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An Ounce of Prevention: Restricting Minors' Access to Cigarettes in NYC

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In the 1940s-60s, the dangers of tobacco use were largely unknown or ignored, and the majority of physicians smoked. Smoking was the norm, and cigarettes were directly marketed to young and old alike. Everyone from sports to movie stars touted cigarettes as relaxing, youthful, sexy, and even healthful. Today, it is recognized that quitting smoking greatly reduces serious risks to your health, including cancer, lung disease, and premature death. Smoking is also recognized as a factor contributing to post-operative complications and delayed recovery.

There is a well-tuned marketing focus describing the evils of smoking and emphasizing the benefits of quitting. Another campaign concentrates on prevention, specifically stopping America's youth from starting or even trying smoking. In recent years, nearly one in five teens leave high school as smokers. This is unacceptable, says Dr. Michael Steinberg, an internist who directs a tobacco dependence program at Robert Wood Johnson University Hospital, New Brunswick, N.J.

Dr. Steinberg believes that restricting a young person's opportunity to try their first cigarette is a necessary part of the prevention strategy. In order to prevent young people from becoming smokers, New Jersey and Long Island raised the required age for purchasing tobacco from 18 to 19 years. New York City Council has just approved a bill to raise the legal age for purchasing tobacco from 18 to 21 years. Mayor Bloomberg is expected to sign it. It is estimated that within seven years, this proposal has the potential to decrease tobacco use in 18- to 20-year-olds by 55 percent and in 14- to 17-year-olds by 67 percent.

For young people, the dangers of smoking are not obvious; the risks are easy to ignore and do not seem to be applicable to them. It is up to those who know better -- the legal authorities, in this case -- to protect them from themselves. Raising the legal age for purchasing tobacco to 21 years provides more time for this age group to mature and learn the dangers of smoking, including the immediate and long-term affect it has on health. Youngsters are convinced they are invulnerable. Everyone agrees that young children cannot determine for themselves the dangers involved in crossing a street, so it is necessary for an adult to hold their hand as they cross. As they get older, they learn to look both ways, so they can cross safely on their own. It's the same with cigarette smoking.

Ninety percent of smokers start before age 18. They most often get their cigarettes from older teens and young adults between the ages of 18 and 20, who buy the cigarettes for them. If we eliminate this source, the chances of youngsters becoming smokers would be greatly reduced. Jonathan Winickoff, a Harvard Medical School pediatrician who spearheads anti-smoking efforts for the pediatrics academy, states that "if you make it to 21 years without smoking, your chances of becoming a smoker drop to about 2 percent." Tobacco is a habit-forming substance that needs to be controlled. The American Journal of Public Health in June 2013 reported that states with more restrictive limits on teenagers purchasing tobacco have lower adult smoking rates.

It is argued that raising the age at which cigarettes can be purchased will adversely affect small businesses by reducing revenue and that the city will lose tax revenue as a result of restricting the sale of cigarettes to young adults. This is fallacious argument and is easily countered. Smoking kills almost half a million people a year in the United States and the loss of half a million people means a loss of customers. Certainly, if our population dies younger than necessary, the result is a loss of older consumers, which would impact small businesses with significant decrease in sales of canes, hair dye, and Depends. It's a tradeoff: Sell products that kill your customers or protect them for potential longevity and increased product demand and consumption. Undoubtedly, the latter contribution to tax revenue, morality, and appropriateness is preferable.

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