Chairman Davis and members of the committee:
Thank you for taking the time today to discuss the issue of raising the age to purchase and possess tobacco and vaping products. The Heartland Institute is a 34-year-old independent, national, nonprofit organization whose mission is to discover, develop, and promote free-market solutions to social and economic problems. Heartland is headquartered in Illinois and focuses on providing national, state, and local elected officials with reliable and timely research and analyses on important policy issues. Heartland would like to submit the following testimony.
Many states have proposed legislation to raise the age required to purchase tobacco products. Often, this legislation classifies e-cigarettes and vaping devices, also called tobacco harm reduction products, in a manner similar or identical to products that contain tobacco.
Such proposals limit individual freedom, fail to curb consumption, ignore potential health gains, and cost millions of dollars in lost revenue. Rather than restricting adults’ choices, legislators should make use of revenues already received through tobacco taxes and settlements to promote cessation efforts.
Increasing the age required to smoke and purchase tobacco and vaping products from 18 to 21 limits individual freedom and grossly undermines the responsibility governments place on individuals aged 18. 18-year-olds can serve in war; are tried as adults in courts; and can amass tremendous amounts of debt in contractual loans, such as student loans, which student loan debt averaged roughly $30,000 in 2016. Why then should lawmakers require so much responsibility from these individuals but remain intent on banning young adults from purchasing tobacco or vaping products?
Although one can make a reasonable argument that adults shouldn’t use tobacco products, raising the age for consumption of cigarettes does not necessarily provide the public health benefits officials aim for. For instance, in the 2018 Monitoring the Future Study: Trends in Prevalence of Various Drugs, the National Institute on Drug Abuse noted more than 53 percent of 12th graders and more than 37 percent of 10th graders reported consuming alcohol in the past year. Alcohol and marijuana are illegal for persons under the age of 21 in every state, and yet there is no connection between lower consumption rates and age restrictions.
The Centers for Disease Control and Prevention (CDC) reports nearly 90 percent of tobacco users started smoking by age 18. Nearly all current smokers started by age 26.
More notably, raising the age to purchase tobacco and vaping products doesn’t take into account how minors currently obtain such products. A U.S. Food and Drug Administration study found that 86 percent of youths aged “15 to 17 years old obtained cigarettes by asking someone else,” and 89 percent relied on these sources for e-cigarettes. These so-called social sources include siblings, friends, parents, and even strangers. As indicated in the aforementioned numbers on youth alcohol consumption, youth are able to find social sources to help provide them with products restricted to persons 21 years and older and will merely rely upon these same sources to procure tobacco products.
Even more troubling with the proposed legislation is that Maryland currently uses very little funding from tobacco settlement payments and taxes on tobacco control programs. Of the $538.3 million the state received in fiscal year 2018, Maryland “allocated $10.6 million in state funds to tobacco prevention in fiscal year 2018, just 22 percent of the CDC’s annual spending target.”
The American Lung Association gave Maryland an “F” ranking in 2019 for the state’s tobacco prevention and cessation funding, despite the fact legislation passed in 2000 by the Maryland General Assembly requires all tobacco settlement payments to be deposited into Maryland’s Cigarette Restitution Fund to “implement strategies to reduce the burden of tobacco related disease in Maryland,” among other health care costs, yet very little is dedicated to tobacco prevention and education. In 2013, of the $149.1 million Maryland received in tobacco settlement payments, $85.7 million was “budgeted to go to Medicaid.”
Most troublesome with this legislation is that it treats electronic cigarettes and vaping devices, also called tobacco harm reduction (THR) products, as though they are tobacco products. This is despite the fact data continue to indicate THR products are significantly less harmful than combustible cigarettes. Legislation that classifies these products as tobacco products does a disservice to the public health gains e-cigarettes provide for adult smokers.
Research on electronic cigarettes and vaping devices has found similar reduced harms. In 2018, the National Academies of Sciences, Engineering, and Medicine released a report that found “substantial evidence that completely switching from regular use of combustible cigarettes to e-cigarettes results in reduced short-term adverse health outcomes in several organ systems.” In the same year, the American Cancer Society noted that based on the “currently available evidence, using current generation e-cigarettes is less harmful than smoking.”
