America almost had it. After a century of scientific research, litigation, and ad campaigns, our society was close to a consensus that habitual smoking was a thing of the past. After all, cigarette smoking used to be ubiquitous in the United States, and in 1965 the CDC found that 42.4% of adults smoked cigarettes. Compare that to the 14% in 2017, and it is clear that we have made huge societal progress. The effort to marginalize cigarettes as a source of leisure or style is a testament to our ability to do the seemingly impossible. Tobacco industries used to wield major political power--the economies of entire states once hinged on its production. It is certainly not hard to understand why we needed to take a radical approach. Tobacco can cause dozens of deadly cancers and cardiovascular diseases. These effects pose dangers to bystanders as well as to the smokers themselves. Among children, even second-hand exposure can cause weakened immune systems, asthma, bronchitis, lymphoma, and brain tumors. To make matters far worse, this deadly pattern of behavior is insidiously self-sustaining due to the addictive nicotine in all tobacco products. Governments have instituted many different public health initiatives because of these issues, and they have succeeded in causing cigarette use among middle and high schoolers to nearly bottom out. However, in the past decade, middle school and high school use of e-cigarettes or “vapes” has exploded. This explosion has led officials to consider the same big question that they faced during the cigarette crisis: how far should we go to keep kids from becoming addicts?
In 1964, the US. Surgeon General released their first report on the health effects of smoking tobacco. In it, they identified tobacco as a causal factor for lung cancer and laryngeal cancer in men, and a probable causal factor for lung cancer in women, as well as a leading cause of chronic bronchitis. Even though evidence of this had existed for years, this revelation was shocking because of the popularity of smoking. Tobacco companies at the time claimed that their brand of cigarette had health benefits ranging from soothing your throat to helping with digestion. After the health concerns surrounding tobacco began to appear, companies rolled out “filtered” cigarettes, which in reality did nothing to filter out deadly chemicals like tar and carbon monoxide.
As new concerns arose, tobacco companies routinely came up with a new spin or new products to maintain their consumer base. The most important element of this consumer base was high school and middle school children. CDC figures show that, as of 2014, 90% of adult smokers started smoking before they turned eighteen even though the legal tobacco purchasing age has been eighteen in all fifty US states since the 1990s. To reinforce this pipeline of smoking youths who grow into smoking adults, tobacco companies regularly targeted children with flavored tobacco products and youth-focused ad campaigns. We know that this targeting was intentional. RJ Reynolds Tobacco executives were recorded as saying that
Executives recognized the importance of the adolescent demographic to their sales, and knew that without teenagers trying their products, their customer base would dry up. Fortunately, a 1998 effort to stop tobacco companies from marketing to kids, the Master Settlement Agreement, stymied these campaigns. Since then, the rate of teenage smoking has dropped significantly, from 28.8% of high schoolers in 1976, to 15.8% in 2011, to 8.1% in 2018.
While it may seem that the drop in teenage cigarette smoking can be attributed to the many initiatives discouraging youth tobacco use, it is more likely that there is another explanatory factor. While high school tobacco use has dropped from 15.8% to 8.1% since 2011, e-cigarette use has increased from 1.5% to 20.8% in that same period. The use of nicotine-delivery systems among youth has actually increased during a time when it seemed like school-aged nicotine addiction had become a thing of the past. It’s no wonder that many in the media have gone straight to the panic phase of coverage and termed this strong growth trend a “vape crisis” or “vaping epidemic”. There’s certainly no doubt that the use of vapes has increased significantly, but the repercussions of such a trend aren’t yet clear. The question of whether or not panic over teenage vaping is justified is a complicated one; studies on the health impacts of vaping haven’t yet shown the bright red flags that were common in studies of tobacco smoking. Some scholarly articles from institutions like Yale University carry headlines that talk about the “underestimated” health risks of vaping but the actual risks that they talk about seem to be limited to nicotine addiction. Addiction carries its own problems. Scientists have shown that drug use during adolescence can hamper mental development, and can leave users predisposed to becoming addicted to more and more harmful substances as they age. On the physiological side, the US Surgeon General’s website identifies risks like the inhalation of heavy metals and other harmful flavorings and particles, but qualifies these risks by saying they haven’t yet been fully researched. The caution around vaping is informed by our experiences with previous generations, specifically the millions of Americans who developed crippling addictions to substances that they would only too late learn were deadly. Vaping is highly addictive, that much is clear. The public health angle on this issue centers around preventing teenagers from becoming addicted to something that we may learn at some future date causes serious health issues.
