Raising Legal Age of Smoking and Vaping to 21 is the Right Thing to do

Originally published in the Toronto Star Jan 21, 2020

This week is Canada's National Non-Smoking Week- disappointingly very necessary for a 44th year. More than two generations after the immense dangers of smoking were made crystal-clear to society, smoking remains the leading preventable cause of death in Canada and worldwide, killing 7 million annually, including 45 000 Canadians. More than alcohol, drugs, car accidents, murder, suicide and AIDS combined.

Now e-cigarettes, or "vaping", ostensibly initially developed as a means to aid pre-existing smokers, is creating a new health epidemic of unknown future consequences. While studies remain unclear on whether vaping is truly of any benefit in helping smokers quit, the staggering uptake of vaping by our youth is beyond question. A recent survey showed 29.4% of grade 10-12 students have vaped in the last month, more than double two years earlier, still rising, and much higher than has been seen for youth (or adult) smoking in generations. If we hope to avoid another generational, or multi-generational, -sized cohort of nicotine addicts with yet to be determined chronic health problems, bold and dramatic actions are required now.

Raising the minimum age for purchase of all nicotine-related products to 21, i.e. for both smoking and vaping, is clearly one part of the solution. The Tobacco 21 movement had been sweeping across the USA for several years, with 20 states already on board, when, last month, Donald Trump did the right thing, signing a bill making it the country-wide federal law. Canada has lagged behind on this, although Prince Edward Island very recently became to first Canadian jurisdiction to enact such.

Very nice- but will it work? Yes, this has been proven in a controlled study of municipalities in Massachusetts, and preliminary data from early-adopting states is promising. The strategy has been called "An idea whose time has come" by the New England Journal of Medicine. Paradoxically, maybe the most trustworthy piece of evidence comes from an internal Philip Morris report warning "raising the legal minimum age for cigarette purchase to 21 could gut our key young adult market". The USA's Institute of Medicine calculated it would reduce smoking initiation by 25%, and overall tobacco consumption by 12%, saving 4.2 million life-years in kids alive today.

Doesn't that ignore the fact that most already start before the current legal purchase age of 18/19? No; because it works primarily by cutting supply lines. Most teens obtain their products from friends who are just slightly older, many fewer will have such contacts above age 21. Furthermore, the period between ages 18&21 is a critical one when many transition from being occasional experimenters to addicted daily users.

Raising the minimum legal age for sale of tobacco and vaping products to 21 is a smart and needed component of both reinvigorating our longstanding, but stalling, battle against smoking, as well as constructing a defense with any hope of countering the tsunami- like rise in youth vaping currently underway.

Dr. Stuart H. Kreisman