Do Tobacco 21 Laws Really Work?

A recent study claims that Tobacco 21 laws work to reduce teen tobacco use.  But upon closer examination, there is less here than meets the eye.  While this new nationwide study controlled for a host of other variables and spanned from 2012-2019, it still leaves the reader with more questions than answers.  

For example, the supposed effect in survey data in grades 8, 10, and 12 was statistically significant for combustible cigarettes, particularly for grade 12, but NOT for vape products at any grade level, while for the Nielsen sales data the apparent effect was much larger for vape products than combustible cigarettes.  How exactly can this glaring contradiction be explained away?  Also, no significant effect was observed on heavy smoking, which intuitively should have had the largest effect size of all due to heavy smokers facing the greatest "hassle costs" when cigarettes become even somewhat more difficult to obtain.  And even for cigarette smoking in general, the absolute difference-in-differences was a few percentage points at most, for a substance whose popularity and prevalence was already declining among all ages long before the age limit was hiked to 21 (in contrast to vaping, which increased dramatically among young people during this period).

Furthermore, the study did not look beyond the first two years post-enactment of such laws, so any observed effects may very well be merely short-term effects (cf. Miron and Tetelbaum 2009 for the 21 drinking age and alcohol-related traffic fatalities).

Interestingly, the study authors do concede that at least some of the observed effect on people under 18 is a result of increased ID checking and increased perception of risk of of tobacco products.  Of course, we know that it is not really necessary to raise the age limit higher than 18 to achieve such effects.

Overall, this nationwide Tobacco 21 study (the second of its kind) was rather less impressive that an earlier nationwide study by different authors, for reasons that are not entirely clear.  But it is very likely a repeat of what we like to call "The Incredible Shrinking Effect Size", a phenomenon that we have seen before with studies of the 21 drinking age over time.  Which means that it was most likely a statistical mirage all along, at least in the long run.

Regardless of what sort of effects, or lack thereof, that Tobacco 21 laws supposedly had, we at Twenty-One Debunked nonetheless oppose such laws on principle 100%, just like we oppose the 21 drinking age and toking age as well.  Let America be America Again!

UPDATE:  A recent pro-21 article made a Freudian slip about what happened since Texas raised their smoking age to 21 in 2019:

"Since then, the use of tobacco by teens decreased from 21.8% in 2019 to 19.1% in 2021, according to the CDC and the American Lung Association."

That is NOT a particularly large difference in teen tobacco use (which includes both smoking and vaping), especially since teen vaping had already peaked by 2019 and teen smoking had already been plummeting for decades.  Technically, the latter data were from the 2020 Texas School Survey, not 2021, and the 2019 data were from the CDC YRBS, as each survey is done only every other year.  But either way, the point still stands.  In fact, when compared to the 2018 TSS data, the 2020 TSS data are almost identical.

2023 UPDATE:  The study in question has been recently revised, but not in a way that materially alters any of the above conclusions or criticisms.  In fact, reading between the lines, not only does the results look even less consistent and statistically significant than before, but now the effect size on survey results seems to be much larger for vaping than for smoking at all grade levels, implying that some vapers have likely switched to smoking.  That makes the Tobacco 21 policy a net public health loser.

What About Tobacco, Again?

The Biden administration is currently considering two new sweeping FDA rules affecting combustible tobacco cigarettes:  1) banning menthol cigarettes and flavored cigars, and 2) reducing nicotine levels, presumably to a non-addictive level.  Where we stand on these two potential changes is as follows:

The first one, Twenty-One Debunked is on the fence about that, as we can see both sides of that issue, noting that Canada has already banned menthols and the EU has phased them out, while also noting the inconvenient truth of racism and how it intersects with this issue as well.   The flavored cigars we generally lean against banning, while for menthol cigarettes we believe that if they must do it for whatever reason, they should phase them out more gradually and allow existing stocks to be sold well after the designated "quit date" for selling newly manufactured menthols.  Also, possession and consumption of menthols should NOT be banned or punished, and police should NOT go out of their way to target the sale of menthols or "loosies" in underprivileged neighborhoods with people of color.

(For what it's worth, quit rates in Canada have improved significantly since their menthol ban, particularly among formerly menthol-preferring smokers.  That lends credence to the idea that menthol enhances the overall addictiveness of tobacco by making the high nicotine levels less harsh on the throat, which also makes it easier for young experimenters to pick up the habit in the first place.)

The second one, reducing nicotine levels, Twenty-One Debunked has cautiously supported since 2014, and we still do, provided that all of the following are true:

• The phasedown of nicotine to a non-addictive level is done gradually and stepwise over a period of at least a year, in at least three stages.
• The sale of existing domestic stocks of cigarettes above the nicotine cap can continue at least six months after the "quit date" for manufacturing and importing cigarettes above that cap (at each step of the phasedown).  
• The possession/consumption of cigarettes with nicotine levels above the cap is NOT banned or punished.
• The only other tobacco products subject to the same cap shall be little cigars (below a certain size), perhaps all cigars with a smoke pH below 8, and possibly loose roll-your-own cigarette tobacco and/or pipe tobacco with a pH below 8.  Nothing else, period.  We would be fine with, and would actually prefer, if only pre-rolled commercial cigarettes and little cigars (the size of cigarettes) were subject to the nicotine cap.  
• The addition of any harmful or addictive additives to all newly manufactured tobacco products is banned effective immediately as well.  All additives must meet the same standards as for additives to food.  Radioactive fertilizers for growing tobacco must also be banned as well.

While the effectiveness of the flavor ban is a bit questionable at best, the nicotine cap and phasedown would likely greatly reduce the prevalence of tobacco smoking and associated disease and death, simply by making this conveniently deadly product by design far less addictive.  More people would quit fairly quickly, and fewer people would take up the habit in the first place.  And people who miss the old high-nicotine smokes of yore would still be free to use alternative tobacco and nicotine products.

