What Happened in NYC After Raising the Smoking Age to 21?

In 2014, New York City became the first major city in the USA to raise the tobacco purchase age to 21.  Prior to that, it was 18, much like the rest of the country.   The law was passed by Mayor Bloomberg at the end of 2013, and it went into effect in May 2014.

Since then, two states (California and Hawaii) have also raised it to 21 (both in 2016) and several counties and towns/cities as well from 2013-2017, though a few localities had also done so earlier as well.  When Needham, MA did so in 2005-2008, there was much praise from the pro-21 crowd when surveys showed that teen smoking rates had dropped much faster in Needham than in its surrounding communities (which were 18) from 2006-2010.  So it is very curious indeed that no one seems to be talking about what happened in NYC since they raised their smoking age.

We think we know why.  At first glance, it does appear to have had some effect.  According to the CDC's Youth Risk Behavior Survey (YRBS), teen smoking rates did in fact drop from 2013 to 2015 in NYC: 

2005   11.2%
2007   8.5%
2009   8.4%
2011   8.5%
2013   8.2%
2015   5.8%

Those are the percentages of combined 9-12 grade students who reported any current cigarette smoking in the past 30 days.  Looks impressive at first:  a relative 29% drop from 2013 to 2015.  But take a look at the same data for the nation as a whole, for comparison:

2005   23.0%
2007   20.0%
2009   19.5%
2011   18.1%
2013   15.7%
2015   10.8%

As you can see, the nation as a whole also saw a similar (if even faster) drop in teen smoking at the same time, with a relative 31% decrease from 2013 to 2015, despite no change in the smoking age in most places.  And the teen smoking rate in NYC was already much lower before the law change, having dropped more dramatically than the rest of the USA prior to 2007 and then remaining at a low level since. 

How about San Francisco, another major city that raised its age limit to 21?

2005   10.9%
2007   8.0%
2009   10.4%
2011   10.7%
2013   7.5%
2015   5.4%

They also saw a similar size drop from 2013-2015, to the tune of 28% (vs. 29% in NYC and 31% in the USA overall).  Just one problem though.  San Francisco did not raise their smoking age until 2016, so these data show that the drop in the smoking rate happened while it was still 18, before the age limit was raised.  Thus, it would actually be part of the no-change control group, not the experimental group.  And if you include the decrease since 2011, San Francisco in fact saw more progress than NYC.

Thus, we can conclude that the decrease in teen smoking in NYC following the hike in the purchase age was most likely NOT causally linked to it, and would most likely have occurred regardless given the above counterfactual data.  Kinda like we at Twenty-One Debunked initially predicted back in 2013 after first learning of the law change being proposed.  So if that wasn't the cause, what was?  Well, we know that nationwide, as well as in NYC, the secular trend for the past four decades (except a brief increase from 1992-1997) has been downward for both teen and adult smoking.  This was due to a general combination of education/awareness, taxation, regulation, and advertising restrictions, and the resulting cultural changes.  And in very recent years, electronic cigarettes have gained popularity as an alternative to combustible cigarettes, and in fact overtaking the latter and becoming at least twice as popular among high-schoolers by 2015.  Note that this was also true in NYC despite the 21 age limit applying to e-cigarettes as well.

Bottom line:  it looks like the supposed benefits of raising the smoking age to 21 were, shall we say, all smoke and mirrors.  The supposed success of Needham, MA 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.  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.

What Should the Blood Limits for THC Be?

Now that cannabis is legal in eight states for recreational use, and numerous other states for medical use, the issue of how to handle driving under the influence of cannabis (DUIC) is currently being hotly and heavily debated.  Many states, both where cannabis is legal and where it is illegal, currently set an arbitrary non-zero number for their blood-THC limit, while others set the limit at zero (i.e. zero-tolerance), while still others do not set any specific per se limit despite driving while impaired being illegal.  And as of 2017, there remains zero evidence that any of these laws actually save any lives on the highways or otherwise.

