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.

Latest Ancillary Law Study Has Major Plot Twist

A new 2016 study by MADD members James C. Fell and Robert Voas, among others, looked at the impact of various ancillary laws related to the 21 drinking age on traffic deaths involving drivers under 21.  Or more accurately, it looked at the effects of such laws on the ratio of "alcohol-related" to non-alcohol traffic deaths among that age group, biased as that may very well be.  Twenty different laws were studied, and the ones that showed statistically significant reductions were as follows:

Possession of alcohol (-7.7%)
Purchase of alcohol (-4.2%)
Use alcohol and lose your license (-7.9%)
Zero tolerance 0.02 BAC (-2.9%)
Age of bartender ≥21 (-4.1%)
State responsible beverage service program (-3.8%)
Fake ID support provisions for retailers (-11.9%)

Two other laws were also statistically significant, though not particularly large in practical terms:

Dram shop liability (-2.5%)
Social host civil liability (-1.7%)

And now for the plot twist:  There were two laws associated with significant increases in alcohol-related fatal crash ratios:

Prohibition of furnishing alcohol to minors (+7.2%)
Registration of beer kegs (+9.6%)

Yes, you read that right.  Two ancillary laws that would be expected to greatly enhance the supposed effectiveness of the 21 drinking age actually had a perverse effect.  And this calls into question whether even any of these laws, including the 21 drinking age itself, actually save any lives at all.  Let that sink in.

As for zero-tolerance laws, one should recall Darren Grant's landmark 2010 study that thoroughly debunked their effectiveness in reducing traffic fatalities.  As for use-and-lose laws, under which a person under 21 can have their driver's license suspended or revoked for simply drinking in their own home even when no driving is involved, they clearly seem to work at cross-purposes with DUI laws, and would likely be made irrelevant with tougher DUI laws in the first place.

Additionally, another recent study in 2014 by some of the same authors as the first one found that social host liability laws apparently had no significant effect on traffic deaths.  Combined with the weak results in the aforementioned study, this blows yet another hole in the pro-21 argument, as one would expect such laws to give more "teeth" to the 21 drinking age.  As for the apparently strong results of the anti-fake ID laws, that could simply be because the 21 drinking age itself (and apparently some of its ancillary laws) may actually increase fatalities in the long run, and reducing the use of fake IDs may take some of this dangerous edge off.  Thus, the effects of such fake ID laws may not necessarily be a net benefit compared to a drinking age of 18.

Thus, these new studies should be seen as the final nail in the coffin for the 21 drinking age.   Looks like Miron and Tetelbaum (2009) were right in that the supposed lifesaving effect of that ageist abomination was really just a mirage all along.

What Should The Driving Age Be?

One thing that Twenty-One Debunked has been slacking on lately is the other main age limit in the drinking/driving equation--the driving age.  While we have not always been very clear on that particular issue and generally left it on the back burner, it merits attention nonetheless.

There is indeed an interesting paradox compared with the drinking age.  With the notable exceptions of Canada (driving age 14, 15, or 16 depending on province), Australia (16 1/2 in one state, 17 or 18 in the rest), and New Zealand (16), every other industrialized (and semi-industrialized) nation on Earth has a driver license age of 17 or higher, and most are 18.  Yet these countries all have drinking ages lower than the USA, and nearly all of them are 18 or lower.  Many are as low as 16 (though a few European nations have recently raised the drinking age to 18). And most of these countries have far lower rates of traffic deaths, alcohol-related or otherwise, than the USA.

On the surface, that strongly recommends in favor of raising the driving age in conjunction with lowering the drinking age, particularly setting the driving age higher than the drinking age instead of the other way around.  At one time, the founder of Twenty-One Debunked advocated doing exactly that.  But such an approach glosses over some serious issues involving the car culture of the USA.  First, with our inferior public transportation infrastructure, we cannot compare the situation here to Europe.  Canada or Australia would be a much better comparison.  Secondly, the odds of us ever lowering the drinking age below 18 are slim to none, and we no longer consider such a goal worthwhile.  But most importantly, the evidence that a much higher driving age would make roads any safer is questionable at best.

