Case Closed: Tobacco 21 Laws Don't Work

The latest study of Tobacco 21 laws shows they were a resounding....DUD in terms or reducing young adult smoking, vaping, or smokeless tobacco use rates in the USA.  Being published in a famously anti-tobacco journal, Tobacco Control, the authors of course wanted to put a positive spin on it though nonetheless, as shown below (emphasis ours):  

Results Although we did not find evidence that state T21 laws were associated with cigarette, smokeless tobacco or ENDS [i.e. vapes] use overall, the federal T21 law was associated with lower use of all three tobacco products by 0.39–0.92 percentage points. State flavour restrictions were associated with lower use of cigarettes by 0.68 (−1.27 to –0.09) and ENDS by 0.56 (−1.11 to –0.00) percentage points, but not with smokeless tobacco. A three-way interaction revealed that state and federal T21 laws together were associated with a lower prevalence of ENDS use among 18–20 years, but there were no differences in cigarette use from both policies combined versus either alone.

Conclusion State and federal T21 laws are broadly effective at reducing adult tobacco use, while state flavour restrictions specifically lower use of cigarettes and ENDS.

Got that? The state level laws were useless, period, but the federal Tobacco 21 law passed in December 2019 was somehow "broadly effective" because it appeared to trivially reduce tobacco/nicotine product use by not even a full percentage point.  Never mind that that latter was not enforced until well into 2020, enforcement still remained spotty for a while, and that its passage coincided with two major confounds:  1) the EVALI (vaping illness) outbreak that, while clearly due to adulterated black market THC vape products, was fearmongered by the mainstream media to include all vape products, and 2) the COVID-19 pandemic that, for better or worse, seemed to discourage smoking and encourage quitting, since many people feared that smoking made them more vulnerable to the virus.  But no, it HAD to be due to the Tobacco 21 law, because reasons.  Or something. 

Even flavor restrictions were more effective than Tobacco 21 laws!

So how many IQ points did YOU lose from the mental gymnastics of reading all for the above quoted article abstract beyond the stuff in bold?  The study was behind a paywall of course, so we couldn't delve further into it, granted.  But even a cursory reading of the abstract shows that the Tobacco 21 laws are a joke, and not a very funny one at that.  And worse, it may have even driven some young vapers (back) to smoking, which would clearly be a net public health loss.  But try convincing the zealots of that!

These unimpressive findings dovetail nicely with other studies as well.  As for whether raising the tobacco/nicotine age limit from 18 to 21 reduces the use of such products among people under 18, the evidence for that is very weak and mixed at best.

As for the few previous studies that did appear to find statistically and practically significant effects from the Tobacco 21 laws, those apparent results are most likely a result of short-term effects as well as an artifact of confounders like cigarette tax hikes.  

(Cigarette tax hikes, which mean higher prices, are in fact one of the most effective and cost-effective ways to reduce smoking at the population level, though they still have their limits of course.  And while they may be classist, at least they are not ageist, and they don't blatantly violate anyone's civil rights.)

Regardless, even if Tobacco 21 laws were ever proven to be effective, Twenty-One Debunked would still oppose them on principle, as we believe that in a free society worthy of the name, civil rights inherently supersedes "public health".  That is true in regards to tobacco, alcohol, cannabis, or anything else.  

(Mic drop)

UPDATE:  A few older studies have found modest but significant decreases in retail tobacco sales following the raising of the smoking age to 21 in early adopter states like California and Hawaii.  And another study found no change in overall ever or current smoking among California 18-20 year olds, but did find a modest decrease in daily smoking among that age group relative to 21-23 year olds (whose daily smoking actually increased three years later) in the same state.  This of course echoes Miron and Tetelbaum (2009) as well as Asch and Levy (1987 and 1990), Males (1986), and Dee and Evans (2001) in regards to the 21 drinking age.  That is, endogeneity, early-adopter effects, short-term effects, and seesaw/delay effects all appear to be at play here.  The supposed miracle turned out to be a mirage all along, in other words.  Thus, especially in light of the most recent study discussed in this article, there were really no benefits that cannot be alternatively achieved with higher cigarette taxes and/or better enforcement of the previous 18 age limit, and if anything the 21 age limit appears to be counterproductive in the long run.

UPDATE 2:  Even the CDC's very own 2022 study found mixed and ambiguous effects of Tobacco 21 laws, and such effects sometimes even appeared to differ by race as well (in favor of whites, with null or even perverse effects on young people of color).  Oops!

UPDATE 3:  Another recent study found that while self-reported teen smoking and vaping rates declined after Tobacco 21 laws, biomarker exposure showed mixed evidence at best, implying that fewer young smokers are identifying as smokers (and similar findings for vaping).  Thus, the supposed reductions in smoking and vaping in surveys and sales data are at least largely an artifact of underreporting and cross-border shopping rather than real reductions.  Oops!