Recently, the state of Oregon, where cannabis is legal, has effectively stopped enforcing their legal per se limit for THC, citing a lack of scientific evidence to justify such a policy.  To wit, the Oregon Liquor Control Commission’s report on the matter also supports the idea that cannabis is far less impairing than alcohol:

“The rate of drivers tested by Drug Recognition Experts who are positive for THC intoxication rose between 2013 and 2014, but did not increase following legalization [in 2015]. Fatal accidents data is highly variable year-to-year, making trend analysis difficult. But in Oregon in 2015 there were only three more traffic fatalities involving a driver testing positive for THC compared to 2004. Moreover, the rate of THC-related fatal accidents is also considerably lower than such accidents involving alcohol intoxication. Finally, while overall traffic fatalities and alcohol-related fatalities spiked in 2015, THC-related fatalities did not."

Even the AAA now concedes that, while being high on weed can cause driving impairment, it is significantly less impairing than alcohol and is in fact comparable to driving with a “noisy child in the back of the car,” and only half as dangerous as talking on a hands-free cellphone (which is legal in all states).  That said, we should also note that different drivers may be affected differently, and novice users and/or novice drivers may be a lot more impaired than more experienced users and/or drivers.  And combining cannabis with alcohol is known to be significantly more dangerous in terms of driving impairment than either one alone as well.  But there is currently no scientific evidence strong enough to justify a zero-tolerance or per se limit for THC, as its pharmacokinetics are far too complex to correlate blood THC levels with actual driving impairment.  For example, frequent users (including medical users) can test positive several days after the last time they used it, even if they are not impaired in the least, and thus get unjustly snared in the same dragnet as those who are actually impaired from toking up an hour or two ago.

Twenty-One Debunked does not recommend that anyone drive under the influence of cannabis.  But our laws must reflect reality nonetheless.  Thus, we make the following recommendations:

• Follow Colorado's lead and set a prima facie limit for THC instead of a per se limit.  That distinction is crucial, as that would not mean automatic guilt, but a rebuttable presumption of guilt for going over the limit, which can still be challenged in court to prove non-impairment.
• Set the limit at no lower than Colorado's 5 ng/mL, as that level, though imperfect, provides the clearest separation between impaired and non-impaired driving according to the best research.  Zero tolerance = zero intelligence.
• Do not test for inactive metabolites, except perhaps to confirm recency of use.
• Increase the use of field sobriety tests and drug-recognition experts, and use saliva tests to check for recent cannabis use before drawing any blood.
• Work on developing better methods of determining actual impairment, but do NOT use that as an excuse or delaying tactic for keeping cannabis illegal.
• Consider allowing a "medical necessity" defense for medical users.
• Make the penalties for DUIC alone significantly lower than for alcohol and other drugs, but in combination with other substances, or if anyone is injured or killed, throw the book at 'em!
• For illicit drugs other than cannabis, a per se limit would in fact be appropriate.
• Get much tougher on bad and reckless drivers in general, as well as distracted driving.
• And in keeping with the overall mission of Twenty-One Debunked, set the age limit for cannabis at 18 and do not treat drivers aged 18-20 any differently than drivers over 21 with respect to cannabis.

In other words, facts > feelings, even in the "post-truth" era.

We should also note that the rather modest increase in traffic deaths in 2015 and 2016 nationwide, and in 2014 in some states as well, does NOT seem to be caused by recent cannabis legalization in several states.  Increases occurred in both legalized and non-legalized states, as did some decreases, and there was no clear pattern in that regard.  A much more plausible explanation is the massive drop in gas prices from late 2014 to 2016, which is known to increase traffic fatalities (all else being equal), along with the improving economy as well as "reversion to the mean" following an all-time record low per VMT in 2013-2014.  Ergo, QED.