Renowned sociologist and youth-rights activist Mike Males did a famous study in 2006 that found that California's tough new graduated driver license (GDL) law implemented in 1996 did reduce traffic deaths among 16-17 year olds--but also increased traffic deaths for 18-19 year olds enough to more than offset the apparent lifesaving effect among younger drivers.  In other words, it merely delayed such deaths, or worse, led to a net increase.  He also found in another study that much of the increased risk among younger drivers is actually the result of poverty, not "immaturity" or "underdeveloped brains".  The rest can largely be chalked up to inexperience, and the difference between genders (males being worse) dwarfs any unaccounted for age difference.  While his research was seen as controversial among the establishment and many disputed it, it nonetheless pans out rather well.  A 2011 national study by Masten et al. confirms Mike Males' general findings: after adjusting for potential confounders, stronger GDL laws (compared with weaker ones) were associated with lower fatalities for 16 year olds but higher fatalities for 18 year olds (and possibly 19 year olds as well), and the net effect for 16-19 year olds as a whole was not significantly different from the null.  In other words, it was a wash overall.

Of course, it is true that 16 year old first-year drivers do have significantly higher fatal crash risks that 17 year old first-year drivers--though 17 year old novices are apparently no worse than 18 or 19 year old novices.  (There are apparently not enough first-year drivers 20 and older to make a valid comparison for them, but I imagine it would be similar.)  Thus, it is possible that raising the driving age to 17 would in fact result in a net reduction in traffic deaths over the lifecycle compared with the status quo, while raising it to 18 or higher would likely only delay deaths compared with a driving age of 17.  New Jersey, for example, has a driving age of 16 for permit and 17 for license--the highest in the nation besides NYC with a de facto age of 18--and their teen traffic death rates are, contrary to stereotypes, lower than neighboring states (interestingly even before their GDL law was implemented, and declined further after that).  Compared with Connecticut, New Jersey's fatality rate was much lower for 16 year olds, slightly higher for 17 year olds, and slightly lower for 18 year olds, so the net effect was death reduction.  So being a year behind may not necessarily negate the benefits of delaying entry to licensed driving--though raising the age any higher than that might. 

So what should the driving age be in the USA?  The optimal age may in fact vary depending on how rural or urban a state or region is, but we do not believe it should be any higher than 16 for permit and 17 for license.  And of course we believe that the drinking age should be 18.  Additionally, we should definitely make the road test tougher like it is in other countries, and improve our driver education courses as well.  Raising the alcohol taxes and the gas tax would likely save many lives as well.  But on balance, raising the driving age any higher than 17 in this country would likely do more harm than good. And while GDLs in general are likely beneficial on balance, there is likely such a thing as too strict--particularly when it only targets drivers below a certain age (as opposed to all new drivers like in many other countries like Canada), and such a poorly designed one can actually backfire.

What Would The Optimal Vice-Tax Policy Be?

Ever since the invention of taxation thousands of years ago, there has always been much controversy about it.  One of the oldest (if not the oldest) types of tax is the excise tax, which is an indirect tax on specific goods and services.  Common examples in the USA and most other countries include taxes on things like alcohol, tobacco, and gasoline/diesel fuels.  Though originally intended primarily to raise revenue, and highly effective in that regard, such taxes can also have a Pigouvian logic to them:  they help offset negative "externalities" related to the consumption of such goods/services, and also help to reduce such consumption and externalities as well.  Of course, such reasoning only adds to the controversy surrounding the idea.

We at Twenty-One Debunked believe that such taxes are a good idea on balance, and are infinitely preferable to prohibition, including "selective prohibition" for young adults under 21.  We have noted in several previous posts how such taxes are far more efficient than the blunt sledgehammer of prohibition, not to mention cost-effective as well.  In most cases, the taxes already exist and it is simply a question of raising and/or tweaking them, they raise revenue rather than cost it, and they don't violate anyone's civil rights either.

After reviewing the literature and thinking very hard about it, Twenty-One Debunked has come up with the following recommendations about various vice and fuel taxes.

Alcohol

• Raise and equalize the federal taxes on beer, wine, and distilled spirits to the real (inflation-adjusted) 1991 level for spirits:  $24/proof-gallon in 2016 dollars.  (Note how it's proportional to alcohol content)
• Beer of 6% ABV or less should be allowed to treated as a flat 5% ABV per barrel for tax purposes.
• Microbrewers should be exempt from any such tax hikes, at least on the first two million barrels per year.
• Adjust all taxes for inflation annually from now on.  Fix it, and forget it.