And doing it gradually enough will make it so there is no more of a black market for higher-nicotine cigarettes than there is for incandescent light bulbs.

As for vaping, Twenty-One Debunked does not support such a massive reduction in nicotine levels to that proposed for combustible cigarettes, but rather we support reducing the nicotine content in vape products to the maximum levels permitted in the EU, UK, and Israel.  That would nix the super-addictive ones that notoriously get young people hooked within seven days (JUUL, we're looking at you!) while still allowing plenty of nicotine for adult vapers who are trying to quit smoking.  (Twenty-One Debunked does NOT recommend anyone take up vaping, except as a last-ditch effort for truly hardened and refractory adult smokers who cannot quit any other way.)

Of course, we also think the smoking age should be lowered back to 18, just like we feel about the drinking age and toking age.  We are not called Twenty-One Debunked for nothing, after all.  Raising the age limit to 21 was at best useless, and is an ageist abomination.  In the meantime, though, the above is our nuanced and well-thought-out stance on the latest tobacco-related measures being proposed. 

FINAL THOUGHT:  By the way, the fact that they use the "think of the children!" argument to justify the banning of menthols and flavored cigars, is really just a tacit admission that raising the smoking age to 21 was essentially useless in keeping cigarettes and cigars from "trickling down" to people under 18.

The Federal Smoking And Vaping Age Has Been Raised To 21

Well, it's now official.  As part of a must-pass budget bill to avoid yet another government shutdown, Congress attached several provisions unrelated to spending, most notably a rider that hikes the federal age limit for the sale of tobacco and vape products from 18 to 21 nationwide.  And on December 20, 2019, Trump signed it into law, and even had the GALL to brag-tweet about it.  And while Republican Senate Majority Leader Mitch "Awkward Turtle" McConnell, a big supporter of the age limit hike, was no doubt very pleased with himself for his "victory", we need to remember that both duopoly parties overwhelmingly supported it.  Tyranny is apparently as bipartisan as it is whimisical--and very cowardly as well.

For practical purposes, the new age limit actually takes effect after 180 days plus an additional 90 days, meaning an effective delay of nine months from the date of signing.  Thus, by September 2020, Tobacco 21 will have been fully phased in nationwide.

The text of the new federal Tobacco 21 law does two things:  1) amends the Family Smoking Prevention and Tobacco Control Act of 2019 by changing "18" to "21", and 2) while it technically no longer forces states to change their own laws (unlike the original version), nonetheless amends what was once called the Synar Amendment by requiring states to enforce (against vendors) the new federal age limit of 21 for the sale of tobacco and vape products, in order to quailfy for certain substance abuse prevention grant monies.

Though weaker than its original version, it is that second provision that may prove to be the Achilles heel of this law if it were to be challenged in court, on both Tenth Amendment as well as Fourteenth Amendment.  And if such a challenge ever proves successful, it will no doubt also overturn South Dakota v. Dole, and the National Minimum Drinking Age Act along with it.  But until then, it is long past time to be very, very angry at what passes for "leadership" in America's long, dark night of the soul.

Winter is coming, in more ways than one.

UPDATE:  Looks like the FDA isn't wasting any time in raising the tobacco and vape product sale age to 21.  As of December 27, 2019, they officially noted on their website that it is now illegal to sell tobacco or vape products to anyone under 21.  FEH.

Pennsylvania Raises Smoking Age To 21

It's official, Pennsylvania just raised the legal age limit for tobacco products from 18 to 21, effective July 1, 2020, making them the 19th state (and counting) to do so.  And the new law also expands the legal definition of tobacco products to include vaping products as well, since apparently they didn't even have an age limit for vaping products at all (though the federal age limit of 18 applied by default from 2016 onwards).

The part about including nicotine vapes in the definition of tobacco products is totally reasonable.  But raising the age limit to 21 is really not justified at all.  And Pennsylvania had been seeing so much progress in reducing teen smoking and vaping already, mainly due to tax hikes on both.  It would really be a shame to risk derailing such progress now with such an utterly illiberal and ageist law.

Yes, there is an exception in the new law for active military and veterans, who only need to be 18 or older instead of 21 to buy tobacco products.  But that one silver lining does still not make it OK to deny adult rights to otherwise legal adults over 18 who are legally old enough to join the military, regardless of whether they are actually in the military or not.  Thus, the exception does not actually resolve the inherent ageism and hypocrisy of this otherwise bad law.

I like to joke about "the other Tri-State Area", where NY, NJ, and PA all meet.  Port Jervis, NY, Montague, NJ, and Matamoras, PA are all right next to each other, and Matamoras is basically "come for the fireworks, stay for the cigarettes", since fireworks are legal in PA to sell to nonresidents, cigarettes are cheaper in PA, and the age limit in PA for tobacco has been 18 (until July 2020) while it is 21 in NY and NJ.  Looks like the tobacco part of that equation will no longer be true, at least the age limit part, and the price difference is also narrower now for cigarettes, and reversed for vape products, due to the tax hikes.  And gas is also more expensive now in PA than either of the other two states, while NJ gas is almost as pricey as NY now.  Thus the whole microeconomic dynamics of "the other Tri-State Area" are fundamentally different now, except for the fireworks of course.

It's Not Just JUUL: The (Un-)American Vaping Association (And Trump) Also Throws Young Adults Under The Bus

As Trump announced the other day that his administration is looking at, among other things, raising the federal age limit for vaping products from 18 to 21 (which would require an act of Congress), the president of the American Vaping Association, Gregory Conley announced that he (and by extension, his trade group) openly supported the move as an alternative to prohibition.  Such a stance of regulatory appeasement by throwing 18-20 year old young adults under the bus to protect the vaping industry is cowardly at best, and will ultimately backfire as well.