Trump Is The Ultimate Wildcard

In terms of alcohol and drug policy, Donald Trump remains somewhat of a mystery.  On the one hand, he went on the record in the early 1990s calling for the legalization of all drugs, period.  Since then, however, he has flip-flopped several times on the issue of cannabis legalization, most recently seeming to oppose legalization for recreational use while supporting legalization for medical use, and even on recreational use contradicting himself by saying that we should "leave it up to the states" (which really means supporting federal legalization without actually saying the "L-word").  And if that does not result in result in enough head-scratching on the part of the reader, he has nonetheless nominated the racist, uber-conservative drug-warrior Jeff Sessions for Attorney General, who "joked" that he thought that the KKK was fine until he found out that they smoked pot.  Yes, he actually said that. And Mike Pence would likely be no friend of legalization either, at least from what we gather so far. 

As for Trump's position on the drinking age, he does not seem to have a clear position either way.   On the one hand, he himself is a teetotaller because he lost his older brother at an early age to alcoholism.  On the other hand, despite his right-wing authoritarian and proto-fascist tendencies he seems to be one of the least likely to adhere to conventions or traditions compared to any of the other candidates he ran against in any political party.  Thus, on both the drinking age and the War on (people who use a few particular) Drugs, he remains a wildcard.  Like a cross between a joker and a jack(ass), basically.  We at Twenty-One Debunked do NOT support him by any stretch of the imagination, and Ajax the Great voted for Bernie Sanders in the primary and Hillary Clinton in the general election.  But if he does somehow manage to budge in our direction on those particular issues, we will effectively stand with him on those issues while still opposing him nonetheless on practically all of the other issues.  And we are indeed prepared for him to flip-flop numerous times while in office as well, as we see that he is clearly quite fond of doing.

Have A Safe And Happy Holiday Season

(This is a public service announcement)

It is that time of year again when the holidays are upon us, and many of us Americans (and around the world) will be celebrating with alcohol and/or other substances.  We at Twenty-One Debunked would like to remind everyone to be safe and celebrate responsibly.  There is absolutely no excuse for drunk driving at any age, period.  We cannot stress this enough.  It's very simple--if you plan to drive, don't drink, and if you plan to drink, don't drive.  It's really not rocket science, folks.  And there are numerous ways to avoid mixing the two.  Designate a sober driver, take a cab, use public transportation, crash on the couch, or even walk if you have to.  Or stay home and celebrate there.  Or don't drink--nobody's got a gun to your head.  Seriously.  And the same goes for other psychoactive substances as well, and a fortiori when combined with alcohol.  

ARRIVE ALIVE, DON'T DRINK AND DRIVE!!!   If you plan to drink, don't forget to think!  The life you save may very well be your own.

Drink Nothing Day Cancelled This Year

Due to the disaster that was the 2016 election and the fact that this is the last holiday season before President Trump (shudder!) takes over, I will not be observing Drink Nothing Day this year.  I will be enjoying the festivities as any other holiday.

So eat, drink, and be merry, folks!  But please do so responsibly in any case.  Arrive alive, don't drink and drive!

California Dreaming Has Finally Become A Reality

It seems that there was one silver lining to an otherwise disappointing election:  California, Nevada, Massachusetts, and Maine legalized cannabis for recreational use, joining Colorado, Washington, Oregon, Alaska, and DC, while a few other states such as Florida joined the already numerous states in which medical use is currently legal.  And it is only a matter of time before it becomes legal nationwide.

We at Twenty-One Debunked have mixed feelings about the legalization initiatives, primarily since all of them set the age limit at 21 rather than 18, among other flaws.  But those flaws can be ironed out after the fact.  And cannabis legalization is LONG overdue, so Twenty-One Debunked grudgingly supports these initiatives, as they probably would not have passed otherwise.  Going forward, we will work to get the age limit lowered to 18. 