Tobacco 

• States with cigarette taxes less than $1.00/pack should raise them to between $1.00-$2.00.
• States with cigarette taxes greater than $2.00/pack should cut them to between $1.00-$2.00.
• Don't raise the federal cigarette tax any further, except to keep pace with inflation.
• All taxes on tobacco products should be equalized across types of tobacco products, and collected at the producer rather than the retail level.
• Adjust all taxes for inflation annually from now on.  Fix it, and forget it.

Cannabis

• Legalize and tax recreational cannabis at a rate of $10-50/ounce on average, adjusting it up or down proportional THC content.
• Collect such taxes at the producer level rather than the retail level.
• Medical cannabis should be exempt from such taxation.

Fuel

• Raise the federal gas tax (and diesel tax) by a penny per week until it is $0.50/gallon higher than now.  (Or $1.00/gallon higher than the status quo if we remain without a carbon tax-and-dividend).
• Call it "A Penny for Progress".
• Give a modest "prebate" to all licensed and registered vehicle owners over the age of 21 (or 25).
• Adjust it for inflation annually from now on.  Fix it, and forget it.

Road Tax 

•  As more and more electric and alternative-fuel vehicles replace gas and diesel ones, a new source of highway infrastructure funding will be necessary.
• Pro-rate vehicle registration fees (road tax) by the number of miles traveled in the past year.  Record odometer readings at each annual safety inspection, and adjust registration fees up or down accordingly.

So what are we waiting for?

Gas Prices Down, Traffic Deaths Up in 2015

While cheaper gas is generally good for the economy and the average person's wallet, unfortunately it also seems to come at a fairly high cost:  more traffic fatalities.  The latest data suggest that was the case in 2015.  After stubbornly hovering between $3.50 and $4.00/gallon from 2011-2014, gas prices on average plummeted to around $2.00 from the second half of 2014 into 2015, and even dropped below $2.00 in early 2016--a seven-year low.  And traffic deaths apparently rose to a seven-year high in 2015, nearly 8% higher than the previous record-low reached in 2014.  Additionally, preliminary data for the first half of 2016 in several states also show that traffic deaths are likely to be the same or higher than they were in 2015.

None of this should really come as a surprise.   As we have noted in a previous post in 2010, it has been known for quite some time now that there is a significant inverse correlation between gas prices and traffic crashes, including fatal ones.  And the link is especially true for younger drivers.  Carefully controlled studies have found this to be true, suggesting a true causal relationship.  Contrary to popular opinion, the price elasticity of gasoline is not zero, or even close to zero, and it seems to rise dramatically when prices go above $3.00/gallon.  Longer-term elasticities are about twice as strong, suggesting the effect builds over time.

The effects on fatalities are not limited to reduced vehicle miles traveled; while that drops too, even controlling for this we can see a decrease in deaths with higher prices.   "Discretionary" driving declines the most when gas prices rise, and most fatalities occur from this type of driving.  Speeding and aggressive driving also decline in an effort to save fuel and money.  Thus, the price elasticity for gasoline demand actually understates the effect on fatalities.  And while non-alcohol related crashes may be more affected by changes in gas prices, alcohol-related ones would be affected as well.

By that logic, it seems that one of the best ways we can reduce traffic fatalities (both alcohol and non-alcohol) would be to raise the gas tax.  Of course, that would make a lot of people mad.  But if it saves even one life, it's worth it, right?  Isn't that what groups like MADD have said about things like the 21 drinking age?  Judging by the lack of enthusiasm about raising the gas tax, it appears that the pro-21 crowd doesn't practice what they preach.  Or maybe it's all about liberty for "just us," not all.

If we know higher gas prices save lives, not to mention the planet, what are we waiting for?

The Evidence Is Clear: Taxation Works Better Than Prohibition

I've said it before, and I'll say it again:  I believe that alcohol taxes should be raised significantly, and the drinking age lowered to 18.   The overwhelming weight of available evidence strongly suggests that alcohol taxes are far more effective, cost-effective, and socially efficient in reducing alcohol-related problems than the 21 drinking age can ever be.  And in the past few years we have even more evidence to show for it.

