Tobacco 21 Laws' Benefits Are An Illusion

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!

Looks like it was all just another mirage, kinda like with the 21 drinking age.  What next, a study that finds that water is wet and the sun rises in the east?

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!

Latest California Smoking Age Study More Smoke Than Fire

Last month, a new study looking at the results of California's smoking age hike from 18 to 21 in 2016 turns out to be less than meets the eye.  The study, looking at BRFSS survey data for 18-20 year olds pre versus post implementation, found that, compared to 21-23 year olds in California and to 18-20 year olds in the eight comparison states, 18-20 year olds did not see any significant change in the rate of decline of current or ever smoking, but did see significantly faster declines in the rates of daily smoking in the three years after the age limit was hiked to 21 versus before implementation.  Interestingly, vaping was not examined at all due to apparent data gaps at the time, so this study says absolutely nothing about vaping.

While the part about daily smoking sounds impressive on the surface, one should keep in mind that cigarette taxes were hiked by $2.00/pack in 2016 (effective April 2017), and generally the younger a person is, the more price-sensitive they are since they tend to have less disposable income, and furthermore the earlier they are in the course of their tobacco habits.  So it would stand to reason that the tax hike alone, which makes regular and especially daily smoking that much more of an expensive burden on the smoker, would have had a larger impact on 18-20 year olds than 21-23 year olds in California.  That would also explain why current or ever smoking (which were essentially not affected at all) would be much less affected than daily smoking as well.  

Of note, Pennsylvania had also raised their cigarette tax in 2016 yet still kept their age limit at 18 (until July 2020, that is), yet interestingly that state was NOT one of the eight comparison states.  The results of this study would thus likely have been very different if Pennsylvania was one of the comparison states.

Alternatively, some of the progression to daily smoking may simply have been delayed by a few years by the age limit hike, yielding no real long-run benefits, kinda like some studies have strongly suggested about drunk driving deaths when the drinking age was raised to 21.  Indeed, by 2019 the daily smoking rate among 21-23 year olds was actually a bit higher than it was in 2016.

And as we have previously noted, in NYC and elsewhere, raising the smoking age to 21 does not seem to actually reduce high school smoking rates compared with keeping it 18, so the "trickle-down" theory that is often used as a specious justification for Tobacco 21 laws is very unlikely to be the case in California (or anywhere else) either.

Thus, this study is more smoke than fire.  And regardless, we at Twenty-One Debunked would still oppose the 21 smoking age on principle regardless of its effects.  Young adults who are old enough to go to war, be tried as adults, etc. should NOT have the state dictating what otherwise legal substances they choose to put into their own bodies at all, period.  Seriously.

And that is a hill we will die on.

Et Tu, DeSantis?

Florida's controversial Governor Ron DeSantis (R) has been a bit of a mixed bag overall.  The True Spirit of America Party (TSAP) is, to put it mildly, not exactly a fan of Republicans in general and Trump supporters in particular, but has nonetheless generally agreed with his light-touch, focused protection handling of the COVID-19 pandemic, which has actually yielded a lower cumulative per capita death rate than the national average (and much lower than several lockdown states) despite Florida's significantly older and fatter population.  And in terms of excess all-cause mortality, wide-open Florida even did better than the overall strictest state of all, California.  There are some bad things about DeSantis of course, such as his latest Georgia-style voter suppression efforts and his heavy-handed and poorly-written anti-rioting law that arguably throws out the proverbial baby with the bathwater, but generally he is not too terrible by current low-bar Republican standards.

And of course, Twenty-One Debunked in particular has supported the fact that he was one of the most prominent holdouts in keeping the legal smoking age at 18 despite the trend towards raising it to 21 at the local, state, and eventually federal levels.  After all, he has previously opposed and vetoed every single attempt to raise Florida's smoking age any higher than 18.  Well, until now, that is.  Like most other governors, as of today, DeSantis has officially SOLD OUT and signed into law a bill that raises Florida's smoking and vaping age to 21, effective October 1, 2021.  True, this new law does have an exemption for military service members aged 18-20, making it a shade less bad than some other states, but we still oppose this law on principle like we oppose all inherently ageist Tobacco 21 laws, period.

One could argue that any state law that sets the age limit below 21 is effectively void since the federal smoking age has been 21 since December 2019, but that is beside the point.  A state that chooses to remain 18 in spite of the federal Tobacco 21 law is a principled state with integrity, and is at the very least NOT helping the federal government enforce such an ageist abomination.  Today, Florida lost that status.

DeSantis is now the 34th governor to raise the age limit for tobacco and vaping to 21, bringing it to now more than two out of three states who set it at 21.  With "allies" like him (and Trump, who raised the federal age limit to 21), who really needs enemies?