And it is also all the more nonsensical given how the mysterious vaping lung illness that is sweeping the nation is driven primarily by black-market or counterfeit THC cartridges, not legal and legitimate nicotine vapes, and literally on the same day it was announced that they found further confirmatory evidence that the additive Vitamin E Acetate in the rogue THC cartridges is most likely the main culprit in causing this illness.  It is basically a thick, greasy oil that was NEVER meant to be inhaled, and can cause lipoid pneumonia when one does so.  Though likely other additives or contaminants could be causing it as well, such as cadmium fumes from the jankier vape devices themselves, since not all cases are consistent with lipoid pneumonia, and may be cadmium pneumonitis or metal fume fever instead.  And the Trump trade war with China may have led companies to shift to the use of cheaper and lower-quality devices and cartridges from 2018 onwards, ironically.

Thus, we at Twenty-One Debunked hereby excommunicate the American Vaping Association, just as we already did with the quislings at JUUL Labs.  And we can also add Trump 45 to the list as well now.  May their names and memory be forever blotted out.

New Tobacco 21 Study Leaves Us With More Questions Than Answers

A new and very preliminary study of recently-passed Tobacco 21 laws appears to find that such laws significantly reduce tobacco smoking (both recent smoking and current and established smoking) by as much as 39% among 18-20 year olds.  The study looked at survey results of 1869 18-22 year old young adults in 2016-2017 in 48 states and DC (excluding New York and Massachusetts), and compared those in states and localities that raised the tobacco age to 21 versus those that did not, and further compared 18-20 year olds versus 21-22 year olds, after adjusting for potential confounders such as cigarette taxes as well as demographics and parental and peer smoking.

However, there are still reasons to be skeptical of these findings:

• Correlation is not causation, and there may still be selection bias, reporting bias, and residual or unmeasured confounding.
• Only a few states and localities had an age limit of 21 for tobacco in 2016-2017, especially when New York and Massachusetts are excluded.
• In some of these few Tobacco 21 states/localities, the number of individuals surveyed was in the single digits.
• Even if these results are 100% due to the hike of the age limit to 21, the study may only be measuring short-term effects since the laws are so recent and only data from 2016-2017 were used.  More longitudinal data are needed.
• Such "early-adopter" effects may not be generalizable or durable, as we saw with the 21 drinking age according to Miron and Tetelbaum (2009).
• Data were collected from November 2016 through May 2017, and yet New Jersey was listed a Tobacco 21 state even though their law didn't go into effect until six months later in November 2017.  Thus, we noticed at least one potential coding error.
• California raised the cigarette tax significantly as of April 1, 2017, within the period of the study.  And Illinois and Chicago have raised their cigarette taxes several times in the years before and after Chicago's Tobacco 21 law that was implemented in 2016.
• Smoking was already on the decline nationwide long before any Tobacco 21 laws were passed, and the data are not adjusted for pre-existing trends.
• Vaping was not examined in this study, and in any case all of the data was from before the JUUL craze came on the scene.
• And most importantly, the study did NOT look at people under 18 at all.

Thus, these results are preliminary at best and need to be taken with at least a grain of salt, if not a whole pound.  Especially since, as we previously reported, according to the YRBSS data there is really no robust correlation between high school smoking or vaping rates and whether the smoking/vaping age is 18, 19, or 21.  And even in this new study of 18-22 year olds, the effects were limited to only those who had already tried cigarettes before, and that typically occurs well before 18.  But wait, isn't the strongest pro-21 argument that Tobacco 21 laws would reduce smoking (and vaping) among people under 18?

And for what it's worth, there is no evidence that Tobacco 21 laws (all of which now apply equally to vape products, by the way) have done anything to reduce the JUUL craze that began in very late 2017 and apparently continues unabated to this day in all states and localities regardless of the age limit.

Also, it just so happens that yet another recent and preliminary study was done, this time longitudinally using BRFSS data of 18-20 year olds from 2011-2016 compared to 23-25 year olds, and comparing the local tobacco age limits by metropolitan/micropolitan statistical area (MMSA).  This study, which was driven by even earlier adopters (mainly city and county-level Tobacco 21 ordinances), did find statistically significant reductions in current established smoking by 18-20 year olds that were not found for 23-25 year olds.  But the devil is really in the details, since the effect size was rather small (1.2 percentage points, and at most 3.1 percentage points in some models) for practical purposes, and may still have been driven by reporting bias, selection bias, and/or differential sensitivity by age to tobacco tax hikes at the same time.  And given how effect sizes for later adopters of any given policies tend to shrink over time compared to earlier adopters, these results do not look particularly encouraging.  Especially since a cursory look at the trendlines in the study finds that the slight divergence in smoking rates that emerges in 2014-2015 re-converges and essentially disappears by 2016, suggesting that the findings are likely driven by short-term effects rather than longer-term effects.

Bottom line:  it looks like the supposed benefits of raising the smoking/vaping age to 21 were, shall we say, all smoke and mirrors, at least for people under 18.  The supposed success of Needham, MA, for example, was likely a statistical fluke and/or a result of endogeneity, much like the "early adopter" effects of the first few states to raise the drinking age to 21 creating that particular mirage in the 1980s.  Or perhaps increased enforcement in general relative to neighboring towns did the trick regardless of the age limit, like it did in Woodridge, IL and several other communities the 1990s with an age limit of 18.  Studies show that whenever vendor compliance exceeds 90-95%, there is indeed a dramatic drop in teen smoking regardless, by as much as 50% compared with previously weak enforcement and low compliance rates, especially for the youngest teens.  More recent research bears this out as well, for teen smoking as well as vaping.   And keep in mind that those who make it to 18 without smoking are far less likely to take up this deadly habit later on.

This all should be food for thought for policymakers debating not just the age limit for tobacco, but also for alcohol, cannabis, or anything else for that matter.  And even if such benefits of the 21 age limit were real, we at Twenty-One Debunked would still not support an age limit any higher than 18, on principle alone.  Old enough to fight and vote = old enough to drink and smoke.  'Nuff said.