How To Make Tobacco Less Appealing And Addictive Without Banning It Or Reducing Nicotine Below Natural Levels

Here is a "Cliffs Notes" style list on how to make cigarettes and other smokeable tobacco products less addictive and appealing WITHOUT banning it outright, raising the age limit any higher than 18, or even reducing nicotine below natural levels:

• First and foremost, BAN ADDITIVES!  No non-tobacco ingredients should be added, period.
• Adding extra nicotine deliberately should also be banned as well.
• Require the smoke pH to be 8 or higher to discourage deep inhalation of smoke, as it naturally was prior to the 20th century. 
• Phase out the pH-lowering and environmentally unsustainable practice of flue-curing tobacco. 
• Phase out cigarette "filters", which don't really filter, and merely provide a false sense of security to smokers, and inherently creates a major toxic waste littering problem to boot.

If they still want to reduce maximum nicotine levels to a non-addictive level in ready-made commercial cigarettes and little cigars, go right ahead.  But it would be best to do the other things on the list first.

Also, banning the use of radioactive (!) phosphate fertilizers to grow tobacco is really a textbook no-brainer in terms of tobacco harm reduction. 

Additionally, requiring all tobacco products to be sold only in dedicated tobacco stores, or other places where you have to be 18 or older to enter, would really not be a bad idea either.  It would certainly make it less ubiquitous, convenient, and tempting without the constant reminder in grocery stores, convenience stores, gas stations, pharmacies, etc.

So what are we waiting for?

A Better Way To Phase Out Tobacco

California is now seeking to emulate New Zealand, Norway, Singapore, and the Philippines in phasing out tobacco products with a permanent generational ban on the sale of such to anyone born on after January 1, 2007.  Twenty-One Debunked has generally opposed such an idea on principle, as we had discussed previously.   Not only is it inherently ageist, and further promotes black markets, but it will drag it out and take decades to have the desired endgame effect.

Here's a better idea, that the FDA is already currently considering:  Reduce the maximum allowable nicotine levels in commercial cigarettes, and perhaps other combustible tobacco products, to a non-addictive or sub-addictive level.  This idea, or at least some flavor of it, has long been endorsed by many stakeholders and pundits the world over, from the American Medical Association to Robert N. Proctor to Malcolm Gladwell.  And Twenty-One Debunked has endorsed it since 2013, ideally keeping the legal age limit at 18 (which Congress and Trump unfortunately raised to 21 in late 2019, much to our chagrin).

By that, it means reducing nicotine levels by 95% or so from current levels, down to no more than 0.5 mg/g (0.05%) of tobacco.  Crucially, this would apply to nicotine content, not "delivery," as the latter can be gamed and manipulated too easily.

If done smoothly and gradually enough, and leaving noncombustible tobacco and nicotine products untouched, this will dramatically reduce smoking rates for all ages, and thus save thousands if not millions of lives without creating any more of a black market than already exists from high cigarette taxes alone.  Pairing it with a tax hike (within reason) would also increase its effectiveness as well.

Even if the new nicotine limits applied only to the sale of pre-rolled cigarettes and quasi-cigarettes like little cigars, and nothing else, it would likely still have the desired effect.  That is because those are the products that really drive the deadly tobacco epidemic.

It could be done in either one step with some lead time, or a few steps over a period of months to a year or two, for all cigarette manufacturing and importation going forward, plus an additional year to clear out excess inventory.  Doing it in a few steps would probably be better overall we think.  Either way would probably be fine though. 

Banning the use of additives, which are largely all about increasing the addictiveness of the products, would also make sense as well.  Michigan already has an excellent law on the books, that bans any "deleterious" ingredient or anything "foreign to tobacco" being added to cigarettes.  It needs enforcing.

Redesigning the cigarette to have a more alkaline smoke pH of 8 or higher, as it typically was prior to the 20th century, would make it less appealing and harder to inhale at least for new smokers.  Most cigars and pipe tobacco are already like that currently. 

And for the love of all that is good, ban the use of radioactive phosphate fertilizers yesterday!

Another good idea would be to only allow tobacco products to be sold in designated or dedicated tobacco-related stores (i.e. smoke and vape shops) and/or places that one needs to be 18+ to enter.

As for nicotine vapes, capping the maximum nicotine content at current European or Israeli levels (lower than USA levels but still generous) would reduce overall nicotine addiction rates without driving vapers back to smoking cigarettes.

Do these things and the desired endgame can be achieved in a matter of months to years, not decades.  But that would make too much sense, right?

FUN FACT:  Hemp-based, tobacco-free "blunt wraps" are now commercially available, so even the classic use of hollowed-out cheap tobacco cigars for rolling cannabis blunts is now thoroughly obsolete as well. 

