Editor's note: This story originally stated that Washington was poised to become the ninth U.S. state to pass a Tobacco 21 law. That was incorrect. Arkansas signed its own Tobacco 21 law into effect on Mar. 28, making it the ninth. The story has been corrected.
Washington state is poised to become the tenth U.S. state to raise the age for legal purchase of tobacco and vaping products from age 18 to 21. The state’s new tobacco-age legislation was passed Wednesday by the state legislature, and Washington Gov. Jay Inslee has said he will sign it. The new law will save lives from cancer and other diseases, public-health experts say, by preventing tobacco use and addiction starting in the critical teen and young-adult years.
“This is landmark state legislation that is going to help keep Washington kids from all nicotine and tobacco products,” said Dr. Jonathan Bricker of Fred Hutchinson Cancer Research Center, a tobacco-cessation expert who testified on behalf of the legislation in January.
E.H.B. 1074: Washington state’s Tobacco 21 legislation
Title: An act relating to protecting youth from tobacco products and vapor products by increasing the minimum legal age of sale of tobacco and vapor products
“A person who sells or gives, or permits to be sold or given, to any person under the age of twenty-one years any cigar, cigarette, cigarette paper or wrapper, tobacco in any form, or a vapor product is guilty of a gross misdemeanor.”
The “Tobacco 21" law, as it’s known in this and other states, takes effect Jan. 1, 2020. It makes it illegal to sell or give tobacco or vaping products to people under age 21.
The legislation, E.H.B. 1074, was introduced by Rep. Paul Harris (R-Vancouver) at the request of the Washington state attorney general and the state Department of Health. A bipartisan group of legislators from across the state signed on as co-sponsors. Sen. Patty Kuderer (D-Bellevue) was the prime sponsor of the companion legislation in the Senate.
A 2015 report by the National Academies of Sciences, Engineering and Medicine projected that Tobacco 21 laws could have a substantial effect on smoking rates and smoking-related deaths.
Based on its survey of existing evidence on tobacco use, addiction and brain development, the Academies estimated that raising the national age to purchase tobacco to 21 would reduce adult smoking prevalence by 12 percent and eventually prevent 223,000 of today’s youth from dying early of tobacco-related causes.
Almost all the patients Bricker has ever treated for nicotine addiction first used tobacco and became addicted as minors, he said, a trend that’s reflected in large-scale research studies on tobacco use.
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Through age 25, Bricker explained, the brain is still developing its capacity to weigh long-term consequences when making decisions. While that process is still underway, young people are more likely to decide to use tobacco if presented with the opportunity, and they are more likely to become addicted if they use it.
So, he said, Washington state is now giving young people’s brains three more years to grow before they’re presented with that critical decision: Should I pick up this vape pen or that cigarette?
After the law goes into effect, tobacco and vaping products will still be legally available within the borders of Washington in tribal lands. But in habit formation, Bricker explained, proximity is key. For most of Washington’s 18- to 20-year-olds, it will be an out-of-the-way drive to get to a store where they can legally buy these products.
The law also widens the social gap between young people who can legally get tobacco products and those who can’t, Bricker said. The Academies report cites data that shows the majority of underage tobacco users get it from family and friends. This law takes legal tobacco and vaping products out of high schools and out of the social circles of most teens.
Bricker emphasized that the change also “denormalizes” use of these products for people in that age range. Illegality is a powerful social signal, Bricker explained, especially for the high-achieving, straight-and-narrow kids whom data show are much more likely to try e-cigarettes like Juul than traditional, tobacco-burning cigarettes.
In recent years, there has been an explosion in youth vaping, according to the Centers for Disease Control and Prevention. And although research demonstrates that e-cigarettes contain drastically lower levels of cancer-causing substances than traditional cigarettes, they do pack a giant wallop of nicotine, the addictive drug in tobacco. One Juul vape pod has as much nicotine as at least 26 cigarettes, one recent study found. (For context, a single pod isn’t vaped all at once like a cigarette is smoked; a pod often lasts users one or more days.)
A 2018 study, however, showed that most young people don’t realize that these products have nicotine at all. And research shows that after getting hooked on nicotine via e-cigs, many young people eventually switch to cigarettes.
“I think the harms have been underplayed. They’re real,” Bricker said. He noted that we don’t yet have good data on the health effects of using e-cigarettes, or how vaping compares to evidence-based methods for helping people stop using traditional cigarettes.
Bricker’s research group is testing several different methods — such as smartphone apps, chatbots, and telephone counseling — to help people overcome nicotine addiction and other harmful habits. They employ a mindfulness-based method known as acceptance and commitment therapy, or ACT, to help people cope with cravings. (Visit the HABIT group’s website for more information about the studies and how to get involved.)
There have been numerous attempts to pass Tobacco 21 legislation in Washington state, with bills introduced in both chambers every legislative session since at least 2015.
The law’s expected passage in the Evergreen state reflects a growing momentum across the country.
Two days before the Washington state legislature passed E.H.B. 1074, Utah Gov. Gary Herbert signed that state’s own Tobacco 21 law into effect. Arkansas Gov. Asa Hutchinson signed Arkansas' version on Thursday. Arkansas, Utah and Washington now join California, Maine, Massachusetts, New Jersey, Oregon, Virginia and Hawaii, which passed the first statewide Tobacco 21 law in 2015. Now, New York and Illinois are considering their own. And Tobacco 21 laws have been passed in more than 450 cities, counties and other localities, including Boston, Chicago, San Antonio and Washington, D.C.
The Washington state legislature is now considering legislation that would tax vapor products, with the goals of reducing access by increasing price for consumers and of raising money for cancer research and public health efforts.
It’s going to take a combination of policy efforts like these, joining forces with public health and research, to keep people from ever getting addicted to nicotine and to help those who use tobacco products to quit, Bricker said.
“It’s a marathon,” Bricker said. “For me, I hope that when I reach the end of this marathon, tobacco use will be near-zero. Maybe this is mile 13.”
Susan Keown is an associate editor at Fred Hutchinson Cancer Research Center. She has written about health and research topics for a variety of research institutions, including the National Institutes of Health and the Centers for Disease Control and Prevention. Reach her at email@example.com or on Twitter @sejkeown.