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Catching fire: Tobacco 21

Despite tremendous progress in reducing cigarette smoking in the United States, tobacco use remains a major public health threat, responsible for nearly half a million deaths each year -- more than alcohol, car accidents, HIV, guns and illegal drugs combined.

Young adults are uniquely vulnerable to the ill effects of tobacco and nicotine. That’s because addiction in adolescents can take hold quickly and cause adverse, lasting consequences. In fact, if cigarette smoking among youth continues at its current rate, more than 5 million teens will die prematurely, according to the Centers for Disease Control and Prevention (CDC).

Yet despite the known risks, 3,200 young people try a cigarette for the first time every day, and many will go on to become long-term smokers. However, research shows that by raising the purchase age to 21, tobacco use by teenagers and young adults can be delayed, maybe even prevented. And the age group that would benefit the most are those age 15 to 17 years.

The movement to raise the legal age to purchase tobacco to 21 has gained traction recently among both parties in Congress, as lawmakers grow increasingly concerned about an epidemic of e-cigarette use among teenagers that health experts fear could lead them to go on to use traditional tobacco products.

Meanwhile states and local governments are acting on their own. To date, 12 states and 450 localities across the U.S. have adopted “Tobacco 21” laws, including six states in just the first four months of 2019.

In addition to tobacco products, many of the laws include raising the purchase age of e-cigarettes, in hopes of curbing nicotine use and dependency across the board. There is evidence that manufacturers have strategically marketed e-cigarettes to youth, a concerning trend given the long-term effects of “vaping” are largely unknown and research shows e-cigarette use among teens increases the chance they will use  traditional tobacco products down the road.

Blue Cross and Blue Shield companies are working in their local communities to reduce tobacco use among youth, partnering with local organizations on tobacco prevention, control and support programs.

Blue Cross and Blue Shield of Minnesota (Blue Cross MN) has long been in the forefront of these efforts. In 1994, together with the State of Minnesota, the company filed the first lawsuit of its kind against the tobacco industry, arguing tobacco companies misled Americans about the dangers of their products. Other states joined quickly and a broad national settlement of these suits fundamentally changed the rules around how tobacco products could be marketed. Following the lawsuit, the state saw a decline in smoking rates that fell faster than the U.S. average, dropping from 22 to just under 14 percent over a nearly 20 year period.

Nonetheless, tobacco use remains the leading cause of preventable death and disease in Minnesota, costing an estimated $7 billion annually and taking the lives of more than 6,300 residents a year.

And new data suggest a changing picture largely due to a dramatic increase in e-cigarette use. Facing the first rise in youth tobacco use in 17 years, Blue Cross MN has been instrumental in helping to organize and co-lead a coalition of 60 organizations that have significantly advanced efforts to raise the tobacco purchase age to 21 and limit youth access to menthol-, candy- and fruit- flavored tobacco. To date 30 municipalities in Minnesota have adopted Tobacco 21 policies.

Likewise, Blue Cross and Blue Shield of Kansas City has partnered with the Greater Kansas City Chamber of Commerce on a range of health and wellness initiatives in the region, including changing the minimum age from 18 to 21 for the sale and purchase of tobacco products and e-cigarettes across the metropolitan area. When the campaign launched in 2015, its goal was to encourage 5 cities to adopt Tobacco 21 legislation by 2018. To date, 26 municipalities have signed on.

Yet despite progress in curbing teen tobacco use through Tobacco 21, some populations continue to smoke at disproportionately high rates and are more frequently targeted by tobacco-industry marketing. Among these are LGBTQ youth, who are nearly twice as likely to be addicted to tobacco. As a result, this community is at a greater risk for premature death and disease.

Blue Cross MN is especially focused on reducing smoking rates for people who are experiencing the greatest health disparities. Working closely with the Food and Drug Administration (FDA) as part of a public education campaign called This Free Life, the plan is helping to promote a tobacco free lifestyle among the LGBTQ community using local brand ambassadors and encourages young adults to draw inspiration from their peers to also live tobacco-free. Early results are promising: Daily cigarette use among participants decreased from 19 percent in 2016 to 11 percent in 2018. Additionally, 70 percent of participants exposed to the campaign expressed the intention to quit smoking within six months, compared to only 30 percent who had no campaign exposure. 

We have made enormous progress in fighting the tobacco epidemic, and Tobacco 21 represents an important step toward protecting those most vulnerable to nicotine addiction. But it’s important that in advancing legislation, we avoid loopholes like continuing to allow flavored tobacco products, which would undercut the goal of keeping youth from harm. That’s why continued Tobacco 21 efforts will require continued vigilance and the right policy solutions so the nation can at last break free of tobacco’s legacy of death and disease.   

Read five reasons why tobacco is still a public enemy and our recommendations to the CDC on taking further steps to prevent young people from beginning to use tobacco.

Also, see our infographic on the prevalence of e-cigarette usage among America’s youth.

Blue Cross and Blue Shield of Minnesota and Blue Cross and Blue Shield of Kansas City are independent licensees of the Blue Cross Blue Shield Association.


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