social sources” for tobacco products, including siblings, friends, parents, and strangers; age restrictions won’t solve this problem. The U.S. Drug and Food Administration found “86% of 15 to 17 year olds obtained cigarettes by asking someone else for cigarettes or being offered cigarettes by someone.”


Perhaps the most important issue with the Alabama proposal is that it would include tobacco harm reduction (THR) products, including e-cigarettes, vaping devices, and smokeless tobacco, such as snus. Literature and studies continue to indicate these products are significantly less harmful than combustible cigarettes and therefore should be regulated differently.


For instance, in a 2009 BioMed Central study, after analyzing “the relative risk of cancer among smokeless tobacco users, compared with non-users of tobacco,” the authors found “very little evidence” of a greater risk of cancer by smokeless tobacco products. Brad Rodu, a senior fellow at The Heartland Institute, has more than 20 years of experience researching smokeless tobacco. According to Rodu’s research, smokeless tobacco is “at least 98 percent safer than smoking, even though most Americans are misinformed about the differences in risk.”


Additionally, e-cigarettes and vaping devices are also important THR products that should not be included in mandates regulating tobacco. E-cigarettes and vaping pose a significantly lower health risk than combustible tobacco. In 2018, the National Academies of Sciences, Engineering, and Medicine found e-cigarette use to result in “reduced short-term adverse health outcomes in several organs.” Other public health organizations had reached the same conclusion. In 2017, NHS Health Scotland found using e-cigarettes is “less harmful than smoking.” In 2016, the Tobacco Advisory Group of the Royal College of Physicians in the United Kingdom determined the health hazards associated with THR products are “unlikely to exceed 5% of the harm [caused by] smoking tobacco.” In 2015, Public Health England declared e-cigarette use as roughly “95% safer than smoking.”


THR products such as e-cigarettes and vaping devices could alleviate costs to states’ budgets, too. J. Scott Moody, chief executive officer and chief economist at State Budget Solutions, estimates Medicaid savings could have amounted to $48 billion in 2012 if e-cigarettes had been adopted in place of combustible cigarettes by all Medicaid recipients who currently consume tobacco products.


Lawmakers in Alabama should avoid limiting adults’ choices and instead consider promoting THR products, a decision that would likely help to improve health outcomes in the Yellowhammer State.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute or Tobacco Harm Reduction 101.

Centers for Disease Control and Prevention Link Majority of Vaping-Related Hospitalizations to THC: Welcome
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