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 Hereby Excommunicate JUUL Labs

(Editor's Note:  Twenty-One Debunked has never been affiliated in any way, shape or form with JUUL Labs or any other vaping, tobacco, alcohol, or cannabis company.  And we never will be, either.)

Dear JUUL Labs,

Since you were founded in 2015 as a spinoff from Pax Labs, you have always presented yourselves, at least publicly, as the underdog saving the world in the fight against the evil Big Tobacco.  Little did America know that you were about to pull the wool over everyone's eyes and make fools, and then cynics, of us all.

Why do we hate thee, JUUL?  Let us count the ways:

• You loudly proclaimed yourselves as the enemy of Big Tobacco, but you began to copy their playbook awfully quickly in terms of advertising to young people and cynically attempting to implement your own "anti-vaping" progams in schools. (You claimed that was just an oversight.)
• You chose a much higher nicotine level for your products than other vape brands, by far.  That was most likely to try to edge out the competition, and it worked--at the expense of a new generation of nicotine addicts, that is.
• You lowered your nicotine content when selling in the European Union and Israel (who by law set the maximum allowable nicotine content of vape products much lower than the American version of your products), but curiously still do not offer such reduced-nicotine products in the USA, or any nicotine-free products.
• Until very recently, you failed to adequately warn users that your products contain nicotine and are addictive.  Many young people did not even know that all JUULs contain nicotine, let alone such a high level of it.
• When the FDA finally blew the whistle on you, you responded in the most cowardly way possible.  You decided to throw young adults under the bus by calling for the age limit for vaping products to be raised from 18 to 21, and you banned 18-20 year olds from your website.  And you still made no significant changes to your highly-addictive products, save for the removal of a few flavors.
• And worst of all, you literally SOLD OUT to Altria Group (aka Philip Morris), whose name is literally synonymous with Big Tobacco.  You know, the evil industry you once claimed to be fighting against?  Your deal with the devil may have made you richer and bought you some temporary protection, but everything comes with a price, and your day will come very soon.

Thus, in light of the above grievances, we hereby excommunicate you.  Here is your bell, book, and candle, you cowardly quislings.  Now go take your crack nicotine and shove it!

Say It Ain't So, Governor Cuomo! New York State To Raise Smoking/Vaping Age To 21

No, this is NOT an April Fool's Day joke.  New York State is now set to become the eighth (or ninth?) state to raise the age limit for tobacco and vaping products to 21.  The legislature passed it, and Governor Cuomo is expected to sign it.  If (really, when) he does, it will take effect in 120 days.  Which is very, very soon.

Many counties and cities in the state, including NYC and most of its "backyard", already set the age limit at 21.  That of course includes my home county of Westchester, which raised it from 18 to 21 last year.

The only silver lining is that the new age limit of 21, like the old age limit of 18, will only apply to vendors, as it will still not be illegal for "underage" people to possess or consume tobacco or vaping products.   But that still does NOT mean we should support it one bit!

With the "bookend" states of California and New York now down, plus several other populous and not-so-populous states, not to mention hundreds of localities across the country, and even our nation's capital, is our movement lost for good?  We sure hope not.  It looked like the Tobacco 21 movement had stagnated last year, but now with New York, Utah, and possibly Washington State next to jump on the bandwagon, perhaps we got too complacent last year.  It certainly does NOT bode well for any near-future attempt to lower the drinking and toking ages to 18!

Hindsight is 2020, both the year and the vision.

We Already Know How To Reduce Teen Smoking and Vaping Without Raising Age To 21--So What Are We Waiting For?

A recent study in the medical journal Pediatrics only confirms what Twenty-One Debunked has been saying all along.   That is, tougher enforcement of the minimum sales age limit of 18, directed at vendors, does in fact lead to lower smoking as well as vaping rates among teens, and these lower usage rates apparently persist even after such youth reach the legal age to buy such products.

In this study, the proxy for tougher vendor enforcement was the grade (A through F) by the American Lung Association (ALA) on the strength of the local tobacco retail licensing (TRL) laws in the jurisdictions studied.  Strong TRL laws imply more frequent retail compliance checks with decoys, since such laws require licensing fees that make the program self-funding, and fines and penalties for violations such as failed compliance checks.  This in turn would lead to higher retailer compliance rates in adhering to the age limits for sales, and thus reduced access for youth below the age limit.  The study looked at various localities in California, in January-June 2014 and again in January 2015 through June 2016, while the age limit was still 18.

Unsurprisingly, jurisdictions with a grade of A (strong) for their TRL laws indeed had much lower teen smoking and vaping prevalence rates in the surveys compared to those with grades of D or F (weak).  At the same time, the ALA grades given for other local tobacco control laws (such as smoke-free laws) in place at the time did not seem to have much if any effect on youth smoking and vaping prevalence rates, and were statistically insignificant.

Thus, even though teens can still often manage to get cigarettes and such from their older friends and relatives (i.e. social sources), the net effect of restricted retail availability to people under 18 is significantly and persistently lower youth smoking and vaping rates.  Apparently generosity has its limits, and any forbidden fruit effect (reactance theory) of the age limit itself is outweighed in practice by greatly reduced access and convenience when retail compliance rates are very high, especially for younger and/or less mobile teens.  For example, if one in five retailers is willing to sell to people under 18, that is still pretty easy to get, but if only one in 20 retailers is willing to do so, that becomes very inconvenient to acquire and sustain a habit, especially in towns with only a few retail outlets.  Remember, a license to sell temptation goods like cigarettes and alcohol is practically a license to print money, and retailers would not want to jeopardize that by breaking the law when the law is strictly enforced with swift and certain sanctions for violations.

And while cigarette taxes were not studied here, since there would not have been within-state local variation in taxes, one should note that an older landmark study found that the two most important predictors of teen smoking rates over time (inversely) were 1) tax/price, and 2) retailer compliance rates.  This was particularly true for daily smoking rates.

