PEDIATRICIAN Spring 2003 - AAP-CA

Selling Tobacco Products as a
Public Health Issue
Trisha Roth, M.D.
This year, the California State Legislature
will be acting on a bill to
increase the sale age for tobacco to
21. This proposal causes us to think about the
current state of smoking in California, question
the age-18 law that is a standard nationwide,
look for any signs that this would help reduce
tobacco addiction, and think about the social
mores regarding a person’s age and their relative
ability to take risks with their own lives.
It is clear that California is at the cutting
edge of national and international tobacco
reforms. The state has comprehensive restrictions
on smoking in public places, an 87¢
per-pack tax on tobacco, and an aggressive
anti-tobacco advertising campaign.
For most California adults, the tobacco
culture of the 60s and 70s is clearly waning.
There are few public places, aside from workplace
entryways crowded with smokers, where
adults see other adults smoke. We are also relatively
free of widespread tobacco advertising;
there is no longer a skyscraper high Marlboro
Man on Sunset Boulevard, and there are few if
any tobacco advertisements in our newspapers
and major publications.
Yet this is not a time to grow complacent.
The fact is, while we may think that the battle is
being won, it has actually just moved below our
radar. According to a Surgeon General’s report,
if a person is not addicted by the age of 21 there
is less than a 5% chance that they will ever
become addicted. For this reason, the 18-20
year old population is the new battleground, and
the tobacco companies have shifted their $10
billion advertising campaign to most directly
affect the smoking rates for this age group.
This tobacco industry strategy has
worked. In California the smoking rate for
18-20 year olds has increased more than 35%
over the past eight years. The rate of addiction
for this age group is 40% higher than for those
over 30 years old. This growing rate of smoking
threatens to undo the effects of years of
tobacco reform in California.
In addition, the tobacco industry has
recognized that their advertising to 18-20 yearolds
has a certain “spillover” to younger teens.
By advertising in Sports Illustrated, Spin, Vibe,
and Rolling Stone, they are able to reach the
impressionable minds of 12-17 year olds. To
help the tobacco companies even more, the
current 18-year old sale age for tobacco allows
thousands of high school seniors to legally buy
cigarettes and bring them to the high school
campus. Thus, the powerful combination of
advertising, peer pressure, and ready access is
permitted to take hold — all with sanction by
our current state laws.
Now the California Legislature is recognizing
the problem and trying to do something
about it. At the urging of the California Medical
Association and with the help of the Preventing
Tobacco Addiction Foundation, a proposal
is on the table to increase the minimum age for
purchasing tobacco to 21. This measure, AB
221 by Assemblyman Paul Koretz, may be just
the action necessary to stymie the industry’s
hopes for a resurgence of tobacco addiction
in our state.
The proposal to increase the sale age for
tobacco has grown out of the experience with
age limits for alcohol. In the early 70s, as the
nation reduced the voting age to 18, states
throughout the nation reduced their drinking
ages. This resulted in increased teenage alcoholism,
a spike in drinking for younger teens,
and more drunk driving deaths.
As a result of the unintended consequences
of the younger drinking age, President
Reagan championed the Uniform Drinking
Age Act in 1984, which called on all states to
return their drinking age to 21. This resulted
in a dramatic decline in usage, a reduction in
teenage alcoholism and related deaths, and
more negative teenage attitudes towards drinking.
These positive benefits came even though
there were no significant changes in enforcement
and educational efforts targeted towards
this population.
If the change to 21 for tobacco has similar
effects on usage, it can be expected that teenage
smoking would be reduced by a third. The
Board of Equalization, which collects data
associated with the tobacco tax, has suggested
that the implementation of an age-18 sale law
would reduce smoking among 12-20 year
olds by 30 million packs per year. And these
reductions in smoking are getting at the bud
of nicotine addiction. According to a report by
the Surgeon General, the chance of someone
developing an addiction after the age of 21 is
less than 5%.
A poll completed just before the 2002
General Election showed that 58% of likely
California voters support an increase in the
purchase age for tobacco to 21. This confirms
the results of a June 2002 ABC poll that found
Americans by nearly a 2 to 1 margin favor raising
the minimum legal age to buy cigarettes to
21 in their state. The support in the poll was
found to be strongest among the state’s growing
Latino population, with 68% supporting
the measure and 64% stating “strong support.”
Additionally, two-thirds of the state’s African
American voters support the increase to 21.
According to a Surgeon General’s report, if a person is not
addicted by the age of 21 there is less than a 5% chance that they
will ever become addicted.
Even with this strong support, some will
cling to the old saying “Old enough to fight and
die, old enough to drink and smoke.” Yet if the
drinking age experiment showed this country
anything, it was the necessity for us to collectively
decide the best age at which young
people can responsibly deal with these dangerous
life decisions.
We must not take lightly the need to
protect personal rights, and we should not run
roughshod over the ability of Californians to
make decisions for themselves. Yet the data
clearly suggests that delaying for a few years
access to this heavily marketed product may
avert a lifetime of addiction and premature
death in literally millions of our state’s youngest
citizens. Increasing the sale age for tobacco
is a logical, sensible and timely step for California.
To find out more information, you may
contact the author at TrishaRoth@aol.com
or www.trisharoth.com, Paul Mitchell at
paul@tobacco21.org, or visit the campaign
website at
http://www.tobacco21.org/california.
CALIFORNIA PEDIATRICIAN — SPRING 2003/ 25