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Pediatricians See Burning Need to Raise Legal Age to Buy Tobacco


Jonathon P. Winickoff, MD, MPH, FAAP​
November 19, 2015​​​

As pediatricians, we see how quickly tobacco addiction can take hold of young patients.

I rece​ntly treated a 15-year-​old patient who was given free cigarettes and shared hits from a friend's e-cigarette at the beginning of high school. Within a month, he had begun purchasing from a 19-year-old, paying a dollar per cigarette. He stole money from his mom's purse when his allowance ran out each week. By the time I saw him, he was a half pack-a-day smoker and was unable to quit.

Statistics show that 95 percent of tobacco-dependent adults began using tobacco before their 21st birthday. The earlier young people first use tobacco, the more quickly they become addicted to nicotine and other drugs they try, and the harder it is for them to quit. According to the U.S. Surgeon General, if current trends continue, 5.6 million of today's youth will die prematurely from smoking.

That's why new policy recommendations from the American Academy of Pediatrics (AAP) are so critical to protect young people from the deadly effects of tobacco. The recommendations strongly urge raising the minimum age to buy tobacco products, including e-cigarettes, to 21 nationwide--equal to that of alcohol. As I've come to understand from my work in Massachusetts, increasing the age of sale will reduce tobacco use among teens and young adults at a critical time when they are heavily targeted by the tobacco industry and when nearly all smoking begins.

​​"Statistics show that 95 percent of tobacco-dependent adults began using tobacco before their 21st birthday.​"

This Approach Works​
This lifesaving policy approach already has been established in 81 cities and towns in Massachusetts, where I practice and have been involved in numerous tobacco use studies. The first town in the state to raise the age of sale to 21 saw a 48 percent reduction in high-school smoking in the years after implementation. Massachusetts residents can be proud that other states and cities, like Hawaii and New York City, have taken notice and followed in our footsteps. 

Why Now?
This clear recommendation from the AAP comes as popular new tobacco products threaten to addict young people more quickly and easily than ever. Along with traditional tobacco, the industry is now marketing and distributing a new generation of electronic tobacco delivery devices to the critical age group of 18- to 20-year-olds, when many young people move from experimenting with tobacco to becoming lifetime daily smokers.

In states where purchasing tobacco under age 21 is allowed, 18- and 19-year-old students often buy products not only to smoke personally but also to share with or sell at a profit to younger students. The consequences for high school students couldn't be worse. Fully half of those who become addicted to smoking tobacco will eventually die from a tobacco-related disease.

"It will take all of us - pediatricians, parents and community organizations - to work together to protect children and adolescents from the dangers of tobacco." 

​What You Can Do
Pediatricians should support efforts in their communities and beyond to make sure every board of health knows about and establishes the "Tobacco 21" policy. Members of the U.S. Congress are beginning to heed the call for federal action. The Tobacco to 21 Act (S.2100/H.R. 3656), proposed legislation co-sponsored by Massachusetts Senators Ed Markey and Elizabeth Warren, would prohibit the sale of tobacco products across the country to anyone under the age of 21.

It will take all of us—pediatricians, legislators, parents and community organizations—to work together to protect children and adolescents from the dangers of tobacco. By helping to advance the AAP's new recommendation, we can help a generation of young people avoid a future clouded by tobacco addiction.

​Ab​out the ​​Author


Jonathon P. Winickoff, MD, MPH, FAAP, a member of the American Academy of Pediatrics Tobacco Consortium, is a practicing pediatrician and associate professor at Harvard Medical School and MassGeneral Hospital for Children.