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

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

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

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

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

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

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

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

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

Dear Governor Cuomo,

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

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

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

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

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

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

Sincerely,
Ajax the Great, Twenty-One Debunked

Cannabis Legalization Taking Major Bite Out Of Drug Cartels

With more and more states legalizing cannabis each year, it sure seems to be taking a major bite out of drug cartels and other criminal elements that once had such a massive grip on the illicit cannabis trade.  A recent study found that seizures of weed at the US-Mexico border have plummeted by a whopping 78% from FY 2013 through FY 2018, showing that legalization is far more effective than any border wall could ever be in stemming the flow of drug smuggling across the border.  (By the way, they build tunnels under the walls/fences that already exist).

Now if only all 50 states would do the same and legalize cannabis yesterday, along with the federal government as well.

What's New For 2019?

The dreadful year of 2018 has come and gone.  The drinking age remains 21 in all 50 states and DC, the toking age remains 21 in the increasing number of states that legalized cannabis, and Tobacco 21 laws have continued to spread further (though it seems like their spread is decelerating a bit).  Thus, our "18 in '18" campaign failed miserably.  So what will become of 2019?

It remains to be seen what 2019 will be like, but we must redouble our efforts this year and never give up.  Remember, first they ignore you, then they laugh at you, then they fight you, and then you win.

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.

The Kids Are (Mostly) Alright in 2018

According to the latest Monitoring the Future results for 2018, it was mostly good news.  The use of most substances is down or unchanged compared with 2017 among 8th, 10th, and 12th graders, including alcohol and combustible tobacco which are currently at record lows.  The opioid epidemic still does not seem to be engulfing teens the way it has for their elders--opioids are also down among teens.   And most notably, cannabis use did NOT increase in spite of increasingly widespread legalization, decriminalization, and medicalization in more and more states--and paired with the recent sharp decline in teen drinking, one could even argue that cannabis may be displacing alcohol a bit.

The bad news?  The second wave of the teen vaping surge from late 2017 through 2018 (after dropping from its previous peak in 2015 to a lower level in 2017) does in fact seem to be real.  And there was no similar increase in adult vaping at that time, in contrast to previous years.  But for that, we can thank the mainstream media and the FDA for fanning the flames of moral panic over teen vaping, which was probably the best (and free!) advertising that JUUL could ever possibly dream of.  And, of course, JUUL's unusually high nicotine content as well.  And, we repeat, teen smoking has continued to drop to a new record low.  As for the increase in vaping cannabis, that does not seem to have led to an overall increase in cannabis use, but rather a displacement of smoking weed to vaping it instead, much like was the case with tobacco from 2011-2017.

There's No Benefit To The 21 Drinking Age

We need to tell the truth and see the forest for the trees.  There is literally NO overarching net benefit to society in setting the drinking age so ridiculously high at 21.  Zip, zilch, nada.  At least compared with a properly enforced drinking age of 18.

The 21 drinking age has been the greatest alcohol policy failure since Prohibition, and that is no exaggeration.  As the the famous Miron and Tetelbaum study has shown, the specious notion that the 21 drinking age saves lives was really just a mirage all along, and that was not the only study to reach this conclusion either.  This ageist abomination also appears to have only a minor impact on teen drinking, small enough to be accounted for by increased underreporting in surveys, while forcing alcohol underground only makes it far more dangerous than it has to be.

And plenty of other countries have seen massive decreases in both teen drinking as well as traffic fatalities without raising the drinking age to 21.  That includes our neighbor to the north, despite being a car culture like the USA.  Ditto for the UK, which had historically been even more of a drink-to-get-drunk culture than the USA.  Ditto for Australia, also historically a car culture and drink-to-get-drunk culture.  Even Germany, with a drinking age of 16 for beer and wine and 18 for distilled spirits, has seen such progress.  Now that really says something.

So what actually does work to reduce alcohol-related harms for all ages?   We have known the answer for decades now, and it's really not rocket science:

• Increasing alcohol taxes, or otherwise increasing the price of alcoholic beverages
• Restricting alcohol outlet density and/or trading hours (albeit with some nuance)
• Cracking down on drunk driving, drunk violence, and drunk and disorderly conduct
• Improving educational intiatives
• Improving access to treatment

All of these are far more effective, and in many cases cost-effective, than the 21 drinking age and other dubious measures.  As for young people specifically, there is nothing that the 21 drinking age can accomplish that cannot also be replicated with a drinking age or purchase age of 18 that is strictly enforced on vendors.  The British experience with both alcohol and tobacco, as well as the American experience with tobacco, illustrates that very well.  Ditto for Puerto Rico.  This is especially true when paired with an alcohol tax hike, particularly on beer.

"But America is different", you say.  "Americans can't handle a lower drinking age", you say, even if the rest of the world can.  Hey, would you like to be a bit more specific as to exactly why Americans are somehow inferior to our European, British, Canadian, Australian, etc. counterparts that would justify such a ridiculously high drinking age?  Thought so.  And by the way, the logical conclusion to such a specious argument would be to bring back Prohibition for ALL ages, not just people under 21.  Think about it.

Thus, there is no good reason to keep the drinking age any higher than the age of majority.  And in most states, that age is 18.  If you're old enough to go to war, you're old enough to go to the bar.  'Nuff said.

Things Underage Drinkers Didn't Do

A few years ago, Twenty-One Debunked had a segment called "Things Underage Drinkers Didn't Do" (TUDDD), to highlight some off the outrageous misbehavior that over-21 drinkers have done recently.  We decided to bring it back.  In the past week or two:

An underage drinker did NOT drunkenly crash into a school bus in Massachusetts, injuring many adults and children.

An underage drinker did NOT drunkenly and belligerently threaten other passengers and crew on an airplane, causing the flight to be diverted.

An underage drinker did NOT kill one passenger and injure several others, including the other driver, in a DUI crash in Santa Ana, CA.

An underage drinker did NOT drunkenly run over a pedestrian in a parking lot with a pickup truck, landing her in the hospital.

An underage drinker did NOT kill both of his passengers in a DUI crash, himself walking away unscathed, in rural Mendocino County, CA.

An underage drinker did NOT get so incredibly wasted that she literally crashed into a house, injuring a child in that house.

An underage drinker did NOT get sloshed, tried to give her 10 year old daughter and 8 year old son bourbon, had stabby thoughts, asked her daughter to get a knife so they "would all die together", then grabbed and threw her son on the bed before she (luckily) passed out before anyone was killed.

And that, my friends, is just the tip of the iceberg.  But hey, at least they were over 21, right?  Move along, nothing to see here folks...

No Increase In Stoned Driving In Canada Despite Cannabis Legalization

Cannabis has been legal in Canada for everyone over 18 (or 19, depending on the province) since October 17, 2018, and yet a month later there has still been no noticeable increase in stoned driving and related crashes according to police.  While it may still be too soon to tell, that is still very encouraging news that takes much of the wind out the sails of both prohibitionists and ageists alike.

This adds to the growing body of evidence that legalization of cannabis was not a disaster after all, and that there is no good reason to set the age limit any higher than 18.  Food for thought indeed. 

About That Tobacco Endgame Strategy

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

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

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

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

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

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

Food for thought indeed.