Such results dovetail nicely with those of the famous studies of Woodridge, IL and Leominster, MA, in the 1990s that found that sustained tougher enforcement directed at vendors greatly reduces youth smoking rates without having to raise the age limit any higher than 18, and without having to involve the criminal justice system at all.  Now if only such logic would be applied to alcohol and cannabis as well.

And lest anyone claim that this would not apply to alcohol with a drinking age of 18, keep in mind that this is precisely what happened in the UK with both alcohol and tobacco upon implementing increased retail enforcement combined with higher tax rates on both substances.  So what are we waiting for?

To Governor Cuomo: Do NOT Raise Smoking Age to 21!

Dear Governor Cuomo,

First, we at Twenty-One Debunked, and I personally as a New Yorker, would like to thank you for supporting cannabis legalization, albeit with some nuance.  We also would like to thank you for standing up to Trump whenever possible thus far.

That said, we at Twenty-One Debunked simply cannot get behind your recent proposal to raise the age limit for tobacco and vaping devices from 18 to 21.  We believe it is an unnecessarily ageist policy to set the age limit any higher than the current age of majority, which is 18 in New York.  Thus, first and foremost, we oppose such a policy on principle--just as we feel the same way about the drinking age and the soon to be legal toking age as well.

And while there are already several counties, including NYC and its entire "backyard", such as Westchester County where I live, that have raised the smoking and vaping age to 21, there is really no hard evidence that it reduces youth smoking rates compared to keeping it 18.  The same goes for other states and localities that have raised their age limits in recent years.  In fact, to the extent that it makes vaping devices harder for 18-20 year olds to get, it could easily steer current vapers back to smoking, which would clearly not be good for public health.

So what can be done instead to further reduce already low and falling smoking rates for both youth and adults?

• Tobacco taxes can of course be hiked further, though in New York they are already the highest in the nation, and even higher still in NYC.  And there is already quite a black market for contraband cigarettes now.  
• The current age limit of 18 can of course be more vigorously enforced, as there is still room for improvement in terms of retailer compliance rates.
• Limit and reduce the number and density of outlets that sell tobacco products (for example, your plan to ban tobacco sales in pharmacies).
• Build on NYC's already successful smoking cessation program, with free nicotine patches and gum available for all smokers who wish to quit.
• Advertising restrictions to the greatest extent that the US Constitution will allow.
• Counter-advertising, such as the Truth campaign, has been shown to work wonders in other states like Florida and California.
• Consider phasing down the maximum allowable nicotine content of cigarettes to a non-addictive level.
• For e-cigarettes, cap the nicotine content of vape products down to European and Israeli levels (JUUL, we're looking at YOU).

Thus, we ask that you please reconsider your support for the 21 age limit for tobacco and vaping, and we hope you will realize that keeping it 18 is the right thing to do.

Sincerely,
Ajax the Great, Twenty-One Debunked

About That Tobacco Endgame Strategy

With all the fanfare about the FDA's crackdown on vaping, and then menthol cigarettes on the horizon as well, they have also been quietly mulling over another initiative since at least July 2017 if not earlier:  reducing the nicotine content of manufactured combustible cigarettes to a minimally addictive or non-addictive level.  This is something that Twenty-One Debunked has long discussed, and has generally supported, since 2013.  And it truly has the potential to be a game-changer.

However, Twenty-One Debunked also feels that there is a right way to do so, as well one or more wrong ways to do so.  Currently, as several anti-smoking groups caught wind of the FDA's still-tentative proposal, they have been making recommendations on how to do it--mostly in the direction of the wrong ways.  As for the right way, Twenty-One Debunked recommends the following:

• Phase the nicotine content limit down to 0.4 mg/g gradually rather than immediately, over of a period of at least one year but no more than five years.
• If decided to implement in a single step, have a delay of at least six months to a year between finalization of the rule and the effective date.
• Allow existing non-compliant inventories to be sold, applying the nicotine limits only to products manufactured or imported after the effective date of such limits.
• Exempt large cigars, defined by size or weight of tobacco, as well as pipe tobacco (which can be defined as having an alkaline pH that is a bit harder to inhale).  While still addictive and harmful, the tobacco epidemic is not driven by these products.
• And of course, exempt smokeless tobacco.
• For vape products, cap nicotine levels at current European and Israeli levels (but no lower).  Note that nearly all brands, with the notable exception of JUUL, would already be compliant.
• And of course, DO NOT raise the age limit for any of these products any higher than 18.  Ever.  Period. 

Why?  Because any quicker or stricter than the above would be practically begging for a black market and its attendant externalities, and can backfire royally.  And we really need that like a hole in the head.

Rather, we should think of manufactured combustible cigarettes and little cigars the same way we did with A19 incandescent lightbulbs effective 2014.  Did we really end up missing those?  Was there ever a black market for those?  Gee, I wonder why.   And now, four years later, the cost of LED bulbs has plummeted so much, to the tune of 90%, that they are now available in Dollar Tree and similar dollar stores.

Gradually and gingerly is the best way to do it.  And any fears of harmful compensatory behavior (i.e. puffing harder and deeper, and/or smoking more cigarettes) during the relatively brief phasedown period can be rendered moot by simply raising the federal cigarette tax a bit again, if we must.

Food for thought indeed.

Has the Tobacco 21 Movement Already Crested?

The ignoble experiment to raise the legal drinking age to 21 in the 1980s has generated much controversy despite the political and media pseudo-consensus favoring it, and we at Twenty-One Debunked have, well, debunked it time and again.  Of course, the data from the 1970s and 1980s on which nearly all drinking age studies are based are now quite outdated, as the USA is almost a completely different country now.  So what if there was a way to re-run this same natural experiment today?

