Presented by: Melitta A. Johnson, MHA, August 7, 2015 Increasing the Legal Age to Access Tobacco Products - An Introduction - Presented by: Melitta A. Johnson, MHA, August 7, 2015

Smoking and Tobacco Use Progress has been made since the 1st Surgeon General’s Report in 1964 The rate of tobacco use has declined from 42% in 1964 to 18% today Yet, tobacco use is the #1 leading cause of preventable deaths Half of those who smoke die of smoking-related illnesses Nearly 500,000 deaths are attributed to tobacco-related causes Yet, 42 million American adults and about 3 million middle and high school students continue to smoke http://www.surgeongeneral.gov/library/reports/50-years-of-progress/fact-sheet.html

Tobacco Use Typically Begins at an Early age Of the adults who smoke daily Approximately 90% of adult smokers report smoking prior to the age of 18 Nearly 100% of smokers report smoking prior to the age of 26 Increasing legal age will likely prevent or delay initiation of tobacco use by adolescents and young adults

Smoking Causes More Deaths Smoking kills Smoking HIV Illegal drug use Alcohol use Firearms Motor vehicle accidents http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/

Smoking in the U.S. http://www.npr.org/sections/health-shots/2014/07/31/336386346/amid-smoking-decline-look-whos-still-lighting-up

Smoking in LA County

The Cost of Smoking and Tobacco Use Tobacco industry $9.17 billion U.S. $300 Billion http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/ 2013 figures

How Smoking and Tobacco Use Effect the Body http://www.cancer.org/research/infographicgallery/tobacco-related-healthcare-costs?gclid=CjwKEAjw3PGtBRCWgajpu_uY9hYSJAAICRalKYJqFkEgf8V00ADjPcSxUaNT0ujvTHGyWEy7nMjFaBoCJa3w_wcB

Why Do People Smoke? Diabetes Cancer Lung disease Fertility issues Heart disease Fertility issues Diabetes Social pressures Social rewards Parental/family influence Marketing Stress relief Addiction Everyone knows that smoking can lead to each of these things, but why do people still smoke?

Food and Drug Administration and Institutes of Medicine Committee In 2009, the Family Smoking Prevention and Tobacco Control Act granted the FDA authority over tobacco products In March 2015, the Institutes of Medicine concluded that raising the legal age to access tobacco products will have positive impact on public health and save lives.

Public Health Implication of Raising Legal Age of Smoking Institutes of Medicine identified some predictors of public health outcomes. They include: Tobacco use initiation Developmental biology and psychology Tobacco policy In 2009, the Institutes of Medicine created a committee to determine the public health implications of raising the minimum legal age to access tobacco products

Prefrontal Cortex and the Adolescent Brain Prefrontal cortex: The part of the brain for Decision-making Impulse control Sensation-seeking Peer pressure susceptibility Emotion control The prefrontal cortex fully develops after adolescence Tobacco initiation primarily effects adolescents and young adults because their ability to make sound decisions & control peer pressure influences has not yet fully developed

How Do We Reduce Tobacco Use Initiation Rates? Continued tobacco cessation efforts at the city, county and state level Increasing advertisements that discourage tobacco use Partnerships with cancer societies Raising the legal age to access tobacco products from 18 to 21 Adolescents 15-17 years of age will be most impacted by an increase in the legal age The majority of underage users rely friends that are over 18 to obtain tobacco products (i.e. other high school students/peers)

Tobacco Policy State and local municipalities have the power to control the legal age for tobacco use Hawaii became the first state to increase the minimum age from 18 to 21 (effective January 2016). At least 80 localities in 8 states have already increased minimum legal smoking age, including New York City Tobaccofreekids.org CDC July 2015

Conclusion Raising the legal age for tobacco use will save lives by: Reducing the rate of initiation Reducing the number of tobacco users State and local governments have the power and authority to increase the legal age to access tobacco products The public health impact will depend on state and local initiatives that lead to smoking cessation

Philip Morris “Raising the legal minimum age for cigarette purchaser to 21 could gut our key young adult market (17-20) where we sell about 25 billion cigarettes and enjoy a 70 percent market share.” - Philip Morris report, January 21, 1986