Young woman smoking

“18 or 19 is too young to allow legal access to a known carcinogen, an addictive substance which can never be used safely.”

(Oyston CMAJ. 2016 Jul 12;188(10):755. doi: 10.1503/cmaj.1150108.)

 

It is easy to see that human bodies mature physically with age. Children grow taller and lose their baby teeth. Girls develop breasts; boys get a deeper voice and facial hair. Eventually, the wisdom teeth come through and growth stops. Hidden inside the skull, the brain also changes physically and does not adopt its final form until the early twenties.

Both physical and mental maturation occur to different degrees at different times in different people. There is no one birthday on which children suddenly become adults.

For legal purposes, societies draw arbitrary lines.

Some movies anyone can see, that movie you have to be 14 to watch, the other one you cannot get into until you are 18.

In Manitoba and New Brunswick a child can be left alone at age 12. At this age, you can also get a permit to buy ammunition. You have to be 17 to join the armed forces, but 19 to join the RCMP.

You can get a private pilot’s licence at 17, but you have to be 18 to get a commercial licence. You can donate a kidney at 16 in some provinces, but you have to be 19 in others.

You can consent to sex and get married at 16, but you cannot enter a strip club until you are 19 in Nova Scotia. You have to be over 19 to adopt a child in BC.

In Alberta, you can get a learner’s permit at 14. In Ontario, you must have no alcohol in your blood while driving up to the age of 21.

There is no minimum age to be a physician in Canada, but the length of training makes it difficult to be a doctor before age 25 or a surgeon before age 30.

You have to be 18 to vote, but you must be at least 30 to become a senator.

What should the age limit be for smoking? Currently, the Canadian federal limit is 18.  It was last changed, from 16 to 18, in 1994. In six provinces and Nunavut the smoking age is 19. In the USA, the smoking and drinking ages were both 21 until the Vietnam war. It was felt that 18-year-olds who could be drafted to fight should also be able to smoke and drink. When many young people died in drunk driving accidents, the drinking age was increased to 21. Hawaii, California, and 200 cities in the USA have increased the smoking age to 21.

Internationally, most countries have a minimum legal age (MLA) for buying tobacco of 18 or 19. In Japan, it’s 20. Honduras, Kuwait, Samoa and Sri Lanka have an MLA of 21.

Institute of Medicine Report Summary

Institute of Medicine Report Summary

The Institute of Medicine issued a report in 2015 which said that the earlier people start smoking, the more likely they are to become dependent on nicotine and the more likely they are to be heavy smokers throughout life. It investigated the options of an MLA of 19, 21 or 25, and concluded that 25 would be the most effective option. Tasmania is also considering legislating an MLA of 25, with the aim of becoming the healthiest state in Australia.

Given that we know that cigarettes are addictive, contain many known carcinogens, cause at least twelve types of cancer and many other diseases, cannot be used safely, and kill half of the people who smoke them, maybe they should not be legal at any age? Some countries, such as Singapore, have considered increasing the MLA by one year, every year until no one is old enough to smoke, and tobacco use is wiped out in one generation.

So why “Tobacco 21”?

Over 88% of smokers started smoking before 21, so if no one could acquire tobacco products before 21 then, ideally, 88% fewer people would start smoking. However, smoking ages are a bit like speed limits. A limit of 100 km/hr does not mean that everyone drives at 100km/hr or slower, but it does discourage people from driving at 120 km/hr or faster. The current limit of 18 or 19 means that many 15 to 17-year-olds can get cigarettes with fake IDs, older friends or relations, or by knowing vendors who will break the law for them. An MLA of 21 will actually be most effective at stopping 15-17-year-olds from smoking.

Age Of Starting Smoking

Age Of Starting Smoking

Will it work?

We know from studies undertaken when the legal age for buying tobacco in the UK rose from 16 to 18, and from studies of high school drinking in the USA after the drinking age was increased from 18 to 21, that changing the legal age does result in a change in usage of alcohol and tobacco.

 

Tobacco 21 reduced smoking in Needham

Tobacco 21 reduced smoking in Needham

The most direct evidence comes from the community of Needham, just west of Boston, where the MLA was increased from 18 to 21 over the years 2005 – 2008. This resulted in a much faster decline in smoking than was seen in the surrounding areas, and halved smoking in high schools in the community.

The Institute of Medicine calculated that raising the MLA to 21 would immediately improve the health of teenagers, reduce the risk of 12 type of cancer, decrease second-hand smoke, improve the health of mothers and their babies, and save 223,000 lives.

A recent editorial in the New England Journal of Medicine described Tobacco 21 as an “idea whose time has come”.

Tobacco 21 - Time has come - NEJM

Tobacco 21 – Time has come – NEJM

This is surely as true in Canada as it is in the United States.