Like most things, controversy surrounds the government’s efforts to address these issues. For some, preventing middle schoolers and high schoolers from becoming addicts is a noble calling; to others, it is a slippery slope. The outcome is decided by how officials decide to go about solving the problem. One of the most important steps that has been taken recently is the FDA’s move to prevent flavored vapor liquid from being sold to minors. Just as with cigarettes, pleasant flavors like bubblegum and strawberry have helped children get into a habit that might not otherwise be palatable. Flavored cigarettes were banned by the FDA in 2009, which contributed to their drop in popularity with kids. A similar initiative for e-cigarettes makes perfect sense. E-cigarette advocates say that they serve an important role in our society by giving cigarette addicts a healthier alternative. These addicts certainly do not need flavored vapes to keep up with their nicotine addiction. Numerous states have already implemented new initiatives and laws to stamp out teenage addiction. Some states place excise taxes on the sale of vapor products. Minnesota, for example, places a whopping 95% tax on the wholesale price of vapor products. It’s not clear if this tax has had a significant impact, however, as their HS vaping rate of 19.2% is only 1.6% below the national average.
Some states have seen fit to take their efforts to halt vaping even further, and have taken steps to increase the smoking/vaping age from 18 to 21. A bill recently passed by both Virginia legislatures and signed by Gov. Ralph Northam will raise Virginia’s minimum smoking age as of July 1st of this year. Advocates of these efforts say that the age range from 18 to 21 is when many move from experimental smoking to habitual smoking. Others argue that many high-schoolers illegally buy vapor products from 18- or 19-year-old friends, and an age increase can prevent these straw purchases. But for many, this effort crosses a line. Defenders of vaping point to its usefulness as a healthy alternative for those already addicted to tobacco products, and see efforts like this as preventing afflicted smokers from access to the tools they need to help them quit. Still others see these efforts as a pointless removal of agency from young adults to decide how they want to spend their free time on their own private property. Perhaps the correct debate that we should be having in the United States today is the meaning of the age of maturity and turning 18. At age 18, in every state, you are adjudged to be old enough to sign legally-binding contracts, join the military, and vote for our national leaders. If the argument is that the brain has not finished developing at 20 and needs to be protected, then that deserves to be scrutinized. If policymakers are convinced that the 20-year-old mind is not yet fully developed and thus cannot make responsible decisions, then perhaps they should be consistent. Perhaps they should follow scientists’ findings and raise the smoking, drinking, driving, and voting age to 25. After all, that’s when they say the human brain is finally fully developed. However, if we don’t use brain development as the basis for our judgements on the age of majority, then there seems to be a lack of other reasons to raise it. In the end, many of these arguments are the same that were made when the national drinking age was raised to 21. At least the lawmakers who oversaw that effort had the consideration to grandfather-in those who were over 18 and under 21 at the time. This law has no such provisions. Furthermore, teenage drunk driving was a national epidemic when that change was made. Very reasonable arguments for an age-minimum adjustment could be made. While it is true that vaping has grown to “epidemic” levels in middle and high schools nationally, the threat this epidemic poses is far less severe than the deadly threat posed by drunk driving. More importantly, an age-requirement increase doesn’t solve the problem at hand. Research has failed to find a relationship between raising the minimum smoking age and lower rates of youth smoking. Policymakers should be pursuing policies that researchers have empirically found to be effective, like excise tax hikes and restrictions on smoking and vaping in public places.
These efforts to halt new addictions to nicotine come from good intentions. Governments are fully justified in trying to stamp out potentially harmful behaviors in minors. Minors do not have legal agency, since they aren’t emotionally or mentally equipped to make choices that will affect the course of their entire lives. Once the threshold to adulthood has been crossed, however, the decision to partake should be a personal one. Excise taxes and partially-restrictive regulations are optimal in cases like this because they depress potentially harmful behaviors, but still allow people the freedom to choose. Restricting access to flavored vapes can put a sizeable dent in youth vaping numbers. Initiatives that try to educate on the potential ill effects of smoking and vaping are also encouraging, because it gives people all of the information they need to truly act as their own agent once they become adults. Vaping does not need to be a public health issue, and can be a genuine source of pleasure for adults acting on their own agency. A broad-brush government approach suffocates that possibility. This issue on its own may not seem very important, but the question of informed self-determination is one that can be found in almost every topic of political debate. We can only hope that public officials end up striking the right balance between concern for the public health and personal freedom.