Smoking age, e-cigarette measures will save lives

State Sen. Ed Hernandez, D-Azusa, records the vote on his measure to raise the smoking age to 21 on March 10.
State Sen. Ed Hernandez, D-Azusa, records the vote on his measure to raise the smoking age to 21 on March 10. The Associated Press

Last week, the Legislature sent bills to Gov. Jerry Brown to regulate e-cigarettes and raise the legal age for buying tobacco products to 21.

The governor should listen to scientists and the growing body of evidence that deterring young people from picking up a nicotine habit is the most powerful way to save lives and cut the health care costs of tobacco-related diseases.

Every decade or so, in response to falling profits, tobacco manufacturers champion innovations designed to assuage their customers’ valid health concerns. Fifty years ago, after the first surgeon general’s report linking smoking to cancer and heart disease, Big Tobacco promoted cigarette filters in ads featuring doctors. When filters proved useless, companies rolled out menthol and “low tar” cigarettes. In fact, each new product proved more dangerous than the last, as smokers inhaled more deeply to get their nicotine fix.

E-cigarettes are tobacco’s latest dream product: hip, safe alternatives to cigarettes for millennials turned off to tobacco. They are enticingly flavored, inexpensive and unregulated. Tobacco companies have aggressively cornered 75 percent of the e-cigarette market and have focused their prodigious marketing, legal and lobbying forces to shield this emerging bonanza.

E-cigarette use among adolescents is up 800 percent in just the last few years. This saved the industry from declining use of traditional cigarettes. More kids are becoming addicted to nicotine now than a decade ago.

Now, industry apologists want to delay action on e-cigarettes. But science shows that e-cig vapor still has plenty of nicotine and known carcinogens. There is no reason not to require e-smokers to simply step outside.

We also hear from the industry and its allies that 18-year-olds are legal adults. After the Vietnam War, the voting age was lowered to 18, and the alcohol industry used this opportunity to press state legislators to lower the drinking age to 18. The result was a spike in fatalities caused by youthful drinkers. President Ronald Reagan persuaded Congress to force all states back to 21 to buy alcohol.

Parents know adolescents are prone to risky errors in judgment. And smoking does not only harm the smoker. The Centers for Disease Control and Prevention says smoking costs the U.S. economy $300 billion every year. Medi-Cal’s annual smoking-related cost is $3.5 billion. Maternal smoking doubles infant mortality and contributes to our epidemic of premature birth.

Nicotine is a powerful toxin that attacks the brain and circulatory system. A pack-a-day smoker – whether traditional cigarettes or e-cigs – ingests high levels of nicotine hundreds of times a day into the deepest parts of the brain, where anger, lust, hunger and fear reside. Chronic nicotine use eventually starves the brain of its major controlling neurotransmitter, dopamine, leading to frequent cycles of irritability, anxiety and depression. That unbalancing may be one reason that smokers are so prone to mental illness and substance abuse.

Can we really say that young people who become addicted to nicotine are really just hurting themselves? Or, that we have no duty to offer them a little protection while their brains are most vulnerable?

So far, 135 cities across the country, including San Francisco, Boston and just Wednesday Chicago, as well as the state of Hawaii, have said “no sale” to tobacco for those under 21. They’ve recognized that tobacco belongs with alcohol, handguns and gambling.

We should all thank California legislators for their courageous stand against a powerful industry and hope that Gov. Brown is also willing to face down these avaricious merchants of addiction, illness and death.

Rob Crane, a clinical family medicine professor at Ohio State University, is president of the Preventing Tobacco Addiction Foundation, an advocacy group based in Dublin, Ohio. He can be contacted at