Texas is among 18 states that have passed legislation to raise the legal age of purchasing tobacco products to 21. The passage of Senate Bill 21, often referred to as Tobacco 21, is a first step in the right direction for public health in Texas. The law has the potential to reduce tobacco use among 18-to-20-year olds, the group that has the highest rate of tobacco use and that is more likely than any other age group to initiate or start using tobacco products. The law also has the potential to reduce tobacco use among adolescents by making it more difficult for high school students to obtain tobacco products from their 18-year-old peers. However, the law does exempt certain Texans, leaving them vulnerable to increased tobacco use and consequently worse health outcomes. Anyone who was already 18 years old when the law went into effect on Sept. 1, 2019, or anyone who has a military ID is exempt from the new law.
The two exemptions to the law are concerning for public health. The grandfather clause exemption for anyone who was already 18 years old when the law went into effect will delay the public health impact of the legislation. Additionally, the military ID exemption is concerning because military personnel are disproportionately affected by tobacco use and in need of increased public health attention to reduce the burden caused by high tobacco use among active military, veterans and their families. On July 7, 2019, the Surgeons General of the Air Force, Army, Navy and United States released a joint statement regarding their concerns about high levels of tobacco product use among uniformed service members.
Recent data from 2017 indicate that 11.3% of Texas high school students are smoking traditional cigarettes and an alarming 18.9% are vaping electronic cigarettes. Our research team has been monitoring trends in tobacco use among Texas adolescents and young adults and have found that while traditional cigarette use decreased for adolescents, e-cigarette use rose slowly then increased rapidly over the past couple of years. The increase in vaping is likely being driven by the popularity and market share of recently available and widely marketed e-cigarette products, such as Juul.
The alarmingly high prevalence of e-cigarette use among Texas high school students has also contributed to the recent shift in the political narrative regarding tobacco legislation. During the 86th Texas Legislative Session, there was bipartisan support in both the Texas House and Texas Senate to raise the legal age to purchase tobacco products to 21. Texas Legislators have historically been against statewide legislation to regulate tobacco products, and Texas is one of only 12 states without a statewide smoke-free indoor air law.
Overall, SB 21 will have a positive public health impact on youth and young adult vaping and tobacco use, but the law has room for improvement, and more legislation is needed to curb tobacco use in Texas. One area that we can further improve in the law, is to focus on banning flavored e-cigarettes as well as other flavored tobacco products, like in Michigan and other municipalities. All tobacco products are available in mint and menthol, and most, such e-cigarettes, hookah, little cigars and cigarillos, are available in a multitude of flavors that are particularly appealing to youth. In 2014, 73% of high school students and 56% of middle school students who used tobacco products reported using a flavored tobacco product. Texas can also do more by increasing funding for statewide efforts to prevent and reduce tobacco use and its associated negative health effects. In fiscal year 2019, Texas spent $4.2 million on tobacco prevention efforts. In comparison, the tobacco industry spends an estimated $652.4 million to market their products in Texas each year — more than in any other state in the country. SB 21 is the right step to protect the public, but emerging data and research should guide additional legislative action and the best practices for preventing youth addiction to tobacco products.
To learn more, watch Discovery Minute: Alexandra Loukas.
Darrien Skinner, MS is a recent graduate from the Health Behavior and Health Education graduate program in the Department of Kinesiology and Health Education at UT-Austin. Alexandra Loukas, Ph.D. is the Barbie M. and Gary L. Coleman Professor in Education, Interim Associate Dean for Research and Graduate Studies in the College of Education, and Principal Investigator of the Tobacco Research and Evaluation Team, Department of Kinesiology and Health Education at UT-Austin.