Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products (2015) / Chapter Skim
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9 Other Considerations for Policy Makers
9 Other Considerations for Policy Makers
Pages 241-264
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From page 241... ...
None of the state and local initiatives has been followed by a rigorous evaluation published in the peerreviewed literature. Because a review and synthesis of existing empirical literature cannot answer the question at hand, the committee drew on a comprehensive review of the relevant scientific literature, on its collective expertise, and on models of population-level smoking behavior to predict changes in adolescent and young adult initiation attributable to raising the MLA and to project the impact of these changes on the prevalence of use and on health outcomes.
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From page 242... ...
Finally, the chapter identifies two factors of possible public health relevance that were not taken into account in making the estimates and projections described in the report. The more important of these factors is the possible impact of the marketing and use of new tobacco products, most notably electronic nicotine delivery systems (ENDS)
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From page 243... ...
EFFECTS OF OTHER TOBACCO CONTROL POLICIES Both simulation models predict the potential effects on future initiation of increasing the MLA. The SimSmoke model also includes modules for 1 The National Minimum Drinking Age Act of 1984, Public Law 98-363.
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From page 244... ...
In this connection, it is important to emphasize that there are significant variations in the strength and efficacy of existing state and local tobacco control programs. These variations reflect differences in the number and intensity of tobacco control activities and in the resources allocated to support them.
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From page 245... ...
Enforcement Against Retailers Federal support for youth access enforcement, together with funding incentives, has significantly strengthened state enforcement of youth access policies and has thereby curtailed retail availability to underage persons. The committee has assumed that the current levels of enforcement and penalties for violators will continue, creating a credible threat of punishment sufficient to sustain current levels of compliance.
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From page 246... ...
Recall that the 1992 Synar Amendment to the Alcohol, Drug Abuse and Mental Health Administration Reorganization Act2 was designed to incentivize states to enact, enforce, and continuously evaluate laws that prohibit the sale and distribution of tobacco products to individuals under age 18. As discussed in Chapters 1 and 5, states are required to follow specific guidelines for random compliance inspections, surveillance, and reporting as a condition of their receipt of federal Substance Abuse Prevention and Treatment block grant funding.
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From page 247... ...
For example, in Hawaii County, failure to post signage regarding the MLA 21 policy results in a $500 fine, and any person who sells or distributes tobacco products to a person under age 21 is subject to up to a $2,000 fine. Similarly, the penalties associated with New York City's recent Tobacco 21 law include a $500 fine for failure to post required signage, a $1,000 fine for the first sales violation to someone ages 18 to 20 or any other violation in the same day, and a $2,000 fine for the second and any subsequent violation within 3 years.
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From page 248... ...
It requires additional time and effort, in addition to money, for someone to obtain cigarettes indirectly instead of purchasing them directly from a store. As such, forcing underage smokers to find and use indirect sources raises their costs of obtaining tobacco products, which in turn is likely to reduce their consumption.
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From page 249... ...
. Nonetheless, it seems quite unlikely that enforcement of the MLA restrictions against social sources and proxy buyers of tobacco will be intensified so substantially as to create underage demand for black market tobacco products.
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. The case against punishing underage users of tobacco was put forcefully in Growing Up Tobacco Free: Imposing penalties on minors for buying, possessing, or using tobacco products is controversial.
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From page 251... ...
There are few rigorous studies regarding the effects of PUP laws on underage use, mainly because the laws are so rarely enforced, and the limited evidence is mixed. It seems likely, in the committee's view, that meaningful enforcement of PUP sanctions against underage persons for purchasing, possessing, or using tobacco products would deter tobacco use by some underage persons, most likely those who are at least risk for becoming addicted.
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From page 252... ...
These developmental factors, along with adolescents' vulnerability to the rewarding effects of nicotine and their risk of addiction, are widely thought to justify policies that curtail access to tobacco products by teenagers (IOM, 1994, 2007; IOM and NRC, 2011)
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(See also Chapter 3.) Authorities on adolescent development generally agree that the period of development that is typically labeled adolescence stretches from the onset of puberty into the early 20s ( teinberg, S 2012)
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POSSIBLE PUBLIC HEALTH EFFECTS OF NEW TOBACCO PRODUCTS The prevalence of use of electronic nicotine delivery systems among adolescents and young adults appears to be increasing substantially (see Chapter 2; Arrazola et al., 2013; Wadley and Bronson, 2014)
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From page 255... ...
Under this scenario, there may be net public health benefits over the long term, but some portion of those benefits would be attributable to the initiation of ENDS, not to the raising of the MLA. A second possibility is that initiation of ENDS would delay conventional tobacco use, as adolescents and young adults who begin with ENDS switch to conventional cigarettes at a later time, due in part to nicotine dependence and to the relatively lower levels of nicotine delivery from ENDS compared to conventional cigarettes.
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From page 256... ...
The committee sees no reason to believe that the effects of the legal norm and its enforcement on retailer compliance, retail availability, or access to social sources would differ materially for ENDS compared with other tobacco products. Given the evidence that adolescents who currently initiate tobacco use with ENDS rather than with conventional tobacco products are younger (Wills et al., 2015)
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From page 257... ...
(2004) found that smoking bans reduce alcohol consumption in older adult females.
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From page 258... ...
However, the existing empirical literature does not allow estimating a specific magnitude or even a potential range of estimates of those effects in the population overall, let alone among adolescents and young adults specifically. CONCLUDING REMARKS The committee was charged with assessing the potential public health implications of raising the minimum age of legal access to tobacco products.
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From page 259... ...
Perhaps the greatest uncertainty in the committee's assessment is the currently unpredictable effects of the marketing and use of electronic nicotine delivery systems and other novel tobacco products. However, in the absence of transformative changes in the tobacco market, social norms and attitudes, or the epidemiology of tobacco use, the committee is reasonably confident that raising the MLA will reduce tobacco initiation, particularly among adolescents 15 to 17 years of age, will improve health across the life span, and will save lives.
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From page 260... ...
2013. A comprehensive examination of the influence of state tobacco control programs and policies on youth smoking.
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2000. State youth-access tobacco control policies and youth smoking behavior in the United States.
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From page 262... ...
2014. New law prohibiting sale of cigarettes, tobacco products, and electronic cigarettes to people under age 21 in New York City: What you need to know.
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From page 263... ...
2000. Effectiveness of comprehensive tobacco control programmes in reducing teenage smoking in the USA.
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