I have noted in the past that the landmark Miron and Tetelbaum study of 2009 has not only thoroughly debunked the idea that the 21 drinking age saves lives, but it also had a more subtle finding as well.  Namely, it also quietly confirmed the long-accepted finding that raising the beer tax actually does save lives, even if modestly.  And ironically, that was found when they tweaked the pro-21 Dee (1999) study that at first seemed to cast doubt on the beer tax--adding Alaska, Hawaii, and DC as well as more years to the model completely reversed Dee's original findings in that regard, as the original model apparently didn't have enough useful variation or statistical power to detect such results when state-specific trends were added to the regression.

Also, Ponicki et al. (2007) found that while there is supposedly a modest lifesaving effect of the 21 drinking age, high enough beer taxes can actually make that effect irrelevant as the two policies apparently act at cross-purposes.  When one is increased, the other becomes less relevant as a result, for obvious reasons.

Fast forward to newer studies on the effects of alcohol taxation and pricing.  Even pro-21 researcher Alexander Wagenaar appears to be a huge fan of raising alcohol taxes these days.  In 2009 and 2010, Wagenaar did two large meta-analyses on the effects of alcohol taxation on drinking as well as alcohol-related mortality and morbidity, respectively.  In both, the effects were clear:  it is quite effective indeed as a public health measure.  When alcohol taxes/prices go up, problems and deaths go down.  More recent studies also confirm such results as well.  No wonder Mark Kleiman famously said that, "Any sentence about drug policy that doesn't end with "raise alcohol taxes" is an incoherent sentence".

Thus, raising the alcohol taxes, even doubling or tripling them, should be a no-brainer.  So why aren't we doing it?   Clearly, the alcohol industry opposes any attempt to raise such taxes, and they always threaten a loss of jobs if they pass.  But there is really not much if any evidence that such a thing happens, and the industry consistently fails to produce any robust evidence in that regard.  As for the idea that alcohol taxes are regressive and hurt poorer folks and "responsible" drinkers, that is also not really true either:  the economic burden would fall mostly on heavier drinkers and wealthier folks, while moderate drinkers really wouldn't pay very much.  While I do not advocate extremely high taxes like they have in the Scandinavian countries, there is really no good reason not to raise and equalize all alcohol taxes back to at least the 1991 level for distilled spirits, adjust it for alcohol content, and index it for inflation from then on. Microbrewers, on the other hand, should be exempt from any tax hikes.

It is true that Thomas Jefferson said, "No nation is drunken where wine is cheap".  But that was then.  Nowadays, beer, wine, and even hard liquor have apparently become too cheap for our own good.  And far cheaper than back then or even a few decades ago, at least relative to most people's incomes.  Yet the social costs of excessive drinking have not gone down much, so there is a problem of increasing "externalities".  And unlike most policy measures, raising alcohol taxes would also raise revenue rather than cost it, and there would be no loss of individual rights either.  Clearly, it's a win-win-win situation for everyone except the heaviest drinkers and the merchants of death that profit from them (along with funeral directors, of course). 

For once, MADD is correct about something:  if it saves even one life, it's worth it.  I guess even a stopped clock is right twice a day.

Violence Has No Place In Our Movement

At a time in history where various social justice movements are gaining rapid momentum, the question of the use of violence inevitably arises.  That is, under what circumstances, if any, is violence of any kind acceptable as a protest tactic?  While I am not a full-blown pacifist (for example, I believe in the use of physical force in cases of absolute and immediate self-defense, and no "duty to retreat" when one is truly cornered), and I will leave it an open question as to how "self-defense" is defined and whether or not violence has a place other social justice movements, I will say that I do NOT believe that violence as a protest tactic has any place in the movement to lower the drinking age or the broader youth-rights movement in general.  Period.

