UB expert: Hawaii’s new cigarette law may be only part of the solution

Lynn Kozlowski writes that states should adopt differential age limits based on product risk

by David J. Hill,  University of Buffalo News, January 12, 2016

BUFFALO, N.Y. – Hawaii has made headlines by becoming the first U.S. state to raise the minimum legal age to buy cigarettes and other tobacco products and electronic cigarettes to 21 from 18.

Such a move was encouraged by a review done by the National Academy of Sciences’ Institute of Medicine. The move has largely been lauded as a major step toward reducing cigarette smoking, and the myriad negative effects it has on public health.

But in a newly published article, a University at Buffalo tobacco expert argues that Hawaii’s decision is only one part of the solution, and that the new law incorrectly lumps e-cigarettes and lower-risk smokeless tobacco products (Swedish snus) in with the much more harmful nicotine cigarettes.

“Lumping all tobacco and nicotine products in the same standard ignores the considerable differences in harm to users or bystanders caused by different products,” Lynn Kozlowski, professor of community health and health behavior in UB’s School of Public Health and Health Professions, writes in Issues in Science and Technology, a quarterly publication that provides experts in science, engineering and medicine with a platform to share their perspectives with policy makers and the public.

“The precautionary bias that treats all tobacco products the same obscures an opportunity to reduce the most dangerous form of tobacco use and its costs to society — costs that are increasingly borne by those who are already unhealthy, uneducated and poor,” Kozlowski writes. The article, titled “A Policy Experiment is Worth a Million Lives,” appears in the winter 2016 edition of the publication, which is out now, and is also online.

Kozlowski, an internationally renowned expert on tobacco use who has more than 40 years of experience in researching the drug, argues that policy experiments could lead to encouragement of less harmful products, such as e-cigarettes and Swedish snus, as substitutes for the more hazardous products like nicotine cigarettes, which kill half a million Americans each year.

He writes that states should take advantage of the flexibility they have to adopt different legal purchasing ages. “Such quasi-experiments, in fact, proved valuable for alcohol regulation, where the de facto standard legal drinking age of 21 was arrived at, in part, by comparing the experience of different state age limits,” Kozlowski writes.

Kozlowski suggests that 18 could be the legal age to buy less harmful products like e-cigarettes and snus, while the legal age for cigarettes could be higher, anywhere from 19 to 21. “The need is to try to determine the benefits of pushing the age for cigarettes above that for products that are much less dangerous,” he writes.

If some states used this standard, it would help answer several important questions, such as:

• Would there be an overall decline in smoking?
• Would smoking-related health problems in states that allow people to purchase less harmful tobacco products at an earlier age decline compared to states that regulate all tobacco products uniformly?

“We can’t know the answer to these questions until we do the experiment,” Kozlowski writes, “but if we fail to do the experiment we miss the opportunity for potentially major public health benefits.”

And, he adds, if troubling trends began to emerge in states with differential age limits, the mistake could easily be fixed by moving the legal age for the less harmful products up to that of cigarettes. On the other hand, if the results are positive, other states could adopt differential age limits, too.

Kozlowski previously worked at the Addiction Research Foundation in Toronto, where he led the behavioral research program on tobacco use. He came to UB in 2006 and served as dean of the School of Public Health and Health Professions from 2008 until 2014, when he resumed his role as professor. Kozlowski has published articles on e-cigarettes in several media outlets, including The Huffington Post and The Conversation.

He has also published articles on tobacco policy perspectives in Science, JAMA, American Journal of Preventive Medicine, Tobacco Control, Addiction and other leading scientific journals.

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