Let's Finish The Job Already

In a previous post, we at Twenty-One Debunked noted how successful Australia has been at reducing the perennial scourge of drunk driving casualties since the early 1980s.  In fact, they have been much more successful than the USA has been despite (or more likely, because of) Australia keeping the drinking age at 18 combined with tougher DUI laws and enforcement.  This is true even though the Land Down Under is an avid car culture where binge drinking is known to be quite the art form (and more so than the USA), so that really says something!

Canada, with a drinking age of 18 or 19 depending on the province, has also seen more success overall than the USA, though not quite as much as Australia has.  Like the USA, they had been slacking a bit from the mid-1990s through the 2000s, though recently some provinces like Alberta and British Columbia have toughened up and resumed their previous decades of progress.  And in the past decade the USA has stepped up enforcement a bit as well.  But truly there is much more room for improvement in the USA, which out of all "developed" nations has generally seen the least amount of overall progress in reducing traffic deaths despite (or perhaps because of) raising the drinking age to 21 in the 1980s.

So what does Twenty-One Debunked recommend that we do to "finish the job", aside from lowering the drinking age to 18 and raising the alcohol excise taxes?  Well, for starters, we could:

• Lower the BAC limit to 0.05, with graduated penalties that rise dramatically with BAC.
• Increase the use and frequency of sobriety checkpoints and/or roving patrols to catch drunk drivers.
• Impose administrative sanctions, such as license suspensions and vehicle impoundment, including for drivers of with BAC of 0.05-0.08.  (British Columbia and Alberta are good models to follow in that regard)
• Require alcohol ignition interlocks for all impaired driving offenders (and make it a standard feature on all new vehicles as well).

Additionally, we could also adopt what I like to call the "fish in a barrel" method of catching drunk drivers before they get on the road.  Park a police car outside each bar, observe who is about to drive under the influence, and catch them as soon as they put the key in the ignition.  Gotcha!  Alternatively, one can intercept them before they even enter their vehicles, and offer them a ride home instead.  Either way, that will scare many potential drunk drivers straight, and bars would thus be under economic pressure to offer free "safe rider" programs in order to maintain the same volume of customers patronizing them without fear of getting a DUI.

Another idea, loosely borrowed from UCLA researcher Mark Kleiman, would be the "blacklist".  To wit, if someone is convicted of drunk driving, drunk violence, drunk vandalism, or repeated drunk and disorderly conduct, they would be banned from purchasing alcohol or entering a bar for at least a year or until 21, whichever is longer.  Subsequent offenses would be two or more years.  Ditto for anyone who buys or furnishes alcohol to anyone under 18 (other than one's own child) or any adult who has been blacklisted thusly.  Driver licenses or ID cards to blacklisted individuals would read "do not serve alcohol under penalty of law".  Additionally, we can allow problem drinkers without convictions to opt-in voluntarily to be blacklisted as well for up to five years, much like they have for casino gambling in some states.  We could call such a program "86 Me" or something along those lines, and that looks very promising indeed.

It's 2016, and time to finish the job already.  The question is, do our leaders have the intestinal fortitude to do so?

What Australia Gets Right

One thing our movement has a habit of doing is comparing the USA to Europe for the purpose of ascertaining what the effects of a lower drinking age would be like.  While there is some truth to such a comparison, the pro-21 side routinely calls us out on the important differences between here and there.  For example, they have much better public transportation than we do, they are more urbanized, driving licenses are much more difficult to obtain, gas prices are much higher, and thus they are much, much less of a car culture that we are.  All of which would dramatically affect traffic fatalities and skew any comparisons.  As a result, Twenty-One Debunked typically prefers to make comparisons to Canada instead, which is also a car culture that is the most similar to the USA.  And they have seen a similar or faster drop in traffic deaths than the USA despite NOT raising the drinking age to 21, and their traffic death rates have been consistently lower than the USA.  But there is also another major car culture as well with a drinking age of 18--Australia.

