The snowball effect on the age-21 movement for buying tobacco products has reached an acceleration point once thought unfathomable within the industry and society as a whole.

In the past nine days, the top two U.S. tobacco manufacturers — Altria Group Inc. and Reynolds American Inc. — have signaled their support for an expected Food and Drug Administration recommendation to Congress to raise the minimum purchasing and usage age from 18 to 21.

As recently as 2014, the top manufacturers — which included Lorlliard Inc. at that time — were adamant in their stances for preserving 18 as the minimum age for their products.

The strategic policy changes likely come in large part from an FDA request, made Sept. 12, that Juul Labs Inc., R.J. Reynolds Vapor Co., NuMark, Fontem Ventures and Logic submit details within 60 days on how they plan to curtail use of their products by youth, in particular flavored electronic cigarettes.

The shift to age 21 comes with an estimated $2.5 billion cost in lost annual sales from consumers ages 18 to 20, representing about 2.5 percent of the industry’s revenue stream.

“I imagine that the shrewd thing is for tobacco companies to fall into line with proposed regulation in order to appear socially responsible,” said Stephen Pope, managing principal of financial-advisory group Spotlight Ideas of London.

“It would appear that the U.S. is taking a harder line than the U.K. with regard to age and place of use,” Pope said when asked if Reynolds’ policy change could be related to being owned by British American Tobacco Plc.

“That said, given the potential market size and the cash flow needs of BAT’s in the U.S., taking the path of least resistance is arguably the most sensible course right now.”

Gregory Conley, president of the American Vaping Association, said there could be a quid-pro-quo element to Reynolds and Altria’s switch to supporting age-21.

“Both Altria and Reynolds seem to recognize the only way of getting pre-market tobacco applications and substantial equivalence reforms approved is to give something up,” Conley said.

Both companies have entered the FDA regulatory gauntlet seeking pre-market and/or modified risk certification of e-cigs, heat-not-burn traditional cigarettes, moist snuff, snus and other innovative products.

The manufacturers have said the future of their companies is dependent in large part on having a dependable pipeline of FDA-approved innovative tobacco products.

A substantial-equivalence filing is for products that either have the same characteristics as those marketed on/before Feb. 15, 2007, or have different characteristics but do not raise different questions of public health impact.

A modified-risk tobacco product application seeks authorization to market products as reduced harm or reduced risk compared with traditional cigarettes.

On July 28, FDA Commissioner Dr. Scott Gottlieb unveiled a regulatory “road map” that supports a continuum of risk strategy to tobacco products that may have a role for e-cigs, heat-not-burn traditional cigarettes and other innovative products.

Gottlieb has stressed in recent weeks that the FDA will limit the availability of flavored e-cigs in the marketplace that adults are using to reduce traditional cigarette consumption if necessary to curtail teenage use of e-cigs.

Predictable move?

So, how did we get here?

Advocates say the primary goal of age-21 is further limiting youths’ exposure to cigarettes, and possibly all tobacco products, in hopes of delaying or preventing the start of any form of use.

Many studies, most prominently a 2012 U.S. Surgeon General report, show that about 90 percent of Americans who smoke begin before age 18.

Still, tobacco manufacturers rebuffed all attempts at raising the minimum age.

For example, Reynolds said in 2014 its position “is that our companies follow the law wherever it applies.”

Robert Bannon, director of investor relations for Lorillard, cited in 2014 that Congress already has set the minimum age — and 18 is considered adult enough to legally vote and serve in the military.

Yet, industry observers and analysts say the 180-degree turn by the manufacturers had become predictable, if not inevitable, with the FDA’s focus on tightening marketing and sales regulations amid what Gottlieb has called “an epidemic” of youth e-cig consumption.

Reynolds said Wednesday it “identified several specific actions that our companies would take, and additional regulatory proposals we believe that FDA should consider implementing across the industry.”

Those include:

  • Supporting legislation to raise the age of purchase to 21 for all tobacco products;

Reynolds said its support of a minimum age of 21 also extends to any potential state action.

  • Imposing penalties to contracted retailers who sell to youth; and
  • Implementing additional safeguards on online purchases to address youth purchase and straw purchases.

Shannon defined straw purchases as “any person who purchases on behalf of an underaged person.”

On Oct. 26, Altria said its support for age-21 is based on a phased-in approach

“The data we’ve seen from (studies) show that the primary source of youth access to these e-vapor products is social access, and we think if the minimum age to purchase is raised to 21, it should have a significant impact on that,” said Howard Willard, Altria’s chairman and chief executive.

Unintended effects

Before Altria and Reynolds threw their support behind age-21, and top-selling e-cig maker Juul Labs Inc. in April, momentum was left to states and large cities to build.

In 2014, no state banned tobacco product sales to individuals under age 21.

Now, six states — California, Hawaii, Maine, Massachusetts, New Jersey and Oregon — have passed laws mandating age 21.

In 2014, there were about 40 municipalities and communities who took their own action on age-21.