Well, it turns out that there is, albeit with a different psychoactive substance:  Tobacco 21 laws have proliferated since 2012 and especially since 2015, mostly at the local level but increasingly at the state level as well (with Massachusetts being the most recent one to do so).  And what were the results?  A big nothing in terms of teen smoking rates, basically.  There has been essentially no hard evidence that there was any sort of correlation between a state's or locality's tobacco age limit vs. their teen smoking (or vaping) rate, period, regardless of whether it was 18 or 21 (or, less commonly, 19).  Thus, raising the age limit from 18 to 21 has been an unnecessarily ageist endeavor, and one can thus easily extrapolate these results to alcohol and cannabis going forward as well.

True, from 2013 to 2017, there was a massive drop in teen and young adult smoking.  But that was more likely due to the explosion of vaping during that time than any other factor, and happened in states in localities that kept their age limits at 18 all along as well as those who raised them.  Which, by the way, also debunks the laughable idea that vaping is somehow a "gateway" to combustible cigarettes--if anything, raising the age limit for e-cigarettes/vapes may even steer young people back towards combustible cigarettes according to some studies.

As for Chicago's supposed success story in terms of reduced smoking rates in the first year after hiking their age limit to 21 in 2016, note that Chicago also recently hiked their cigarette tax as well, to make their cigarettes some of the most expensive in the nation.  Pennsylvania also hiked their own cigarette tax while leaving their age limit at 18, and if anything Philadelphia has seen more progress in reducing teen smoking than Chicago from 2013-2017 according to the YRBSS.  Thus, no causal link has been proven.

And while the Tobacco 21 movement luurrrves to gloat about their very first victory in the Boston suburb of Needham, MA, they conveniently ignore another Boston suburb, Cohasset, where teen tobacco use actually increased in the year following enactment of their own local Tobacco 21 law.

Some may dismiss the relevance of tobacco age limits to alcohol (or cannabis), of course, but keep in mind that just a few years ago, Tobacco 21 advocates actually predicted that raising the age limit for tobacco to 21 would be more effective that raising the drinking age to 21 was in the 1980s.  Tobacco is far more addictive, which in economic terms means that while the short-run elasticity is lower than for alcohol (or cannabis), the long-run elasticity is higher than for these other substances.  And easy access to a daily or almost daily source is thought to be far more important for tobacco as well.  Thus, the failure of Tobacco 21 laws to have any meaningful impact on teen and young adult smoking rates would also apply a fortiori to alcohol and cannabis as well.

The Tobacco 21 movement now seems to be running out of steam, as their initial euphoria pinned on irrational exuberance is fading fast.  This year, only one state raised their smoking age to 21, compared with three states last year and two states in 2016, and fewer localities have changed their laws this year as well.  The momentum is almost completely gone now.

And the fact that Big Tobacco has now recently jumped on the Tobacco 21 bandwagon (yes, really), after at least feigning opposition at first, shows that the movement has jumped the proverbial shark, and is now tainted as well.  Strike three, yer out!

2018 is almost over, and the current 2010s decade is also almost over as well.  Let this be the time now to flush the idea of the 21 age limit (for any age-resticted product) down the toilet for good with all of the other dumb things from this despicable decade.

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.

FDA and New York Take Aim at Flavored Vapes

After much saber-rattling with JUUL and other leading vape manufacturers, the FDA now plans to ban the sale of most flavored vape products (except mint and menthol) in retail stores and gas stations to reduce availability to young people.   Flavored vapes would only be allowed to be sold in vape shops and tobacco shops, and online sites with strict age verification measures.  New York State plans to go even further, banning the sale of flavored vapes entirely, much like San Francisco has already done.

Oh, and the FDA also apparently wants to ban menthol combustible cigarettes as well, because they are believed to be harder to quit than non-menthols (though that is probably due to their generally higher nicotine content, the harsher taste of which is masked by the menthol).  All other flavors have already been banned as of 2009.  This particular ban, however, will likely take much longer to finalize and longer still before it is actually enforced.

Twenty-One Debunked has mixed feelings about these bans.  On the one hand, they are in some ways still better than hiking the age limit to 21, and there is some truth to the idea that fruity flavors may make nicotine-containing vapes seem more benign than they actually are, increasing the likelihood of accidental addiction among young people.  On the other hand, these bans, though modest, can also be a slippery slope and even perhaps a boon to Big Tobacco.  So while we do not oppose these bans, we are still a bit wary about them nonetheless.

What would probably have the largest effect in terms of reducing the number of young people getting hooked on vaping is capping the maximum allowable nicotine content of vape products down to European and Israeli levels.  Over there, JUUL reduced their nicotine content so they can be sold in those markets, and such products remain effective smoking cessation devices with a somewhat lower likelihood of accidental addiction happening quickly  among young experimenters.  Meanwhile, in the USA, there is a joke that the unusually high-nicotine JUUL products sold here are kinda like the horror film The Ring: you will get hooked in seven days.  Not really far off the mark.

The best thing to stop the "epidemic" of teen vaping, of course, is to stop fanning the flames of moral panic.  After such modest bans like the ones discussed above are in place, hopefully the mainstream media will finally STFU about this supposed "epidemic".

UPDATE:  On November 13, 2018, JUUL announced that they will no longer restock any orders to retailers for any flavored vape pods other than tobacco or menthol, and will only continue selling them online to people 21 and older, and will also end all social media promotions as well.  So it looks like 18-20 year old vapers who prefer such flavors will need to stock up very fast at their local stores before they run out.

And as of November 15, the FDA will go ahead and pursue the aforementioned regulations.  The new regulations may not be fully implemented for months in the case of flavored vapes, and years in the case of menthol combustible cigarettes, but are essentially a foregone conclusion now.  Flavored vapes, except for mint, menthol, and tobacco, will only be sold in stores that do not allow people under 18 to enter or have separate sections that disallow people under 18. 

Thus, in their zeal to pre-empt regulators, it looks like JUUL is being unnecessarily ageist towards 18-20 year olds.  And why can't JUUL just offer a nicotine-free option for pods, and reduce their sky-high nicotine content in their current ones to European levels?