This is consistent with findings from other public health groups. In 2015, Public Health England found e-cigarettes are less harmful than combustible tobacco cigarettes, noting that “the current best estimate [shows] using e-cigarettes is around 95% safer than smoking.” A 2016 report from the Tobacco Advisory Group of the Royal College of Physicians concluded that hazards from e-cigarettes are “unlikely to exceed 5% of the harm from smoking tobacco,” and these products have created “a massive opportunity for a consumer – as well as healthcare – led revolution in the way nicotine is used in society.”
Most importantly, public officials should recognize the public health gains these products provide. A 2015 policy analysis by State Budget Solutions examined electronic cigarettes’ effect on Medicaid spending. The author estimated Medicaid savings could have amounted to $48 billion in 2012 if e-cigarettes had been adopted in place of combustible cigarettes by all Medicaid recipients who currently consume tobacco products. A 2017 study by the R Street Institute examined the financial impact to Medicaid costs, should a number of current Medicaid recipients switch from combustible cigarettes to e-cigarettes and vaping devices. The author used a sample size of “1% of smokers [within] demographic groups permanently” switching. In this analysis, the author estimates that Medicaid savings “will be approximately $2.8 billion per 1 percent of enrollees,” over the next 25 years.
Rather than limiting the personal choices of adults, lawmakers in Maryland should reform how they are currently using tobacco funds and direct more resources towards cessation and education efforts. Policymakers should also understand the role of THR products, and recognize the potential health gains these products provide. Legislation that regulates these products should be done on a continuum of harm that reflects the risks associated with each tobacco product.
 “Student Debt and the Class of 2016,” TICAS, The Institute for College Access & Success, September, 2017, https://ticas.org/sites/default/files/pub_files/classof2016.pdf
 “Monitoring the Future Study: Trends in Prevalence of Drugs,” Drug Abuse, National Institute on Drug Abuse, 2018, https://www.drugabuse.gov/trends-statistics/monitoring-future/monitoring-future-study-trends-in-prevalence-various-drugs.
 “Smoking & Tobacco Use,” Centers for Disease Control and Prevention, February 5, 2019, https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm.
 “FDA Study Confirms Youth Reliance on Social Sources,” NATO News, National Association of Tobacco Outlets, March 24, 2016, https://c.ymcdn.com/sites/www.mpca.org/resource/resmgr/2016_Newsletter_Attachments/032816_March_24_2016_NATO_Ne.pdf.
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 Sarah Glantz, “Maryland’s tobacco history: Behind the numbers,” Baltimore Business Journal, March 12, 2013, https://www.bizjournals.com/baltimore/news/2013/03/12/marylands-tobacco-industry-behind.html.
 Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems, “Public Health Consequences of E-Cigarettes,” The National Academies of Science, Engineering, and Medicine, 2018, https://www.nap.edu/catalog/24952/public-health-consequences-of-e-cigarettes.
 “American Cancer Society Position Statement on Electronic Cigarettes,” American Cancer Society, February 2018, https://www.cancer.org/healthy/stay-away-from-tobacco/e-cigarette-position-statement.html
 A. McNeill, L.S. Brose, R. Calder, S.C. Hitchman, P. Hajek, and H. McRobbie, “E-cigarettes an evidence update,” Public Health England, August, 2015, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/457102/Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_England_FINAL.pdf.
 Royal College of Physicians, Nicotine without Smoke: Tobacco Harm Reduction, April, 2016, https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0.
 J. Scott Moody, “E-Cigarettes Poised to Save Medicaid Billions,” State Budget Solutions, March 31, 2015, https://heartland.org/wp-content/uploads/documents/20150331_sbsmediciadecigarettes033115.pdf.
 Edward Anselm, “Tobacco Harm Reduction Potential for ‘Heat Not Burn,'” R Street Institute, February 2017, https://www.rstreet.org/wp-content/uploads/2017/02/85.