UPDATE:  Apparently New Zealand will, starting in 2025, mandate that only very low nicotine cigarettes (VLNC) be sold, similar to what we advocate above.  Also, in 2024 they will sharply reduce the number of tobacco retail outlets by 90-95%, and ban the sale of cigarettes at kiosks, gas stations, or supermarkets.  This will be in addition to their generational ban for anyone born after January 1, 2009.  Thus, the generational ban is completely redundant and unnecessary, given the other two components.  And also the price of a pack of smokes there, $36 NZD, is the equivalent of over $20 USD (that is, more than a dollar per cigarette!) thanks to their already high taxes, making it a very expensive habit as it is.

And vape products would remain unaffected. 

Twenty-One Debunked's preferred plan, in a nutshell, is basically the New Zealand plan MINUS the generational ban and keeping the age limit at 18, plus a few other things above listed above.

UPDATE 2:  Bhutan, the only country in the 21st century that had completely banned tobacco across the board, has failed so miserably in doing so (thanks to the black market and international smuggling, and despite very stiff penalties too) that they ended up reversing their ban in 2021, largely out of fear that rampant cross-border smuggling would.... increase the spread of Covid.  Seriously, you cannot make this stuff up!  This should really be a cautionary tale.

Awkward Turtle! Mitch McConnell Wants To Raise Federal Tobacco And Vaping Age To 21

In 2019, there seems to be one thing that Big Tobacco, JUUL Labs (which sold out to Big Tobacco), most anti-tobacco groups, Sen. Elizabeth Warren (D-MA) and Sen. Majority Leader Mitch "Awkward Turtle" McConnell (R-KY) can all agree on.  And that thing is a federal Tobacco 21 law that raises the sale age limit for all tobacco and vaping products to 21 nationwide.  Politics certainly does make some very strange bedfellows indeed!

This would require an act of Congress, of course, as the FDA is explictly denied (as they should be!) the authority to raise the federal age limit any higher than 18.  And unlike the drinking age where the feds had to make an end-run around the Constitution to coerce states to raise their drinking ages to 21, this time they will not have to do so and can simply set a federal age limit of 21.  They already set a federal age limit of 18 as of 2009, so that law can very easily be amended.  Crucially, this law  only applies to the age limit for sales, and only sellers are targeted and penalized (unlike the drinking age in which public possession by young people is an offense), so this is still within Congress’s authority.  

Except, of course, for the substantive due process and equal protection argument invoking the 14th Amendment, since the age limit would be higher than the age of majority, but that is a separate issue from state's rights and the 10th Amendment.  And that can potentially be challenged in court, albeit as a VERY uphill battle.

Thus, this bill is likely to pass, unfortunately.  Write your Congresscritters and convince them to oppose it.  And point out all of the other things they can do instead:

• Raise the federal cigarette tax, apply it to the producer level, and set a national price floor to discourage interstate smuggling.
• Create a federal vape products tax on all nicotine-containing vape juices and pods, ideally proportional to nicotine content.
• Ban fruity and candy flavors in any nicotine-containing product.
• Cap the nicotine content of vape products down to European and Israeli levels.
• Give out free nicotine patches, gums, inhalers, etc. to any smokers who want to quit (NYC already does this.)
• Consider gradually phasing down the maximum allowable nicotine content of combustible cigarettes to a non-addictive level.
• Consider gradually phasing out menthol cigarettes like Canada did and the EU is in the process of doing.
• And last but but not least, enforce existing laws better in terms of the current 18 age limit for tobacco and vaping products.  In fact, amend the Synar Amendment and Program to raise the passing grade for retailer compliance checks from the currently low bar of 80% to 90% and then 95%, and include vape products.  

But do NOT raise the age limit any higher than 18.

We Know Who To Thank For The "Epidemic" In Teen Vaping (Fearmongers, We're Looking At YOU!)

The FDA found that, according to new 2018 survey data, vaping is up nearly 80% (78%) from 2017 among high school students and up nearly 50% (48%) among middle school students.  Previously, teen vaping had increased 900% from 2011-2015 (while also displacing combustible cigarette smoking which is now at a record low, mind you), dropped slightly in 2016, and held steady in 2017 before this much more recent increase in 2018 that is believed to be driven by flavored vapes, particularly the JUUL brand which didn't really catch on until late 2017.

The recently announced FDA restrictions, in which flavored vapes (other than mint, menthol, and tobacco) will no longer be sold in stores unless those stores prohibit the entrance of people under 18, are largely a reaction to such data.   But let's look at the sequence of events here:  despite JUUL being founded in 2015, it is unlikely that many people had ever even heard of JUUL until the fearmongering mainstream  media's moral panic began in 2017, providing the very best (and free!) advertising that JUUL could ever possibly dream of.  Thus, we all know who to thank for that--fearmongers, we're looking at YOU!

If they really want to reverse this media-induced deviancy amplification spiral, the best thing for the media and the FDA is to simply STFU now that the new regulations are a foregone conclusion.  Also, reducing the maximum nicotine content of vape products (JUUL is apparently unusually high) down to European and Israeli levels would also make it less likely that young experimenters would get hooked.  But of course, that would make too much sense.