Smoking Tobacco May Actually Be Eradicated By 2030

Well, in the UK at least, particularly in England, according to a new report.  The British currently have the second lowest smoking rate in Europe after Sweden, and only slightly higher than the USA, and rapidly falling for the past several years.  And if current trends of the past five years continue, smoking rates will drop below 5% of the adult population (what researchers define as a "smoke-free" country) by 2030.  Given that nearly half of British adults smoked in the early 1970s, this is no small feat.

And the real kicker?  This is all happening without raising the smoking age to 21, as it is currently 18 (just like their drinking age) with no plans to hike it any further.  The Tobacco 21 fever currently sweeping the USA by storm simply hasn't caught on over on the other side of the Atlantic.  And unlike in the USA, there is no moral panic over vaping either.  If anything, Public Health England encourages current smokers to switch to vaping to help them quit.  These kinds of ageist American-style moral panics, with very few exceptions, are really quite foreign to them.

And come to think of it, after an initial boom in e-cigarettes for a few years, even vaping is now on the decline as well.   It appears that's what happens when you don't turn something like that into a media circus / moral panic / deviancy amplification spiral.

It is things like this that almost make us wish that Britain, our mother country, would just revoke America's hard-won (but subsequently squandered) independence.  (Tongue firmly in cheek, of course.)

Guess Who Now Openly Supports Tobacco 21 Laws? Go On, Guess...

Tobacco 21 laws, or laws that raise the age limit to buy tobacco products to 21, are unfortunately gaining popularity as a sort of "feel good" measure despite the relative dearth of evidence backing them up.  Well, now we can add a new name to the list of supporters:  Philip Morris Altria Group.  That's right, a company whose former name is literally synonymous with Big Tobacco now supports, whether grudgingly or otherwise, a smoking age of 21 (even at the federal level) despite at least feigning opposition just a few years ago followed by awkward silence on the topic.

So why the sudden turnaround?  Probably a cynical combination of public relations as well as the realization that raising the smoking age to 21 (compared to 18) in several states and localities did NOT really end up hurting their bottom lines after all.  And even more cynically, they can perhaps now leverage the arguably enhanced forbidden fruit effect to their own benefit, all while patting themselves on the back for their "corporate social responsibility".

(RALPH!)

You know, kinda like they did all along (to one degree or another) when the age limit was 18, and like the alcohol industry has done with the 21 drinking age.  Put up a public fight at first, take a dive, stay quiet for a few years, then publicly support the new laws while leveraging them (and simultaneously fighting against higher taxes or any new regulations).  Quislings.

Thus, it is safe to say that our cynicism is now fully maxed out.  And that really says something indeed.

Do Tobacco 21 Laws Really Work?

One preliminary study seems to think so about California's law that raised the age limit to buy tobacco and e-cigarettes from 18 to 21 as of June 9, 2016.  But the devil is really in the details.  The study did not, I repeat, did NOT, look at actual teen smoking rates, only the degree of retailer compliance as measured by decoys, which did in fact improve since then in terms of sales to people under 18.

The two problems with this logic are 1) it is not necessary to raise the age limit to 21 to discourage retailers from selling to people under 18, as simply better enforcement against scofflaw vendors would do the trick, and 2) survey data do not really show any decrease in teen smoking that can be unambiguously linked to the policy change, whether in California or elsewhere with a Tobacco 21 law.  Teen smoking dropped nationwide from 2015 to 2017, and while it dropped somewhat faster in California, keep in mind that California also raised their cigarette tax significantly during that time, by $2.00/pack, and Pennsylvania saw an even larger drop in teen smoking despite keeping the age limit 18 and a cigarette tax hike of $1.00/pack, only half as large.

As we have noted before based on survey data for the past few years, there is really no robust correlation between a state or local smoking age (whether 18, 19, or 21) and the teen (or adult) smoking rate.  The strongest predictors of both teen and adult smoking are the tax/price of cigarettes and the prevailing social attitudes towards smoking, and in fact prices seem to have a larger effect on young people than adults.  It is practically axiomatic.  Retailer compliance is also inversely correlated with smoking by people under 18, but again it has proven to be entirely possible achieve nearly 100% compliance without raising the smoking age any higher than 18, as long as there is the political will for it.  And it doesn't even require the criminal justice system at all, since the best tobacco-control success stories involved only administrative penalties (i.e. fines and/or tobacco license suspensions) against rogue vendors.  Nor does it require criminalizing young people themselves.

If anything, if NYC is any indication, retailer compliance actually deteriorated following their age limit hike from 18 to 21 in 2014.  This was in spite of heavy crackdowns against contraband tobacco during that time.  In any case, while teen smoking rates declined in NYC following the law change, they did not drop any faster than the rest of the state or the nation as a whole, in fact they declined at a slower rate in NYC compared with the control locations, and teen vaping actually increased despite the fact that the law applied equally to e-cigarettes as well as combustible cigarettes.  If that's "success", we would really hate to see what failure looks like.

And in fact, this also once again calls into question how effective the 21 drinking age (and now toking age in some states) is as well.  Spoiler alert:  not very.  Thus, if there is a silver lining to the recent hike in the smoking age to 21 in some states and localities, it is that re-running this same failed social experiment with a different age-restricted psychoactive substance only to see it fail yet again in more modern times, a fortiori, is probably the strongest evidence against the very concept of such ridiculously high age limits in general.  If you give the pro-21 crowd enough rope...

Israel's (and Europe's) Non-Ageist, Cool-Headed Response to Vaping

Unlike in the USA, it seems like cooler heads are prevailing in Israel and in the EU when it comes to vaping.  Rather than respond from a position of moral panic over teen use, which only fuels the deviancy amplification spiral, they instead took a much more measured public health response.  Israel recently banned JUUL due to its unusually high nicotine content, and almost immediately afterwards, JUUL began selling the same reduced-nicotine version there that they have already been selling in the UK and Europe to comply with EU regulations.  And interestingly, Israel doesn't even have an age limit for vaping.  (It varies in Europe, and is 18 in the UK.)

