My Turn: Youth tobacco use is a public health problem for New Hampshire

For the Monitor
Published: 3/3/2020 6:00:21 AM

It is tragic when young adults come into my office addicted to tobacco. As a physician at the New England Heart and Vascular Institute at the Catholic Medical Center, I know first-hand the immediate and long-term health consequences of youth tobacco use, and I am especially concerned as recent data reveals increases in rates of New Hampshire youth e-cigarette use to levels higher than any other state.

With the federal government’s recent action to raise the legal tobacco age to 21, it is still necessary for state legislation, such as Senate Bill 248, to raise the tobacco sales age to 21 to allow for state enforcement. I applaud the New Hampshire Senate for passing SB 248 and encourage the New Hampshire House to follow suit.

Cigarette use in teens had decreased to 4.6% in 2018, but now because of e-cigarettes we are addicting a whole new generation of youth. The tragedy is that 64% don’t know that all e-cigarettes contain nicotine. In fact, JUUL contains 59 mg/ml, almost three times the legal limit for nicotine in the European Union of 20mg/ml. Our youth are now becoming addicted to nicotine at alarming rates.

Youth tobacco use is a public health problem for the whole state: 40% of Granite State youth have tried vaping and nearly 25% report regular use. In comparison to adult brains, adolescent brains are especially sensitive to the addictive properties of tobacco as they are more vulnerable to reward and less averse to risk. The prefrontal cortex, the brain area responsible for decision making, impulse control, sensation seeking and susceptibility to peer pressure, is one of the last brain areas to mature and is still developing during adolescence. That said, adolescents falsely believe they could “smoke for a few years and then quit,” yet 95% of adult smokers began smoking daily before 21 years of age.

All forms of tobacco use are harmful and addictive, and can cause serious physical and mental health issues that span a lifetime. Youth tobacco use is associated with the risk of developing mental and behavioral health problems, such as substance use disorder, major depressive disorder, agoraphobia, panic disorder, antisocial personality disorder and academic problems. Youth tobacco use also contributes to adverse physical health effects, including cancer, lung disease, heart disease and stroke.

Almost all lifelong tobacco addictions begin before 21, when the adolescent brain is still forming and most susceptible to addiction, and tobacco companies recognize this as a window of opportunity. Tobacco companies know that if they do not capture an individual before the age of 21, then they have a very slim chance of ever capturing them.

Due to the lack of regulation, relentless tobacco industry marketing toward youth and the ease at which they can access these products, tobacco companies have an easier time attracting Granite State youth, which explains why youth tobacco use is higher in New Hampshire than any other state.

A majority of underage tobacco users rely on social sources to purchase for them. According to findings from the Institute of Medicine, 90% of people who purchase cigarettes for distribution to minors are under 21. Increasing the minimum tobacco sales age to 21 will help reduce minors’ ability to buy from 19-year-olds in their social network.

When the alcohol sales age was raised to 21, decreases were seen in drinking by high school seniors, and today’s adults drink significantly less than those who grew up with a lower drinking age. Increasing the purchasing age raises the barriers to access for minors and addresses the issue of youth tobacco use that the existing age restrictions do not.

Tobacco products are designed to entice young adults and currently they are easy to access, which is why in combination with raising the tobacco purchasing age to 21 we also need other tobacco control efforts, such as: increasing funding for prevention programs, enhancing regulation, licensing and taxation of tobacco products, and prohibiting sales of flavored products.

In December, the federal government made it illegal to sell tobacco products to anyone under 21 in response to increasing youth tobacco use rates nationwide. This legislation is an important step for public health, but it is still necessary for New Hampshire to also raise the age to 21 to allow for state enforcement. We are already seeing the public health benefits in the four New Hampshire towns – Dover, Keene, Franklin and Newmarket – that have enacted Tobacco 21 ordinances. Maine, Vermont, Massachusetts and Connecticut are among the 18 other states that have already raised the tobacco purchasing age to 21 and have seen significant drops in youth smoking rates. State enforcement will help improve the effectiveness of a Tobacco 21 law to have a significant positive impact on the health and safety of Granite State youth.

(James Flynn is a physician at Catholic Medical Center in Manchester.)

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