The Federal Smoking And Vaping Age Is Now 21 (Part Deux)

As we had noted a little over a week ago, Congress raised the federal age limit for the sale of tobacco and vape products from 18 to 21 as part of a must-pass budget bill to avoid yet another government shutdown, 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 parties overwhelmingly supported it.  Tyranny is apparently as bipartisan as it is whimisical--and very cowardly as well.  And of course, Big Tobacco and Big Vape overwhelmingly supported it like the cowardly quislings that they are.

If that wasn't bad enough, it looks like the FDA isn't wasting any time in implementing the raising of 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.  They could have waited up to 180 days to formulate new regulations plus an additional 90 days before enforcing them, according to the new law, but apparently even that very small mercy is somehow beneath them.  And of course there is no grandfather clause either in this disgusting new law, nor will there be in the FDA regulations.  In other words, 18-20 year old young adults in a whopping 31 non-21 states (and several territories) who were legal to buy cigarettes and vapes just a week ago are suddenly banned from buying them now.  Talk about adding insult to injury!

And of course the new federal 21 law also applies just as much to our men and women in uniform, despite a few Tobacco 21 states having the small mercy to carve out an exception for them.  The new federal law has NO such exceptions, and is really a slap in the face of so many of our troops.  You know, kinda like the 21 drinking age has been for over three decades now.

The only silver lining to this ageist abomination is that it may very well anger enough Americans to challenge it in court, and if successful, we may get the two-for-one special of getting that other ageist abomination, the 21 drinking age, struck down as well.  And possibly even for cannabis too, though federally there is no such age limit (yet).  Otherwise, there is really no upside to this new law.  All it will do is effectively create an even more massive black market and greater disrespect for the rule of law.

In fact, it may very well drive many teen and young adult nicotine vapers back to smoking, since even with strict enforcement, regular cigarettes will be at least somewhat easier to get than vape products due to the difference in the size of the markets, general accessibility, and the design of the products.  Talk about a lose-lose proposition for public health!

As a wise man once said, "America will never be destroyed from the outside.  Rather, if we lose our freedoms, it is because we have destroyed ourselves from within."  That wise man, Abraham Lincoln, did not use those exact words it turns out, but his words came very close nonetheless.  And that (mis)quote turned out to be very prescient indeed, as America really seems to be rotting and rusting from within.

The song "21 Guns" by Green Day comes to mind, as does the song immediately following it on the same album, "American Eulogy".  And of course there's also Five Finger Death Punch, with "Stranger than Fiction":

"It's stranger than fiction, how [we've] decayed..."

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.

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.

The Needham, Massachusetts "Miracle", Debunked

Remember when Needham, Massachusetts made history in 2005 by being the first place in the USA to raise the age limit for tobacco to 21 in modern times?  And how the propoents of Tobacco 21 laws used them as an example of how successful such laws supposedly are at reducing teen smoking?  Well, a new article came out that thoroughly debunks that claim.  Scratch that, it debones, slices, dices, and juliennes it, and lays waste to its remains for good.

From 2006 to 2010 (the original study curiously did not include data before 2006), Needham did indeed see a faster drop in smoking rates among high school students compared to surrounding communities which kept the age limit at 18.  But from 2010 to 2012, the reverse was true: surrounding communities that kept it at 18 began to see faster declines in teen smoking rates than Needham.  This inconvenient fact was acknowledged buried in the original study (that went up to 2012) used to sing the praises of Tobacco 21, so it was not simply an oversight by the authors.  And according to the publicly available data that can be gleaned from schools in the surrounding communities, by 2014 the pattern reversed entirely, with the neighboring towns seeing larger net declines in teen smoking (59 to 77% drop) than Needham (40% drop) since 2006.  Hardly miraculous.  And by 2016, we see that some of these other towns raised the tobacco age limit to 21, but without seeing any further decrease in teen smoking (in fact, they saw a slight increase from 2014 to 2016).  If that's "success", we'd really hate to see what failure looks like.

So what explains the short-term success in the first few years in Needham?  Well, it could simply be have been a real but short-lived (and hollow) effect of the policy, just as Miron and Tetelbaum (2009) saw with the 21 drinking age versus traffic fatalities in the 1980s, with the effect being fairly small, dissipating after the first year or two before rebounding later, and further limited to the early-adopting states only (while in the later-adopting, coerced states, it actually had a perverse effect, or at best no effect).  But Needham also increased their enforcement on vendors dramatically, and also had at least some other tobacco laws that surrounding communities lacked.  And the percentage of smokers under 18 who bought their own cigarettes from stores also declined in Needham but not in the other neighboring towns.

Thus, it is very likely that the early decline in teen smoking would have been just as large if not larger had they simply kept the age limit at 18 but stepped up enforcement all the same, ceteris paribus.