The kernel of truth to the concern about youth vaping in the USA has to do with the nicotine, which is hardly a benign substance.  It is a highly addictive drug as well as a known neurotoxin, especially for the early adolescent brain, and yet some teens apparently don't realize that vape juices and pods even contain nicotine at all.  And with JUUL's high nicotine content, by the time some young experimenters realize that it has nicotine, they may already be hooked.  That said, vaping is still safer than smoking, and it seems to be making a dent in reducing youth and adult smoking rates, which are currently at a record low, as well as increasing successful quit rates among adults.  That means that vaping is literally saving people's lives.

The best balancing act would probably be to stop panicking and to cap and reduce the maximum allowable nicotine levels for vape juices/pods to European and Israeli levels.  The FDA already has the authority to do this.  Alternatively, or in in addition, taxing vape juices/pods based on nicotine content would also be a good idea as well.

And stop panicking already!  Seriously, this moral panic is the best free advertising that JUUL and other vape companies could ever possibly dream of.

Oh, and by the way, there is zero evidence that raising the age limit to 21, as was done in several states and localities recently, has had any measurable impact on teen vaping OR smoking rates compared to states and localities that kept it at 18.  And since the apparent success of Needham, MA still has yet to be replicated anywhere, it would be most parsimonious to consider them an outlier, with factors other than raising the age limit being the real underlying causes of success.

Tempest in a Vape Pod: Let's Be Adult About This

Just a few months ago, we at Twenty-One Debunked posted an article about the latest moral panic to sweep the nation: teen vaping, particularly Juuling.  Well, that particular moral panic is now at (or approaching) its ultimate crescendo as we speak, with the FDA not only cracking down on retailers who sell to people under 18, but going so far as to give vendors an ultimatum of sorts:  either they come up with a plan within 60 days to tackle youth use of their vape products, or such products will be pulled from the market.  Such fighting words, aimed primarily at JUUL, have been prompted by largely unpublished data showing an alleged "epidemic" of teen vaping.

Wait, what? Oh, they must mean the "epidemic" where a whopping 2.4% of high school students in 2017 (2.0% in 2015) nationally reported daily vaping.  (And that is the total--keep in mind that among never-smokers, such figures are even lower still, at 0.3%)  Or maybe they mean the "epidemic" in which e-cigarettes have become more popular than combustible cigarettes in terms of experimentation and casual use, and regular vaping is making a dent in displacing regular smoking, but regular vaping among never-smokers still remains vanishingly low, and the use of combustible cigarettes has fallen to a record low.

Yes, you read that right.  A record low. Smoking cigarettes is decidedly "uncool" these days.  And by some measures, vaping has already crested and it too has also declined a bit as well since its 2015 peak.

So what should we make of all this?  First, don't panic, lest we continue to fuel a deviancy amplification spiral rather than let this fad burn out on its own.  The good news, we must repeat, is that combustible tobacco consumption is now at a record low among young people, and still falling.  And again, vaping is actually rarely used by teens who have never also tried combustible cigarettes.  If anything, vaping in general (including, but not limited to, Juuling) is displacing combustible cigarettes on balance, and is significantly safer as well--perhaps even 95% safer by some estimates.  The bad news?  Vaping is, of course, not completely safe, as most vape juices (including all JUUL brand ones, even if its users don't realize it) do contain nicotine, which is highly addictive and is even a known neurotoxin, particularly for the developing early adolescent brain.  Other concerns include the relative lack of regulation as to how these things are made and what sort of contaminants may be lurking inside, but again, it still pales in comparison to the dangers of combustible tobacco cigarettes, which contain literally thousands of other nasty chemicals as well as nicotine, including many known carcinogens, mutagens, and teratogens.  So insofar as vaping displaces smoking, it is a net win for public health.

For currently addicted smokers of any age trying to quit, vaping can literally save their lives upon switching, and we must remember that no matter how much of a fever pitch the ridiculous moral panic over teen vaping ultimately reaches.  Seriously.

Secondly, we should note that this apparent fad exists even in states and localities where the age limit is 21 for both smoking and vaping (or at least for buying these things), including New Jersey.  Thus, raising the age limit is unlikely to solve anything in that regard compared with keeping it 18 and enforcing it on vendors the same as with combustible tobacco products.  Keep in mind that until fairly recently there was no age limit at all for vaping devices and liquids/pods in many states and localities.

And finally, there are practical ways of reducing any potential harm from all of this:

• Regulate vaping devices and juices/pods the same as combustible cigarettes (but no stricter), and require strong quality control standards and testing
• Warning labels alerting users about the fact that they contain the highly addictive drug nicotine
• Tax nicotine-containing vape juices/pods by weight or volume adjusted for nicotine content (but much lower than combustible cigarettes)
• Increase the number of nicotine-free vape juices, particularly for JUUL brand ones which currently lack such options 
• Consider banning or phasing out any vape juices/pods that have fruity, floral, or any other non-neutral or non-tobacco-style flavors unless they are completely nicotine-free ones
• Consider capping/reducing the maximum nicotine content in vape juice/pods, as is already the case in the EU and now in Israel as well.
• Educate the public, especially young people, on the truth about vaping, particularly with an eye towards preventing accidental addiction to something that they may not even realize contains nicotine at all
• Social norms marketing to help defuse any deviancy amplification spiral

Most importantly, we need to see the forest for the trees, and stop tilting at windmills already.

And most ironically of all, this moral panic driven by irresponsible yellow journalism is literally the very best (not to mention free) advertising that JUUL and other vape companies could ever dream of.  Despite being founded in 2015, it is unlikely that very many young people (or anyone else for that matter) had ever even heard of JUUL until it became at the center of the scare stories that started in 2017 and especially 2018.  And if the alleged unpublished increase in teen vaping in 2018 relative to 2017 does turn out to be real, well, we really know who to thank for that!