In the Land Down Under, they have in fact seen a faster drop in alcohol-related traffic deaths than the USA and even Canada since 1982 despite keeping the drinking age at 18.  Not only that, a recent study in Australia found essentially no link between being able to drink legally and motor vehicle accidents of any type, at least not in the state that was being studied, New South Wales.  Using a regression discontinuity design similar to the sort that pro-21 researchers have been doing lately, they found no discontinuous jump in such deaths or injuries in young people upon turning 18.  This stands in stark contrast to the USA, in which various pro-21 researchers have found a significant jump in alcohol-related deaths and injuries among young Americans upon turning 21, an increase that in many cases lingers well beyond one's 21st birthday.

Of course, such a phenomenon is not unique to the USA, as a jump in alcohol-related deaths and injuries has also been observed in Canada at their own respective MLDA (18 or 19, depending on the province), albeit of a shorter duration than in the USA and limited primarily to males who participate in "extreme" binge drinking.  It would seem that a powder-keg effect is unfortunately an almost inevitable consequence of the very concept of a drinking age, regardless of what it is.  So what does Australia do right that seems to defuse the powder keg?

Most importantly, Australia has tougher DUI laws, and tougher and more frequent enforcement of such laws.  For example, not only are penalties tougher, but the BAC limit is 0.05 (as opposed to 0.08 in the USA) and they have random breath testing (RBT), which is unconstitutional in both the USA and Canada.  Though one could argue that nowadays the USA effectively practices a form of "de-facto RBT" via a combination of "no-refusal" laws (i.e. the police often have a judge on speed-dial to issue a telewarrant to compel those who refuse to be tested) and often pull people over for trivial reasons and use that as an excuse to test drivers, and the initial effectiveness of RBT in Australia seems to decay over time to the level of effectiveness demonstrated by American-style sobriety checkpoints and/or roving patrols.  Additionally, driver's licenses are harder to get and easier to lose over there than in the USA, and the road test there is significantly more difficult as well.  Alcohol excise taxes are also higher in Australia as well.  But the biggest and most salient difference is the seriousness with which they take the issue of drunk driving.  You really do NOT want to get busted for DUI in the Land Down Under!

Of course, the picture down under is not entirely rosy.  Australia's drinking culture is quite extreme even by American, Canadian, and British standards (though tame by New Zealand standards), and binge drinking is quite the art form over there.  Indeed, even the aforementioned study found that while traffic deaths and injuries do not increase discontinuously at 18 when they become legal to drink, there is still a discontinuous increase in hospital visits and admissions for alcohol poisoning and injuries from assault at 18.  But the fact that, even in a country with a more Anglo-Celtic, drink-to-get-drunk culture than the USA, it is nonetheless possible to break the link between drinking and drunk driving casualties, really speaks volumes indeed.

In other words, lowering the drinking age in the USA should really not be something to fear.  But we also need to get tougher on drunk driving if we wish to continue the progress of decades past.

Latest Regression Discontinuity Studies Only Confirm Powder Keg Theory

This year, pro-21 researchers Kitt Carpenter and Carlos Dobkin are at it again.  As you may recall, we at Twenty-One Debunked have critiqued much of their past work, particularly their use of the "regression discontinuity" approach.  The researchers found a significant jump in statistical death rates, arrests, and stuff like that immediately after young people turn 21 compared with before.  And their latest study seems to be more of the same, this time looking at non-fatal injuries as measured by both ER visits and inpatient hospital admissions.

Oddly, these researchers actually (and without even a hint of irony) claim that these studies show that the 21 drinking age is effective in saving lives and reducing alcohol-related harm!  But we at Twenty-One Debunked see it rather differently--if anything, it shows that there is nothing at all magical about turning 21 that makes one invulnerable to the deleterious effects of excessive alcohol consumption.  And setting the drinking age at such an arbitrarily high age only sets a powder keg (pun intended) that goes off when young people reach that age.  The higher the drinking age, the larger the powder keg, it seems.  And it also shows that the Law of Eristic Escalation (i.e. imposition of order leads to escalation of chaos) is correct, as well as Fenderson's Amendment (the tighter the order is maintained, the longer it takes for the chaos to escalate, but the more it does when it does).  Hardly a ringing endorsement for the 21 drinking age!

