Comment; Am not a big fan of vaping in general–but it CAN have a place in helping folks get off of tobacco as part of a mult-faceted approach. I think a ban on flavored products would have more impact than an overall ban on folks < 21 years old.

President Trump is expected to sign it into law as part of the overall spending package. Some advocates warn that more action is needed to reduce teenage vaping of e-cigarettes.

Senator Dick Durbin, Democrat of Illinois, discussing a measure to raise the minimum age to buy tobacco products to 21. The measure passed the Senate on Thursday.
Senator Dick Durbin, Democrat of Illinois, discussing a measure to raise the minimum age to buy tobacco products to 21. The measure passed the Senate on Thursday.Credit…Aaron Bernstein/Reuters

By Sheila Kaplan

  • Dec. 19, 2019

The House and Senate have now passed a provision that would ban the sale of tobacco and e-cigarettes to anyone under 21, at a time when Congress and the Trump administration are facing public pressure to reduce the soaring rates of teenage vaping.

President Trump has spoken in favor of increasing the age limit, and is expected to sign the measure into law as part of the overall spending package.

Nineteen states and more than 500 cities and towns have already raised the age to 21. Setting it as a national age limit is viewed as an effort to appease those who are calling for a full ban on e-cigarettes or a flavor ban to prevent addicting a new generation to nicotine.

The measure had received the backing of many companies in the tobacco and e-cigarette industry, as part of a business campaign to soften the public backlash against marketing that appealed to minors.

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Still, many supporters outside the industry said setting a national age of 21 was significant. “This is a big win for public health,” said Senator Brian Schatz, Democrat of Hawaii, who had proposed the higher national age limit to buy tobacco in 2015 after his state adopted it. “Raising the minimum smoking and vaping age to 21 will protect our kids and save lives.”

The higher age restrictions took on added urgency as new federal surveys showed another spike in teenage use of e-cigarettes and as thousands of people, mostly younger adults, suffered severe lung injuries in the last several months that have been largely attributed to vaping THC-related products. On Thursday, the Centers for Disease Control and Prevention said that 54 people had died and 2,506 cases of lung-related illnesses had been reported.

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The twin public health crises pressured some states to impose bans on sales of flavored e-cigarettes, although the vaping industry has challenged many of those efforts in court.

While many lawmakers and public health experts welcomed a higher age limit for sales of cigarette items, others argue that tougher enforcement of sales laws, as well as higher taxes on products, are also needed to deter teenage use.

Senator Dick Durbin, Democrat of Illinois, said raising the age limit was a good step, but he expressed disappointment that the so-called Tobacco 21 provision did not include an e-cigarette flavor ban.

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Mr. Trump said in September that he would soon ban flavored e-cigarettes to reduce youth vaping, but he has since retreated from that position amid intense lobbying from the vaping industry, conservative anti-tax and anti-regulatory groups.

Instead, the White House held a “listening session” last month in which tobacco and vaping industry officials, along with public health leaders and some elected officials, argued the pros and cons. At the meeting, Mr. Trump said he feared a ban on flavored e-cigarettes would cause an influx of unsafe counterfeit substitutes.

“Any serious solution to skyrocketing rates of youth e-cigarette use must include the removal of kid-friendly flavors, not just the tobacco industry’s preferred policy,” Senator Durbin said in a statement.

A federal survey released earlier this month found that nearly one in three high school students reported using tobacco recently. While e-cigarettes are the most popular product, researchers said that one in three users, or an estimated 2.1 million middle and high school students, also smoked cigars, cigarettes or other tobacco products.

Doctors and public health experts have long been concerned about the effects of nicotine on the teenage brain. The National Academy of Medicine has estimated that 90 percent of adult smokers first start the habit before turning 19, when developing brains are most vulnerable to nicotine addiction. In a 2015 study, the academy reported that banning legal access to those under 21 would spur a 12 percent reduction in tobacco use by the time current teenagers became adults; with the biggest impact among 15-to-17-year olds.

That study was published before Juul and other nicotine e-cigarettes caught on with teenagers. Robin Mermelstein, professor of psychology at the University of Illinois at Chicago, who served on the academy panel overseeing the study, said she expects to see a similar drop in youth use of e-cigarettes once the age limit is raised.

“I think that you would be able to see lots of improvements in reduction of tobacco use among teens, all of which is good because the longer you delay any kind of initiation, the less likelihood there is to develop addiction and the less likely it is that use will escalate,” said Dr. Mermelstein.

Although the rate of cigarette smoking has declined to 14 percent from its peak of more than 42 percent in the 1960s, there are still 34 million smokers in the United States, according to the C.D.C. Teenage use of traditional cigarettes has declined too, the C.D.C. said. According to the 2018 national survey by the University of Michigan for the National Institutes of Health, smoking initiation among eighth graders declined to 9 percent in 2018 from 49 percent in 1996.

Robin Koval, chief executive of the Truth Initiative, a nonprofit tobacco control organization, called the new law a step forward, but not a solution to youth smoking, or especially, vaping.

Her organization, and most other public health groups also support a flavor ban on e-cigarettes and excise taxes on tobacco and e-cigarettes, which have been shown to reduce sales, especially to youths.

Micah Berman, an associate professor of public health and law at The Ohio State University, said he wanted to see how federal and state governments enforce the new law.

“With a lot of public health laws and tobacco regulations, there is a tendency to declare victory and walk away,” Mr. Berman said. “My concern is the follow-up.”

In Ohio last year, Mr. Berman said, more than 20 percent of retailers who were inspected by the state were found to have sold cigarettes to minors, in violation of state and federal law.

“Clearly that system has to be strengthened and nothing in this bill would do that,” he said.

In a related action, on Tuesday, the Food and Drug Administration cleared two low-nicotine cigarettes, Moonlight and Moonlight Menthol, for sale in the United States. Manufactured by the 22nd Century Group, the brands contain between 0.2 to 0.7 milligrams of nicotine per cigarette, compared to conventional cigarettes, which have an average of 10 to 14 milligrams of nicotine.

In announcing its decision, the F.D.A. said that these low-nicotine cigarettes had the potential to reduce nicotine dependence in adult smokers. The agency also said that nonsmokers, including youths, would be unlikely to use these low-nicotine cigarettes as a gateway to higher-nicotine products.

The F.D.A. also stressed that Moonlight and Moonlight Menthol differ from conventional cigarettes only in their level of nicotine, and otherwise pose the same health risks.

In July 2017, the F.D.A. said it would eventually require all cigarettes sold in the United States to reduce nicotine content to nonaddictive levels. Under pressure from the tobacco industry, the Department of Health and Human Services has dropped this proposal from its regulatory agenda.

There are currently several other low-nicotine cigarettes on the market, but these do not have F.D.A. authorization. They were “grandfathered in” before current tobacco control regulations took effect.

Dr. Raymond Oenbrink