Up In Smoke (and Vapor): Hawai’i Raises Minimum Smoking Age and Regulates E-Cigarettes
On January 1, 2016, Hawai’i became the first state in the nation to increase smoking age restrictions to 21 years old. Under Act 122, Hawai’i prohibits the “sale, purchase, possession or consumption of cigarettes, other tobacco products, and electronic smoking devices (or e-cigarettes) to anyone under age 21.” Before Hawai’i, only municipalities such as New York City and Needham, Massachusetts restricted tobacco sales to individuals under 21 years old. States however, remain more conservative, with Alabama, Alaska, New Jersey, and Utah increasing the minimum age to buy tobacco to 19 years old. The Hawai’i law began a wave of amendments to state tobacco laws. As of July 14th, 13 states (including Hawai’i) raised their minimum legal sale age to 21 years old, as have 170 different municipalities across the nation. Although raising the minimum age to purchase tobacco is a momentous step, there is another important feature of the Hawai’ian law that some other states also adopted in their bill language. The bill restricts sales and uses of electronic smoking devices, commonly referred to as “e-cigarettes.”
In the tobacco restriction movement, proponents for increased age minimum laws argue that a majority of smokers become addicted to cigarettes before their 21st birthdays. According to New York City Health Commissioner Thomas Farley, restricting laws deter young people from smoking all together because the laws make it difficult for the adolescent to access nicotine. Farley asserts, “an 18-year old can buy [cigarettes] for a 16-year-old.” A high school sophomore can go down the hall of his high school and ask an 18-year-old peer to buy him, or bum him, cigarettes. With the age minimum at 21 years old, that high school sophomore would “have to find someone in college or out in the workforce” in order to obtain cigarettes. This obstacle of significantly decreased accessibility to of-age-buyers makes cigarettes less obtainable for high school students.
The August 26, 2013 issue of Annals of Internal Medicine included a hypothetical health policy model that increased the minimum age for tobacco sales to 21 years old. The model projected that youth smoking rates could drop from 22% to less than 9% amongst 15 through 17-year-olds in seven years with the right legislative initiative. The Hawai’i Department of Health and University of Hawai’i both offered testimony to the Legislature in support of the bill as a strategy to reduce youth tobacco use and help current users quit. Further, the U.S. Army and Navy announced that they will comply with the new Hawai’ian law.
Likewise with non-electronic tobacco products, there is evidence that adolescents may benefit from e-cigarettes restriction and regulation. According to the Hawai’i law’s text, 9th and 10th grade students at 6 Hawai’i high schools were subject to a state study. During that study, researchers found 29% of the students used electronic smoking devices at least once and 18% used electric smoking devices regularly. These numbers were “considerably higher” than rates in other areas in the United States. The bill further states that adolescents consider electric smoking devices as less harmful to health than conventional cigarettes. Still, the Hawai’i Legislature highlighted that electronic smoking devices contain highly addictive nicotine. Through this law, the Legislature hoped to keep their young adults away from electronic smoking devices until there is enough research to prove that these devices are in fact safe for adolescents.
A study posted by the Center for Disease Control and Prevention (CDC) found increases of U.S. adults who have both tried and consistently use e-cigarettes. Further, the population’s knowledge about e-cigarettes jumped from 40.9% in 2010 to 79.7% in 2013 due to millions of dollars spent on e-cigarette marketing. Whereas e-cigarettes are heavily marketed on television, non-electronic cigarettes are marketed at all on television due to a 1970s law that banned cigarette advertising from television.
The National Youth Tobacco Survey of 2014 concluded that e-cigarette use is growing fast amongst America’s youth, and the New York Times reported that, “e-cigarettes have arrived in the life of the American Teenager.” The number of high school students who use electronic smoking devices are on the rise, while the use of conventional cigarettes declined. Interviews with teenagers reveal that e-cigarettes have become almost as common at school as laptops. Some high school students report that they smoke e-cigarettes to fit in with the trend and because they like the taste. With candy flavors such as “Sweet Tart” and “Unicorn Puke” (described as the taste of every color skittle at once), the electronic smoking device industry seems to be targeting adolescents and teens specifically.
One advantage of e-cigarettes may be the unprecedented decrease in conventional cigarette use by high school students. Between 2013 and 2014, the number of conventional cigarette smoking teens decreased by 25%, the fastest pace in years. Given the damage non-electronic cigaretts can cause, some may interpret this statistic as a positive trend. Nevertheless, there is growing evidence that dependence on electronic smoking devices may also be harmful to the human body. As the number of e-cigarette users increases, the number of calls to poison centers regarding e-cigarette liquids exposure rises as well. In 2010, poison control centers received one call per month regarding electronic smoke device liquids. In 2014, that number sprung to 215 calls per month. CDC Director Tom Friedman said, “use of these products is skyrocketing and these poisonings will continue.” Calls to poison centers regarding electronic smoking devices were more likely than conventional cigarettes to cause adverse health effects following exposure.
The U.S. Food and Drug Administration (FDA) does not have regulatory authority over recreational electronic smoking devices. Still, the FDA lists the reported adverse events involving electronic smoking devices on its webpage. These illnesses include: pneumonia, congestive heart failure, disorientation, seizure, hypotension, and other health problems. In 2014, the FDA proposed a “deeming rule” which would regulate e-cigarettes as tobacco products. This proposal has not yet been approved. Nevertheless, a survey shows that 57% of those asked believe that the U.S. Food and Drug Administration should regulate e-cigarettes just as it regulates tobacco.
Hawai’i’s law requires a $10 fine for individuals under 21-years-old who are found in possession of cigarettes or electronic smoking devices, or who are caught buying such contraband. Subsequent offences subject violators to $50 fines. If the repeat violator is unemployed and not in school, a punishment of 48 to 72 hours of community service hours may be issued in place of monetary fines. Individuals caught selling tobacco or electronic smoking devices to a person under 21-years-old shall be fined $500 for the first offense and between $500 and $2,000 for subsequent offences. In California, only people over 21 may purchase e-cigarettes and they are now banned wherever traditional cigarettes are forbidden. In addition, California anti-tobacco groups are seeking a dramatic increase in taxes from $0.87 to $2.00 per pack.
Although these new laws garnered some criticism, many groups, including the Coalition for a Tobacco-Free Hawaii, are excited about the changes. The health results and smoking rates in Hawai’i and the other 13 states could lead to nation wide reform.
Lillian Feinberg is from Leominster Massachusetts and graduated cum laude from The George Washington University. She majored in English literature with minors in health and journalism. Lillian is expected to graduate from Boston University with a Juris Doctor in spring 2017. With interests in legislation, policy, energy law, and health law, Lillian looks forward to moving to Washington D.C. after graduation to pursue her policy interests.