I'm sure some of us, young and old alike, may fantasize at times about using violence against police and judges who enforce the vile and ageist abomination that is the 21 drinking age and its ancillary laws that prop it up.  And you know what?  You are perfectly justified in your fantasies, and your grievances are absolutely NOT trivial.  I am the last person who would try to gaslight you in that regard.  But when one decides to act out those fantasies in the misguided hopes of redressing those very real grievances, that becomes a serious problem for our movement.  Most of us in the movement are non-violent, and any violence committed in the name our movement only gives ammunition to the other side, confirming ageist stereotypes and hardly makes us look like we are mature enough to drink at 18 or any other age for that matter.  Thus, adding violent tactics to our movement is far more likely to backfire than it would in other movements.

I am not against the use of non-violent civil disobedience, by the way.  But when it comes to aggressive, offensive physical force against law enforcement, judges, politicians, or even MADD for that matter, I will say this to any potential "lone wolves" considering such "propaganda by deed":  NOT IN OUR NAME!

As Gandhi would say, "an eye for an eye makes the whole world blind".  And as I like to say, when you fight fire with fire, we all get burned in the end.  Keep that in mind when protesting or debating.

Vote Green, Not Brown!

We at Twenty-One Debunked just seriously lost some respect for California, a state that we, until fairly recently, regarded as one of the least-worst states in the country (though the bar is set rather low to begin with) in terms of social policy in general.  Looks like the Golden State just joined Hawaii, NYC, San Francisco, and a growing number of localities in this country in raising the purchase age for tobacco to 21, with Governor Jerry Brown (remember him?) signing it into law on May 4, 2016.   The law change takes effect on June 9, 2016, just a few weeks later, when the age limit will rise from 18 to 21 overnight without even so much as a grandfather clause.  Brown also signed other bills on the same day restricting e-cigarette use (i.e. "vaping") in public and expanding the coverage of various no-smoking zones, among other things, but the one that really stood out the most (and rankles the most with us) is the 21 smoking age.  The one exception:  active-duty military members age 18-20 can still buy cigarettes and other tobacco products.  But this exception is a rather hollow way of addressing the fundamental injustice of being old enough to die for one's country but being too young to smoke (or drink for that matter), and doesn't make things much better.  So even with this exception, Twenty-One Debunked still opposes this new law regardless.

Hopefully, there will be a ballot measure in November that will undo the hike in the smoking age.  Until then, though, we might just want to boycott all things from California whenever possible.  That includes major Hollywood movies (which still feature omnipresent product placement from Big Tobacco) and fruits/vegetables grown with fracking wastewater thanks to the very same Governor Jerry Brown.  VOTE GREEN, NOT BROWN!!!

Tobacco, The Ulitmate Dark Horse of Drugs

Almost immediately after posting a recent article about the roundly debunked "gateway drug theory", we at Twenty-One Debunked felt we should post another separate article about the particular case of tobacco, especially in the form of commercial cigarettes. While our organization does not generally view tobacco as a particularly high-priority issue, perhaps it is something we should be revisiting given both recent evidence as well as recent efforts to raise the smoking age to 21.

While the primary dangers of smoking tobacco (i.e. cancer, heart disease, stroke, emphysema, birth defects, etc.) have been well-known for decades, what has been much less appreciated is the neurotoxic properties of cigarettes.  The thing is, nicotine is a known neurotoxin, and it is likely that at least some of the thousands of other chemicals in cigarette smoke are also toxic to the brain as well.  One reported effect of nicotine is that it can "prime" the brain's reward system for addiction in general, including to other substances.  This seems to be particularly true for the early adolescent brain.  While these findings are based primarily on rodent studies, human studies seem to dovetail with this idea far more for tobacco than for cannabis or even alcohol.  Thus, the psychopharmacological aspect of the gateway hypothesis seems to hold true indeed for tobacco, and if there were such a thing as an actual gateway drug (which is a very big "if", if you ask us), tobacco would have to be it, hands down.

Additionally, tobacco is also emerging as a potential "dark horse" in the etiology of psychosis and schizophrenia as well.  This has been informally hypothesized for many years now while being overlooked by most researchers, and is only very recently beginning to be taken seriously by mainstream science.  Perhaps cannabis (which is often mixed with tobacco in many countries, and whose use is often predicted by prior and concurrent tobacco use in general) has been taking a major bum rap in that regard as well?  All while Big Tobacco has subtly and sedulously promoted tobacco smoking as "self-medication" for decades, of course.