Now, there are at least 350 municipalities, including Boston, Chicago, Cleveland, Minneapolis, New York City, San Antonio and Kansas City, Mo.

In July 2015, a federal study found that about half of adults strongly favor increasing the minimum age for buying tobacco products to 21. Another 25 percent said they somewhat favored the proposal, according to the Centers for Disease Control and Prevention.

However, several studies have demonstrated that the age-21 initiative may have some unintended consequences.

In March 2016, a Cornell University study found a connection between higher age requirements for purchasing e-cigs and increased use of traditional cigarettes by youths.

In October 2017, a Yale University study found that many of the 47 states that have banned the use of e-cigs and vaporizers by people younger than 18 — including North Carolina — have experienced an increase in the number of youths smoking traditional cigarettes.

The paper by Yale researcher Abigail Friedman, published in the Journal of Health Economics, appears to counter a prevailing anti-tobacco advocacy message: that e-cigs and vaporizers serve as a youth gateway to traditional cigarettes.

Officials respond

Local state legislators said they were pleased with the manufacturers’ willingness to back the age-21 initiative.

“I’m happy to see Reynolds display a corporate responsibility to help reduce use of tobacco products by our youth,” said Sen. Joyce Krawiec, R-Forsyth.

“We have all done a good job of educating citizens on the dangers of smoking, but too many think that vapor products are safe. The additional regulatory procedures being recommended may be a first step in achieving these safety goals.”

Rep. Donny Lambeth, R-Forsyth, introduced in March 2017 a bipartisan bill that would raise the smoking and vaping age to 21. House Bill 435 covers all tobacco and tobacco-derived products, electronic cigarettes and vaporizers, and cigarette wrapping papers.

The bill was sent to the Committee on Rules, Calendar and Operations, where it has not been acted upon.

“I, along with my health committee chairs, proposed raising the age to 21 due to the early age that many of our citizens start smoking,” Lambeth said. “Many have told me they wished they had not started, but were just too young to know better.

“So, yes, I believe this may start a movement across the country to raise the age.

“The health risk and cost are significant and we should do all we can to raise awareness of those at risk and educate young people to the risk,” he said.

Mixed reactions

The response to the manufacturers’ decision was — as expected — mixed, depending on where the observer sat on the public health anti-smoking and anti-tobacco spectrum.

Brad Rodu, a professor of medicine at the University of Louisville and an anti-smoking advocate, made comparisons to the Alcohol21 campaign of the 1980s. Congress raised in 1984 the age restrictions on buying alcohol to 21 — making it for some individuals the final rite of passage into adulthood.

“That effort succeeded in reducing rates of teen alcohol use, and it likely reduced teen deaths,” Rodu said. “Tobacco21 could similarly reduce teen tobacco use.”

Vince Willmore, vice president of communications for Campaign for Tobacco-Free Kids, said momentum began to build toward age-21 after the National Academy of Medicine issued its 2015 report concluding increasing the minimum age would significantly reduce smoking among youth and young adults.

Willmore did caution that while age-21 “is an important step, by itself it will not solve the problem of youth e-cig use.”

“We also need effective, mandatory FDA regulations that apply to all manufacturers, including a crackdown on flavors and marketing that appeal to kids and enforcement of the requirement for FDA review before new products go on the market.”

Workaround needed

John Dinan, a political science professor at Wake Forest University, said Congress does not have the power to simply raise the tobacco-buying age to 21.

“It would have to come up with a workaround of the sort it used in 1984 in inducing states to raise the drinking age to 21.

“States were given a choice of raising the drinking age, but then told that they would lose a portion of their federal highway grants if they didn’t take this step.”

Some industry observers question how much raising the age restrictions would help in further reducing already historic low teen-smoking rates in North Carolina and the nation.

For North Carolina, the teen smoking rate reached 8.9 percent in 2017, while nationally it fell to 7.6 percent. Those rates are based on smoking at least once over a 30-day period.

Meanwhile, the U.S. adult smoking rate fell to a historic low of 13.9 percent in 2017.

With e-cigs and vaporizers, the N.C. youth usage was at 16.9 percent in 2017.

Other industry observers say that while they support age 21 for cigarettes, they would prefer a carve-out for the sale of potential reduced-risk nicotine delivery products, such as e-cigs, to encourage their use. “We should regulate tobacco products proportionate to their risks, and e-cigarette evidence suggests they’re less risky products,” said Dr. Michael Pesko, an assistant professor of health-care policy and research at Weill Cornell Medicine.

Dr. John Spangler, professor of family and community medicine at Wake Forest Baptist Medical Center, said that the surge in youth e-cig use has alarmed not only public health officials, professional medical societies and health care providers.”

“Parents are also terribly worried about their children becoming addicted to these products ... and the harm to the adolescent brain that nicotine inflicts.

Because of these concerns, Spangler said “I think the public is ready for action to raise the age for tobacco use.”

“I think this message has gotten through to politicians, policy makers and — therefore — to manufacturers that something needs to be done.” 336-727-7376 @rcraverWSJ

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