Raise smoking age to 21

The child who entered the emergency room where I once worked as a pediatrician was wheezing so badly he could barely say his own name. Sucking in his chest with each breath, he tried telling me he has asthma and always uses his inhaler. While his parents were on the way, I looked and listened but couldn’t figure out why his asthma had worsened.

Then I smelled it.

The child’s Teenage Mutant Ninja Turtles coat reeked of cigarette smoke, and his parents confirmed they both smoke “outside” the house, but sometimes smoke inside after their child has gone to bed. Both his parents had started smoking in their early teens and were nicotine addicts by 18. By now, so many years later, they couldn’t stop smoking.

The young boy spent two days in the hospital receiving breathing treatments and steroid medication. Sadly, since his parents continued to smoke, he will be back in the emergency room again with asthma attack.

As a pediatrician, I spend hours dealing with the collateral damage of adult smoking, treating ear infections, pneumonia, viral infections and asthma in children whose parents smoke.

As a neonatal specialist, I care for infants — some no bigger than two soda cans — who are endangered from chronic nicotine exposure. I also counsel high school freshmen, most of whom started smoking by getting cigarettes from 18-year-old seniors, about the hazards of cigarettes. They don’t fully realize the risks since the damage to their health is not immediate.

Children who smoke are more likely to come from households where a parent smokes, proving that it is not just the health of the adult smoker who is affected.

We know smoking is a modern public health epidemic, killing about 480,000 people every year according to the Surgeon General. Smoking is the number one cause of preventable death from up to 21 diseases. For over 50 years, the medical community has known that smoking causes lung cancer, heart disease and emphysema

Now there is even worse news for smokers. A recent study published in the New England Journal of Medicine lists six new diseases now linked to smoking, including kidney failure, breast and prostate cancer and infections.

So what can we do?

For one thing, we can curb smoking by increasing the legal age to purchase tobacco products to 21. In medicine, we say an ounce of prevention is worth a pound of cure. The best way to reduce smoking is to prevent adolescents from starting to smoke and opening the pathway to lifelong nicotine addiction. Over 90% of smokers begin smoking 21 — a time when their brains, still actively developing, experience the “rush” of nicotine differently, facilitating addiction.

If children don’t smoke before 21, they are unlikely to ever become smokers.

So why aren’t we even debating the merits of increasing the minimum age for tobacco sales to 21?

New York City and other municipalities have already raised the legal age for tobacco purchase. Soon, Hawaii may become the first state in the nation to set the smoking age to 21.

But in the absence of a national standard, we have a patchwork of regulations. In my area, you can buy cigarettes at 18 in the county in which I live in, but not in the county in which I work.

The public health benefits of this age increase are substantial. Counties that have adopted this measure have seen up to a 50% reduction in adolescent tobacco use, which is why the American Academy of Pediatrics supports this policy. School officials know many 14- and 15-year-olds begin to smoke because they see 18-year-old seniors smoking.

Opponents of raising the age of tobacco purchase argue more with fervor than science. They claim that if 18-year-olds can enlist in the military, they should be able to buy cigarettes. This was the exact same claim made when the drinking age was increased to 21. According to the National Highway Transportation Safety Administration, that measure has saved tens of thousands of drivers and passengers since it passed.

Other critics claim the bill violates individual rights. They believe smoking is a personal choice and should not be intruded upon by an overreaching government. Private choices do have public consequences, however.

Aside from the dangers of increased second-hand smoke exposure seen in my child patients, diseases related to smoking — lung cancer, emphysema and heart disease, for example — usually affect smokers when they are adults at ages that are Medicare-eligible, a social program to which we all contribute. Raising the age to purchase tobaccos products is estimated to save $6 billion per year in health care costs because of emphysema alone based on military data. These are funds that communities can use for better schools, roads and parks.

It is time for us to understand and act on the health and community benefits of this measure. Until then, pediatricians can only dream of the day when children with asthma don’t need to come in to the emergency room gasping for air because their parents smoke.

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