Of course, Carpenter and Dobkin also find evidence of a jump in both drinking and alcohol-related deaths among Canadians upon reaching their MLDA (18 or 19, depending on the province), particularly among males, and the increase in mortality seems to be due to a sudden jump in "extreme" binge drinking.  It seems there is always a risk of increased alcohol-related harm in the short-run after suddenly turning legal, regardless of age.  But as much other research shows, there is good reason to believe that such an effect is worse and longer-lasting when the the legal drinking age is higher rather than lower.  And furthermore, a recent study in Australia (where the drinking age is 18 and DUI laws are tougher) found essentially no link between being able to drink legally and motor vehicle accidents of any type in the state of New South Wales.  Food for thought indeed.

On the plus side, one should also note that another recent study using a regression-discontinuity approach found that being able to drink legally reduced the consumption and initiation of hard drugs (cocaine, heroin, meth, etc.) among young people.  That blows yet another hole in the junk science that is the "gateway" theory.

What About 19?

One question that our movement frequently has to field is whether lowering the drinking age to 19 is a better idea than lowering it to 18.  And our answer is always the same:  unless 19 also happens be the age of majority, there is no good reason why the drinking age should be any higher than 18, period.  And in 47 states and DC (Alabama (19), Nebraska (19), Mississippi (21) are the odd-ones-out), the age of majority is 18.  And if you're old enough to go to war, you're old enough to go to the bar.  'Nuff said.

Yes, but....won't that result in 18 year olds buying alcohol for their younger friends?  Surely 19 would be better in that regard since most 19 year olds are out of high school, right?   Wrong.  The argument is technically true, but it nonetheless misses the point by a long shot.  Last I checked, people under 18 are still getting their hands on alcohol even with a drinking age of 21, and banning 18 year olds from drinking solely to prevent them from supplying their younger friends is inherently unjust.  Besides, there are other ways to discourage 18 year olds from supplying their younger friends with booze or throwing high-school keggers:

• We could put a cap on how much alcohol an 18-20 year old can purchase in one transaction or day.  For example, no kegs or cases, and no more than an 18 pack of beer, 1 gallon of wine, or one fifth of liquor per transaction, and no more than one transaction in any 24 hour period.
• We could ban 18 year olds from purchasing alcohol during the school day, and ban any high school student from showing up to school under the influence of alcohol.
• We could toughen the penalties for buying or furnishing alcohol to people under 18.
• We could ban off-premise sales to 18 year olds unless either a) a person 19 or older is present with them, or b) they show a college or military ID, or a high school diploma or GED. 

And none of these things would really create an undue burden on anyone, while still preserving most if not all of the purported benefits of setting the drinking age at 19 or higher compared with 18.  As for that last item on the list, we had thought of that one very recently.  It seems that back in 1981, Virginia had experimented with raising only the off-premise (i.e. store) purchase age to 19 while leaving it at 18 for on-premise (i.e. bar and restaurant) sales.  But they barely even gave it a chance, as two years later in 1983, they raised it to 19 for on-premise sales as well, and then to 21 in 1985.  Granted, setting the off-premise purchase age higher than the on-premise age may have created a perverse incentive to drive after drinking, especially in rural areas.  But giving 18 year olds the option to buy alcohol off-premise when accompanied by someone over 19 would remove that perverse incentive, while still reducing the supposed "trickle-down" effect since a person under 18 would still have to find someone 19 or older to make the transaction possible.

In other words, there is no good reason to set the drinking age any higher than 18.  Period.