Indeed, one should note that Woodridge, Illinois saw a similarly large drop in teen smoking in an even shorter timeframe (just two years) from 1989 to 1991 while keeping the smoking age at 18.  Leominster, MA also saw a drop almost as large from 1989 to 1991 as well.  And NYC, who raised their age limit from 18 to 21 (with no grandfather clause) in 2014, did NOT see teen smoking rates drop any faster than in the nation as a whole from 2013 to 2015.  Thus, the most parsimonious explanation is that Needham's (short) success story was primarily (if not entirely) due to increased vendor enforcement interacting with secular trends, and not the raising of the age limit itself.  In any case, it turned out to be a promise built on sand all along, if not a total statistical mirage.

Tobacco 21 laws, just like the ageist abomination that is the 21 drinking age, clearly belong on the trash heap of history.  And this is the final nail in the coffin.

When It Comes To Vaping, Don't Throw Out The Baby With The Bathwater

In the wake of both the mysterious vaping-related lung illness epidemic, and also the recent increase in vaping among young people (something for which Tobacco 21 laws have apparently done NOTHING to stem the tide, by the way) both the federal government and several state and local governments are beginning to crack down on vaping to one degree or another.  Yes, Houston, we have a problem.  But it is important to keep a cool head and not throw out the proverbial baby with the bathwater.

The FDA plans to ban all flavored vape products other than tobacco (yuck!) or unflavored (meh), as is Michigan.  San Francisco, on the other hand, already passed a ban on ALL vape products regardless of flavor.  The state of New York just passed an emergency executive ban on all flavored vape products other than tobacco or menthol, effective October 4th.  And California's governor announced a crackdown on counterfeit vape products, though he lacks the authority to pass any flavor bans without the state legislature passing it.

Going too far with such bans would only increase the very black market that is the most likely cause of the mystery vaping illness (though with that it is mostly black-market THC products, though some appear to have been nicotine only).  At the same time, while vaping can help some adult smokers quit, it's not like there really is any overarching benefit society from nicotine that comes in fruity, candy, or dessert-like flavors either.  It really is a balancing act.

Twenty-One Debunked once grudgingly supported some degree of flavor bans in the past, mainly as an alternative to Tobacco 21 laws, but in light of current events, we no longer support such bans today.

New York's flavor ban--if there must be one at all--is somewhat more reasonable than the ones that don't even allow menthol.  And clearly counterfeit products need to be cracked down upon, and bad actors and questionable additives rooted out at once.  And capping and reducing nicotine levels of vape products down to European and Israeli levels would also make such products less addictive than they are currently.  But anything more stringent than these things would likely do more harm than good.  (That goes for setting the age limit any higher than 18 as well.)

As for cannabis vaping products, the best way to eradicate the sketchy and janky black and gray market products is to fully legalize and regulate cannabis nationwide, period, with an age limit of 18, strict quality control, and reasonable taxes on such products.  And again, crack down on counterfeit products and products with questionable additives.  But that would make too much sense, wouldn’t it?

So let's be adult about this, shall we?

UPDATE:  Looks like Michigan's emergency executive flavor ban contains a loophole that allows flavored nicotine-free e-liquids and pods, and also allows flavorless nicotine packets one can combine with such e-liquids (albeit sold separately).  So this particular ban is actually far more reasonable than meets the eye, while still having the intended effect of making it somewhat harder and less convenient for people under 18 to vape flavored nicotine.  And it will likely keep vape shops open for business for the foreseeable future, while JUUL will still get a swift kick in the margins now that their ready-made pods will be verboten if they have any flavor other than tobacco.

And at the other extreme, on September 24th, Massachusetts Governor Baker has literally banned ALL vape products for four months by an emergency executive action.  And that will just throw gasoline on the fire by dramatically growing the black market. DERP!  Didn't think that one through, did you Charlie?

JUUL Is Circling The Drain

Looks like JUUL Labs just bit off far more than they could ever possibly chew, and they are now choking on it as we speak.  These quislings have asked for a ton of karma for years now, and now they seem to be getting it.  Their share price is in warp-speed decline right now.  As per the famously time-tested Seneca effect, their growth was relatively slow at first, but it looks like their ruin will be very, very rapid indeed.

First, they managed to get a new generation of young people hooked on nicotine with a sleek, deceptively seductive, fruity- and candy-flavored product (with excessively high nicotine levels, and more addictive than conventional cigarettes) and even more deceptive, Big Tobacco-style marketing, all while bragging about how supposedly "woke" they were.  Then they made a deal with the devil himself, Big Tobacco, when they literally SOLD OUT to them.  And then when these cowardly quislings were finally called out on their misdeeds, they threw 18-20 year olds under the bus by supporting the ageist abomination that is Tobacco 21 laws.  They even threw the rest of the vaping industry under the bus as well.  At the end of the day, they are really nobody's friends, never were, and never will be either.

