California votes to raise smoking age to 21: Has it worked in other places?

California's Senate voted Thursday to make it illegal to sell tobacco to anyone under age 21. If the governor signs it, it would make California the second state to raise the legal limit.

The California Senate’s vote to make it illegal to sell tobacco to anyone under age 21 could mark the beginning of a visible shift in US policy on tobacco use, public health researchers say.

The vote – part of a broader package of antismoking measures placed before the Senate on Thursday – puts California a step away from becoming the second state after Hawaii to implement the policy. It heads next for Democratic Gov. Jerry Brown's desk, who does not comment on pending legislation.

More than 100 cities across the country – spurred by shifting public opinion around tobacco use and the success of early initiatives in increasing the minimum sales age – have already instituted similar measures. Legislative approval from the nation’s most populous state would only drive the movement forward despite pushback from the tobacco industry and others, researchers and advocates say.

“There’s a huge amount of momentum around this right now,” says Micah Berman, an assistant professor at the Moritz College of Law and the College of Public Health at Ohio State University in Columbus. “There’s a lot more research coming out all the time on the effects of nicotine on the adolescent brain, and [the policy] is incredibly popular. Even people who are current smokers don’t want the next generation of kids smoking.”

“I think when state policymakers see that another state has implemented a progressive public health measure ... they are more likely to positively consider adopting it themselves,” adds Kerry Malloy Snyder, assistant director at Public Health and Tobacco Policy Center at the Northeastern University School of Law in Boston, in an e-mail.

One study that has bolstered the policy’s credibility comes out of Needham, Mass., which in 2005 became the first town to bump the legal age to buy tobacco from 18 to 21. The researchers analyzed data collected from 2006 to 2012 in a school-based census of youth in communities in and around Needham.

By 2010, the researchers found, cigarette smoking among Needham High School students had dropped significantly more – from 13 percent to 7 percent – than among those in the surrounding suburbs, where the age restriction was not in place. The percentage of under-18s who bought cigarettes in stores also declined further in Needham than in the communities around it, according to the study.

Part of the reason may be social: Young people who don’t buy cigarettes directly tend to get them from others their age or in their circles, says Shari Kessel Schneider, co-author of the study and project director at the Health and Human Development Division at the Education Development Center, a health and education advocacy nonprofit in Waltham, Mass.

“When you increase the minimum sales age, you’re not only reducing teenagers’ direct access to cigarettes,” she says. “You’re also reducing the social sources who may be giving them cigarettes.”  

The study, published in June, is the first to link raising the age limit on tobacco sales and its impact on teen smoking. Combined with the findings of the nonprofit Institute of Medicine – which suggest that raising the minimum legal age of tobacco use would decrease the smoking rate in the United States by about 12 percent and reduce smoking-related deaths by 10 percent  – the study has helped draw attention “to the great impact that this policy could have,” Ms. Schneider says.

Still, she and others are careful to say that any effects are often the result of multiple factors.

“[I]t’s always difficult to determine the effect of a particular policy in isolation, given that there are often other factors,” writes Ms. Snyder at the Public Health and Tobacco Policy Center. “In [New York City], for example, Tobacco 21 was adopted around the same time as other innovative tobacco control measures ... restricting certain tobacco product discount sales.”

Some lawmakers have also expressed concerns over the policy, noting that people who are old enough to serve in the military or commit a felony should be old enough to buy a cigarette.

“I can’t stand cigarette smoking. It’s disgusting,” Hawaii Rep. Angus McKelvey (D) told The Associated Press in June, when that state became the first to ban tobacco sales to anyone under 21. “But to tell somebody you can go and fight for your country and get killed but you can’t have a cigarette, that's the thing.”

Others have called it a matter of freedom of choice. “Is this a state that believes in the idea of individual liberty, in the freedom of choice, and that you can buy the products that you want even though they might harm you?”  said California Rep. Chad Mayes (R) of Yucca Valley when the state Assembly gathered to vote on the policy March 3, the Sacramento Bee reports. “I submit to you that we have moved beyond our basic ideals.”

Despite such misgivings, public health advocates are optimistic about the policy’s potential to decrease teen smoking, which is among the most reliable indicators of a lifelong habit: Among adults who become daily smokers, 90 percent started smoking before age 19, the IOM report notes.

That the California Legislature – which saw a surge in financial support from the tobacco industry between 2007 and 2014, according to a report from the University of California, San Francisco Center for Tobacco Control Research and Education – voted to pass the measure now could be indicative of deeper change in attitudes around tobacco use. 

“If I’m in an optimistic mode, I think it signals a new era in tobacco control in California … [which] has been a place where the industry has been so powerful in recent years,” says Stanton Glantz, a professor of medicine at UCSF and the center’s director.

More broadly, public perception of the age-restriction policy has been positive, with about 75 percent of Americans – including nearly 70 percent of smokers – saying they support raising the minimum sales age, according to a 2015 survey by the Centers for Disease Control and Prevention.

“I think public opinion about smoking has really changed dramatically,” says Richard Daynard, a law professor and president of the Public Health Advocacy Institute, also at the Northeastern University School of Law. “My students, their general attitude at this point is, ‘Why would somebody want to do that?’ Certainly that wasn’t the attitude when I was growing up and in generations after.”