Health Experts Seek Extra Step Against Teen Smoking

Fewer teenagers smoke than at any time in the past decade, but health authorities aren’t satisfied. They want to reach the 28% of high school students who continue to light up.

The ideas include creating anti-smoking campaigns for particular ethnic groups, increasing cigarette taxes, and, in possibly the most intriguing proposal, raising the legal age to 21 for purchasing cigarettes.

Assemblyman Paul Koretz (D-West Hollywood) planned to announce today that he is introducing legislation (AB 1453) to make 21 the legal age for purchasing tobacco products in California.

Koretz took up sponsorship of the bill at the urging of the California Medical Assn., which earlier this year proposed raising the legal age.

“California has led the way in anti-smoking measures, and my bill is the next step in reducing teenage smoking,” says Koretz, who adds: “I know I will face great opposition in trying to pass this legislation.”

But novel approaches may be needed to further reduce teen smoking rates, experts say.

“We are working against an industry that spends a million and a half dollars a day in California to promote its products, and young people are the target,” says Dr. Alan Henderson, past president of the state branch of the American Cancer Society.

A National Cancer Institute report released in April said more research should be devoted to understanding why teen smoking rates remain higher than average in certain groups, such as white female adolescents.

The report also suggested that, because teens are so sensitive to cigarette price increases, raising taxes on tobacco products could have a major impact on youth smoking. That idea has drawn broad support from such prominent health groups as the American Lung Assn. and the American Medical Assn.

Efforts are also underway nationwide to strengthen laws barring sales to minors and cigarette advertising aimed at them. But it’s in California that the tobacco-control movement has been taken one step further, with the proposal to increase the legal age for purchasing tobacco products from 18 to 21.

All but three states allow tobacco purchases at age 18. The legal age is 19 in Alaska, Alabama and Utah. And while the majority of health experts say they believe that raising the legal age would significantly curb youth smoking, the proposal stands little chance of becoming law.

“I think there is enough evidence to know there would be a real public health benefit to raising the legal age,” says Matthew Myers, president of Campaign for Tobacco-Free Kids, a nonprofit group in Washington, D.C. “What we don’t know is whether this would be politically acceptable.”

Nonetheless, how the legal-age debate plays out in California may reflect the strength and direction of the anti-tobacco movement nationwide, he said.”People will be watching California, more to determine how far we’ve moved, politically and culturally, on smoking,” says Myers. “People want to know: Is this an issue whose time has come?”

Raising the legal age to 21 is the best way to cut teen smoking rates, says Dr. Leonard Klay, a Santa Rosa obstetrician who proposed the idea at the California Medical Assn.’s annual meeting in February. Numerous studies show that most people begin smoking before 18. A federal study in 1991, for example, found that the average age for first trying a cigarette was 141/2 and that 71% of smokers said they were daily smokers prior to 19.

Studies also show that people who don’t take up smoking by age 21 are highly unlikely ever to become addicted to nicotine.

But ongoing efforts urging retailers to ask for identification from young people seeking to purchase cigarettes have been only marginally successful. Studies show it becomes progressively easier for teens to buy cigarettes the closer they are to 18.

A legal age of 21 would “almost certainly raise the average age at which a store will sell cigarettes to young people,” says Richard Daynard, a law professor at Northeastern University School of Law in Boston, who has studied the concept.

“The evidence is that store [clerks] will, by and large, not sell cigarettes to a 14-year-old but they will sell to a 16- or 17-year-old,” he says. “Raising the legal age to 21 might push back that cutoff point to 19 or 20. And that would be a very important achievement.”

Health groups in the state, however, seem to favor less-radical tactics that have more proof of effectiveness--such as an increase in tobacco taxes.

The California branch of the American Cancer Society has no position on the age-limit proposal, says the ACS’ Henderson, a professor of health sciences at Cal State Long Beach. The only single approach that definitely changes teen smoking habits is raising the tobacco tax, he says.

State health groups, in fact, have enthusiastically endorsed legislation--Senate Bill 1890--that would raise cigarette taxes in the state by 65 cents a pack. The recent National Cancer Institute report on teen smoking notes that a 10% increase in the price of cigarettes is predicted to reduce youth smoking by at least 5%.

Leaders of the California division of the American Lung Assn. have also questioned the effectiveness of the age-21 proposal in comparison to other approaches to reduce teen smoking.

“In concept we support the idea of raising the minimum age,” says Paul Knappath, vice president of government relations for the California ALA. “What we’d be looking for is what impact it would have on existing efforts to enforce laws on tobacco sales to youth.”

Knappath notes there have been laws banning sales to youth for 100 years but enforcement of those laws has fallen short.

“We still haven’t been able to eliminate illegal sales to minors,” he says. “So we support efforts to enforce the laws we already have on the books.”

Even the tobacco industry appears unthreatened by the idea.

“This is not something we would be involved with,” says Tom Ryan, a spokesman for cigarette-maker Philip Morris Cos. “It’s a societal issue to determine what the minimum age should be to purchase tobacco products.”