And now with that mysterious vaping-related illness reaching epidemic proportions, albeit most likely driven by black-market products with questionable additives, as well as homebrew concoctions and modified devices (though JUUL still has yet to be exonerated), the moral panic around vaping that JUUL effectively helped to create has reached such a fever pitch that the Trump administration (and several states) are passing or at least considering flavor bans for vape products.  That will be the final kiss of death for JUUL, since most of these proposed bans will only allow tobacco-flavored products (yuck!) or unflavored products (meh), not even menthol or mint.  Even if the ban is later lifted, if (when) it passes they are basically dead and done by that point.

And if that itself doesn't ultimately bankrupt them, the mounting lawsuits against them sure will.

Now a corporate "person" without a country, what ever will they do?  (Plays the world's smallest violin)

Somebody call the coroner quick, JUUL is now circling the drain as we speak.  Let's hope they take their Big Tobacco parent company, Altria (aka Philip Morris) down with them as well.  And no, we will never, ever mourn their loss, not in a million years.

Good riddance! May your name and memory be forever blotted out, JUUL.

UPDATE:  As of September 25, 2019, their CEO, Kevin Burns, was essentially forced to resign, replaced with a Big Tobacco executive from Altria, and they pulled all advertising from the USA.  And the company agreed to accept the flavor ban as well.  And now they are embroiled in a criminal investigation as well.

We Still Excommunicate JUUL Labs (Updated)

(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 sworn enemy of Big Tobacco, but you began to copy their playbook awfully quickly in terms of advertising to young people and cynically implemented your own "anti-vaping", "anti-tobacco", and "holistic health education" progams in schools and youth camps. (You claimed that was just an oversight.  Riiiiiiight.)
• Your sham "educational" programs even told teens that your products were "totally safe" yet for "adults only" (wink wink).  And some of your summer camp programs apparently targeted children as young as eight years old.
• You recruited social media influencers with slick advertising campaigns that at least gave the appearance of deliberately targeting young people in marketing your products.  You also went out of your way to target Native Americans with your addictive poison-peddling as well.
• You chose a much higher nicotine level for your products than other vape brands, by far.  And your patented nicotine salt formulation clearly gives a much bigger "kick" of nicotine as well.  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 JUUL 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.
• You gave your products various kid-friendly fruity, candy, and dessert flavors, because reasons.  Or something.  I mean, we all know that adults need their nicotine vapes to taste like candy in order to help them quit smoking, right?
• Until very recently, you failed to adequately warn users that your products contain nicotine and are highly addictive.  Many young people did not even know that all JUULs contain nicotine, let alone such a high level of it.  And some still may not know yet.
• In fact, if anyone were to deliberately design the most effective and efficient way to surreptitiously get young people hooked on nicotine in the 21st century, it would really look an awful lot like JUUL.
• When the FDA finally blew the whistle on you in late 2018, 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 in stores.
• 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.
• Finally, thanks primarily to you, young people are losing even more rights now.

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

We at Twenty-One Debunked urge everyone to #BoycottJUUL yesterday.  If you don't currently smoke, vape, or otherwise use nicotine, don't start!  You are far better off without this highly addictive poison in any form, period, even if vaping does reduce most of its other toxic chemical satellites and byproducts compared with smoking.  But if you currently do, make it any brand but JUUL, and give 'em a swift kick in the margins!  And best of all, JUULers who switch to other vape brands may find it easier to phase out and finally quit all forms of nicotine for good.

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.

The Overton Window Has Shifted, And Not In A Good Way

With more and more states raising their smoking ages to 21 (and the federal government likely to follow very soon), along with a burgeoning movement to raise the "juvenile" injustice age to 20 or 21 (or perhaps even higher), one can conclude that the Overton window is currently shifting in the wrong direction.  That is, it is becoming increasingly politically acceptable to raise age limits higher than 18, while lowering age limits is becoming increasingly unacceptable these days.   And both corporate duopoly parties in government today seem to be equally affected/infected by this virulently ageist and illiberal trend towards higher and higher age limits.

Clearly, it doesn't take a rocket scientist to see that the odds of us successfully lowering the drinking age (and toking age) to 18 anywhere in the the USA have really never been lower than they are now.  Even the possible silver lining of a new showdown between the feds and states is exceeedingly unlikely now, since Mitch McConnell's "Tobacco-Free Youth Act" recently had that controversial section about withholding state grants removed before it got out of committee, and it looks likely to pass both houses without it.

Time and momentum are NOT on our side right now, in other words.  Slopes are MUCH slipperier than they appear, and we need to turn this ship of fools around before it's too late (assuming it isn't already too late).