Lung Health

Raise the Smoking Age to 21? What the Experts Say

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By Henry Ford Health System Staff

In 31 years of practicing medicine as a lung specialist, you see more than your share of evidence of the harmful effects of smoking. That’s why Henry Ford pulmonologist Daniel Ouellette, M.D., is adding his voice to the growing group of physicians, researchers and public health officials who advocate for raising the smoking age to 21.

He says the move would help curb access to tobacco products at an early age and lead to reductions in smoking prevalence.

In June, Hawaii became the first state in the United States to raise the tobacco sale age to 21. At least 90 cities in eight states have followed suit, according to the Campaign for Tobacco-Free Kids.

In an Institute of Medicine report released in March 2015, the authors concluded that increasing the age for tobacco products “will likely” prevent or delay initiation of tobacco use by adolescents and young adults. The report also said “adverse maternal, fetal and infant outcomes – including preterm births, low birth weight and sudden infant death – will also probably decrease due to reduced tobacco exposure in mothers and infants.”

Given current smoking rates, 5.6 million Americans under 18 will die in their lifetime from a smoking-related illness. National data show that 95 percent of adult smokers begin smoking before age 21.

“We know that the earlier people start smoking, the harder it is for them to quit later. Raising the minimum purchase age means we can make it that much more difficult for teenagers to access cigarettes and other tobacco products,” adds Amanda Holm, who is the chair of Tobacco-Free Michigan. “The 18-year-old high school senior wouldn’t be able to buy cigarettes for their younger school friends and that can make a difference in the rate of young smokers picking up the habit.”

Research has shown that genetic and developmental factors may make quitting at an early age difficult, and that there’s a strong correlation between young people smoking and health risks like depression, anxiety and stress, Dr. Ouellette says.

“Most of my patients are diagnosed with emphysema or lung cancer at a relatively young age from smoking, despite the media attention given to the health risks of smoking and despite them knowing about those risks,” says Dr. Ouellette. “Cigarette smoking doesn’t affect just smokers, it affects everyone. And we all pay for the health care costs.”

According to the Centers for Disease Control and Prevention, smoking causes one in five deaths in the United States, and is linked to cancer, heart disease, stroke, lung disease, diabetes and chronic obstructive pulmonary disease. An estimated $170 million is spent annually for smoking-related medical care for adults, and more than $156 billion in lost productivity is attributed to premature death and exposure to secondhand smoke.

Are E-Cigarettes a Solution?
Lately, conversations around the effects of smoking often turn toward e-cigarettes, and the possibility that they can significantly improve the statistics. Dr. Ouellette is skeptical about e-cigarettes and their use as a smoking cessation tool. E-cigarettes, whose use among middle and high school students tripled from 2013 to 2014, are largely unproven as a smoking cessation tool. Their potential health risks are not yet known, though hospitalizations related to them have included pneumonia, congestive heart failure and seizure.

To date, Dr. Ouellette says, there’s no medical evidence to show e-cigarettes are less harmful than tobacco products. Four studies have found that e-cigarettes are not effective for quitting smoking, Dr. Ouellette says.

“They’re unregulated so we can’t be sure what’s in them. In some studies, it showed that the particulates may be comparable to that of a regular cigarette,” Dr. Ouellette says. “They also come from China, which makes it hard to know who is manufacturing them.”

According to Holm, who helps to manage the smoking cessation program at Henry Ford, the most effective way to quit smoking is a combination of proven nicotine replacement methods like the patch or gum, and counseling.

Check out Dr. Ouellette discussing this issue in this video:

For more information on smoking cessation programs, visit Henry Ford’s Tobacco Treatment Services page.

Dr. Daniel Ouellette is a pulmonologist who sees patients at Henry Ford Hospital and Henry Ford Medical Center – Sterling Heights.

Amanda Holm is the current chair of Tobacco-Free Michigan and project manager for Tobacco Treatment Services for Henry Ford’s Center for Health Promotion and Disease Prevention.