Smoking is dying out. Governments beseech us to save the cats, Hollywood is begging us to stub out the butts, and entire generations have never known a world without anti-tobacco advertising. It’s one of the biggest public health campaigns in human history, and it’s worked. Between 1965 and 2014, the percentage of smokers in America went from 42.4% to just 16.8%, heavy smokers (those who puff more than a pack and a half a day) dropped by almost half in the first decade of the 21st century, and teenagers now smoke far, far less than the teenagers of yore.
But for some, it’s still not enough. They want the smoking age raised to 21. Welcome to the new battlefield in the war on cigarettes.
The reason to raise the smoking age, according to advocacy groups such as Tobacco21 is simple: It cuts off would-be smokers in high school from cigarettes, and helps keep younger smokers from getting tobacco. The idea is that if teenagers can’t get their older classmates to buy them smokes, they won’t start, and those that do smoke will have a harder time getting at them, thus making them more likely to quit. Nobody thinks this will end smoking entirely, but it will keep would-be smokers away from cigarettes longer.
There’s some evidence to back that this works. The vast majority of smokers are made before the age of 20, and if a would-be smoker can get to 21 without cracking a pack, their odds of never doing it jump substantially. So a movement has sprung up, and it’s been surprisingly effective, at least in getting legislation passed. Hawaii, Maine, California, New Jersey and Oregon have all made the smoking age 21, and cities and towns have followed suit.
The Tabacco21 movement has been nothing if not swift — Hawaii was the first state to raise the age and that was just June 2015. But it hasn’t been without controversy. Maine’s increase, which passed at the beginning of August, was vetoed by governor Paul LePage, who saw his veto overridden by the legislature. California’s law, passed in May 2016, saw governor Jerry Brown approve the age increase, but veto a rule change letting towns and counties decide tobacco tax rates. In a Vice overview of the movement, Chris Sherwin, the vice president for state advocacy for Campaign for Tobacco-free Kids, explained it makes the most sense to go state by state, town by town, steadily chipping away at the legal smoking age.
Right now, Sherwin said, their focus is on passing state and local laws in order to show the impact of restricting tobacco purchase to 21-year-olds. “I think most people have really come to understand the truly devastating effects of tobacco, particularly in terms of use addiction,” he said. “This is a policy that’s very common sense.”
But is it actually common sense? Therein lies the problem. The legislation might look good, and depending on your perspective on individual rights, be either an encroachment by the state or absolutely harmless. The significance of age of 21 comes from a rare moment of federal command of the states: In 1984, the federal government took the unusual step of forcing states to raise the legal drinking age. The National Minimum Drinking Age Act of 1984 tied the minimum drinking age to federal highway funding; if it was below twenty-one, states would see a ten percent cut in desperately needed highway funds. But the goal wasn’t to stop kids from drinking. It was to stop kids from driving drunk.
Whether that worked specifically is an open question, but drunk driving fatalities dropped quickly starting in 1982. This is different — the goal isn’t to get teens to not smoke and drive, it’s to get them to never start smoking or quit if they’ve already started. And according to a Harvard study, shifting the legal drinking age did nothing to stop teenage drinking. It’s unsurprising if you think about it; even with a legal drinking age of eighteen, most teens were already breaking the law to drink. They just kept doing that for longer. Really all the law did was give older brothers that much more leverage over their teen siblings. Thanks, Washington.
There’s little to indicate teen smokers would stop just because a law was in their way. It might be more instructive to figure out why smokers quit in the first place. But there’s little data on that, and what we do have is less than inspiring. For example, a 2013 study of Italians who quit smoking discovered 43.2% quit because their health made it impossible to keep smoking. 31% said they quit to avoid future health problems, at least, so those anti-smoking ads are arguably having a positive effect.
For kids to stop smoking, there does appear to be a clear answer: Price them out of the habit altogether. It’s a technique that works, but also creates an odd age division: Smoking rates are heavily tied to socio-economic status, and long-term working-class smokers are less likely to quit over price fluctuations than younger would-be smokers. In fact, they’re so unlikely to do so that a well-meaning attempt to raise cigarette taxes in Missouri was backed by a major tobacco company as a weapon to drive smaller competitors out of business. That means that lower-class, long-term smokers will get poorer as a result of this play.
The interesting fact is: The vast majority of smokers want to quit. In fact, the CDC found that 7 out of 10 smokers between 18 and 24 tried to quit at least once in 2015. Getting them to quit would save everyone, from the smoker themselves to the states they live in, billions, both in money saved on healthcare and money earned from a longer, more healthy life.
Unfortunately, nobody in state governments seems to care if people stop smoking. Fifteen years after the landmark 1998 settlement where tobacco companies paid individual states billions of dollars, money still flowing into state coffers, NPR tracked down where the money went. It was supposed to go into smoking cessation programs. Instead? It went anywhere but to public health:
In Mississippi, where the settlement money was put into a trust fund, a lot of it was spent on things other than smoking prevention and health care, [former Mississippi State Attorney General Mike] Moore says. “What happened as the years went by, legislators come and go, and governors come and go … so we got a new governor and he had a new opinion about the tobacco trust fund,” he says. “So a trust fund that should have $2.5 billion in it now doesn’t have much at all, and unfortunately that’s one of my biggest disappointments.
And it’s not just Mississippi; Moore says that all across the country hundreds of millions of dollars have gone to states, and the states have made choices not to spend the money on public health and tobacco prevention.
A 2016 analysis found Massachusetts, a state with some of the highest cigarette taxes in the nation, just put that money in the state’s general fund. Stopping smoking may save states billions in the long term, but state budgets are made in the short term, and state legislators are all too willing to kick that can down the road. Smokers who want to quit are caught between the tight budgets and tight incomes of states. Money goes to other state projects, and states, although they won’t admit it, need to collect some of that money from nicotine (until legal marijuana smashes this whole system).
Still, the political will seems to be in place to raise the smoking age from 18 to 21. And doing so will likely help, if for no other reason that it offers one more negative to picking up the habit in the first place. If it deters even one smoker, many would argue, it’s worth it. But if we’re going to really solve the issue of smoking, we’ll need to really tackle it as a public health concern, and spend the money we promised to help smokers kick butts for good.
