March 27, 2019 10:24 am Scott Wilson – Work to ban tobacco and e-cigarette sales to those younger than 21 has been rolling across Illinois for years. Kids who were starting seventh grade when the first city in the state passed such an ordinance can legally buy cigarettes there now.
But legislation now before Gov. J.B. Pritzker would at last accomplish what only seven other states have done in recent years: Require people buying tobacco or e-cigarette products anywhere in the state to be at least 21 years of age.
It's a win for the state's health, as well as for the Illinois AFP.
The chapter's board chair, Asim Jaffer, M.D., of Peoria, testified before the Illinois General Assembly in support of the bills in February. He reminded lawmakers that family physicians are often the primary physicians for teenagers and young adults and that "youth use of nicotine in any form, including e-cigarettes, is unsafe, can cause addiction and harm the developing adolescent brain, affecting attention and learning."
The shorthand for this kind of legislation is Tobacco 21, and it's the law in California, Hawaii, Massachusetts, Maine, New Jersey, Oregon, Virginia, Guam and Washington, D.C. It's also in line with the Academy's position on the issue.(2 page PDF)
A March 2015 report from the (then) Institute of Medicine estimated that a nationwide Tobacco 21 rule would lead to "approximately 223,000 fewer premature deaths, 50,000 fewer deaths from lung cancer and 4.2 million fewer years of life lost for those born between 2000 and 2019."
With data showing that 95 percent of smokers fire up the habit before they turn 21, municipalities nationwide -- including New York City, Boston and more than 400 others in 25 states -- have passed their own Tobacco 21 statutes.
In Illinois, Evanston became the first community to raise the purchase age to 21 in 2014; Chicago followed suit in early 2016. That same year, according to the Chicago Department of Public Health, 9.7 percent of residents 18 to 20 years old reported use of cigarettes or e-cigarettes, versus 15.2 percent in the previous year -- a 36 percent decrease.
But a statewide Tobacco 21 victory in the Illinois General Assembly last year fell victim to a veto from (then) Gov. Bruce Rauner, who argued that underage consumers would purchase cigarettes illegally or across state lines, hurting businesses that sell tobacco and e-cigarette products -- a position that parroted that of smoke-friendly business owners. The Illinois Senate voted to override the veto in November, but a House effort to do the same failed, setting the stage for a new push under a different administration.
By then, Peoria had enacted what Jaffer said was Illinois' first downstate Tobacco 21 legislation.
"No cities in Illinois, outside Chicago and its suburbs, had Tobacco 21 legislation," Jaffer told AAFP News. "But last spring, we partnered with the American Heart Association to make another big push in Springfield and work toward several city-limits efforts, including here.
"That was my personal highlight of advocacy," he added, speaking about the eventual Peoria win. "I was able to take my children with me and have them at the city council meeting when it passed. I have a picture of us there that is one of my favorite things ever."
Jaffer continues to speak to students through the Academy's Tar Wars campaign, a practice he began when his own children -- a 10-year-old son and a 7-year-old daughter -- first enrolled in grade school.
"For the youth in the community to see that their family docs feel this strongly about not smoking, to see us in the news or in the clinics or in their schools, that's important," he said.
Jaffer looks for opportunities to intervene against smoking and nicotine use -- medically, as well as politically. To achieve the latter, he advises his fellow physicians to start at the municipal level, as he did.
"The first step always should be local," he said. "You're able to be eye to eye with your local public official, whether a city councilperson or the mayor, and make the conversation about your community and its youth. You live where your councilperson lives. It's a commonsense approach to talking about health care."
Jaffer's approach in the exam room is no less community-specific.
"It's routine, when I take a medical history, to ask my adolescent patients about illicit use of tobacco and vape products," he said. "I ask whether their school peers are using cigarettes or e-cigarettes, and almost 100 percent of the time they say yes. And so I ask: 'How about you?'
"Often, I do get the honest answer," he added. "That's the beauty of being a family doc. They know I'm not judgmental and they can tell me, and I will talk to them honestly."
Pritzker is not expected to veto the new Tobacco 21 legislation, but regardless of that outcome, Jaffer said he would continue adding his voice to further efforts to curtail youth use of nicotine.
"Anything having to do with limiting the dangers of nicotine, I want to be part of that," he said. "If, through education, we can prevent them now and keep them smoke-free well into their 20s, the data are clear that they're less likely to develop the addiction.
"I want to double down when we're talking about the dangers to youth, including from JUUL and vape products. I do know there was vocal opposition to Tobacco 21 from the vaping community. An article in our local paper said their sales had gone down -- which made me want to celebrate."
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