Evidence supports the need to raise the legal tobacco age

(Editor's note: This article was updated on April 9, 2019 to reflect new Texas legislation filed in 2019, similar legislation passed by other states and current smoking rates.)

In 2017, Texas lawmakers first proposed legislation that would raise the state’s minimum legal sale age for tobacco products from 18 to 21. In 2019, Sen. Joan Huffman and Rep. John Zerwas again put forth legislation to be considered by the legislature, in an effort to protect the health of future Texans and reduce cancer risk. Currently, 9 states and over 450 cities and counties have passed similar legislation raising the tobacco age to 21.

Through the collaborative efforts of the Division of Cancer Prevention and Population Sciences, the EndTobacco® program and the Department of Governmental Relations, MD Anderson experts have served as the primary oncology clinical and scientific educational resources on this issue for state legislators. Similarly, MD Anderson has served as an educational resource for the statewide Texas 21 coalition of public health organizations. The EndTobacco program is an initiative of the cancer prevention and control platform of MD Anderson’s Moon Shots Program™.

Nationwide efforts to reduce tobacco use have resulted in significant reductions in smoking rates across the country. The Centers for Disease Control and Prevention (CDC) report current youth and adult smoking rates of just 8.1% and 14%, respectively. However, tobacco use remains the single largest preventable cause of disease, disability and death in the U.S.

According to the CDC, tobacco use claims an estimated 480,000 lives each year. Tobacco accounts for up to one third of all cancers, increases the risk for heart disease, lung disease, diabetes and stroke, and can affect fertility and fetal development.

Each year in Texas, tobacco is responsible for 28,000 deaths, more than $8.8 billion in direct health care expenses and another $8.2 billion in productivity losses.

The proposed legislation is an effort to continue to reduce the burden of tobacco use in Texas by limiting young people’s access to all tobacco products, including electronic cigarettes and smokeless tobacco.

Approximately 95% of adult smokers began smoking before they were 21. Each day in the U.S., about 2,500 children under 18 smoke their first cigarette, and another 400 become daily smokers. In Texas, every year about 13,700 children become daily smokers.

At a recent hearing of the Texas House Public Health Committee, Ernest Hawk, M.D., vice president and head, Division of Cancer Prevention and Population Sciences, testified as an educational resource on the impact of using tobacco products in children and young adults.

“The age before 21 is a crucial time for brain development, as well as social development of individuals in high school and thereafter,” said Hawk. “Therefore it serves as a particularly vulnerable time for addiction to nicotine and other tobacco-related products. Because adolescence and young adulthood serve as critical periods during which individuals are more sensitive to nicotine’s addictive effects, the impacts of this bill are likely to be significant.”

According to a report from the Health and Medicine Division of the National Academies of Sciences, Engineering and Medicine, increasing the tobacco age to 21 across the U.S. would, over time, reduce the smoking rate by an average of 12%, with the greatest effect in those between the ages of 15 and 17. The action would lower smoking-related deaths by an estimated 10% and result in 223,000 fewer premature deaths.

The report also states that raising the tobacco sale age would significantly reduce the number of adolescents and young adults who start using tobacco, and immediately improve the health of adolescents, young adults and young mothers who would be deterred from ever starting.