That said, Twenty-One Debunked strongly opposes any attempts to raise the smoking age any higher than 18.  Instead, we (along with the TSAP) believe that we should deal with cigarettes the way we would deal with any other defective product such as the historical examples of the Ford Pinto, lawn darts (Jarts), leaded gasoline and paint, DDT, incandescent light bulbs, and old-style refrigerators.  Either 1) require the defects to be sufficiently fixed, or 2) failing that, remove such products from the market.  And yes, commercial cigarettes as they exist today are indeed defective by design in that they addict, enslave, and kill far more people than they have to.  Worldwide, they kill about 6 million people per year, hence the name of Robert N. Proctor's bombshell of a book, Golden Holocaust.

Since 2013, the endgame strategy that the TSAP (and Twenty-One Debunked) currently supports has been to let tobacco phase itself out by gradually reducing the nicotine content of cigarettes to a (relatively) non-addictive level.  Since 2009, the FDA now has the authority to set a legal limit on the nicotine content of tobacco products, as long as the limit is not zero.  Much research indicates that there is a threshold level of nicotine required to create and sustain addiction, and if all cigarettes were to fall below this threshold, smoking rates would plummet precipitously.  In fact, one tobacco executive was quoted as saying, "‘If our product was not addictive we would not sell a cigarette next week."  This idea was originally proposed by Henningfield and Benowitz in 1994, and has been endorsed by the American Medical Association and several other experts including Proctor himself.  Malcolm Gladwell also discussed it in his aptly-titled 2000 book The Tipping Point.   Thus, the TSAP recommends reducing the maximum nicotine content (not delivery) of cigarettes from the current level of 1-2% to less than 0.1% within 5 years, and doing the same for quasi-cigarettes (i.e. little cigars) and perhaps roll-your-own tobacco (but no other products).  That alone would reduce smoking prevalence by as much as 80% within a fairly short timeframe, with further reductions possible in the more distant future.  Alternatively (or in addition), the FDA could require the pH of such products to be raised to 8 or higher to discourage deep inhalation, as is naturally the case for most typical cigars and pipe tobacco currently.

The TSAP and Twenty-One Debunked also recommend that the following measures be taken as well:

• Ban the use of additives in cigarettes, especially those that are harmful or increase the addictiveness of tobacco.
• Ban the use of any radioactive fertilizers or harmful pesticides for growing tobacco.
• Phase-out the practice of flue-curing tobacco, which is a major resource hog and bad for the environment.
• Improve the quality control standards for tobacco products (and electronic cigarettes) to be at least as high as for food.
• End all government subsidies for tobacco farming and production.
• Divest completely from Big Tobacco at all levels of government.
• Vigorously enforce the current age limit of 18 for tobacco and e-cigarette sales to achieve 100% retailer compliance. 
• Continue to allow widespread availability of reduced-harm tobacco and nicotine products (i.e. snus, e-cigarettes, etc.) so that smokers can easily switch to less dangerous alternatives.
• Improve education and smoking cessation programs, funded by tobacco tax revenues.
• Give out free nicotine patches, gum, etc. to any smokers who want to quit.  NYC already does this. 

At the same time, the TSAP most certainly does NOT support outdoor smoking bans or any other policy that treats smokers like criminals or second-class citizens.  Smokers are NOT the villains here, as that dubious honor belongs to the merchants of death known as tobacco companies.  In fact, we have repeatedly pointed out that, far from being a drain on society, smokers actually save society money in the long run since they more than pay their way as far as taxes go.  Cigarette taxes, especially in NYC where they are extremely high, have basically become a "reverse Robin Hood" way to rob from the poor and give to the rich, since smoking has increasingly become a poor man's vice.  And the wide disparity in cigarette taxes across states has led to a serious black market for untaxed/low-tax/counterfeit/stolen cigarettes, with the main beneficiaries being organized crime syndicates and even terrorists.  Thus, we recommend that the handful of states with cigarette taxes higher than $2.00/pack reduce their tax to $2.00/pack or lower, and the states with taxes of less than $1.00/pack raise it to $1.00-$2.00/pack.  NYC should cut its tax in half.  At the federal level, we recommend no further tax hikes, but a national price floor of $5.00/pack including tax to discourage smuggling.

The tobacco industry has basically dug its own grave.  Time to push them in there, yesterday.