Crystal Shen, MD, FAAP
Tobacco 21 legislation, increasing the minimum legal age to purchase tobacco and vaping products to 21 years, was signed into law in April 2019, after years of advocacy from the Washington Chapter of the American Academy of Pediatrics (WCAAP) and coalition partners. The WCAAP’s goal was to educate about the impact of tobacco and nicotine on youth, and to advocate for tobacco control policy to protect youth from tobacco use.
Since 2015, WCAAP’s lobbyist worked with a broad coalition of advocates supporting the legislation, including the state Attorney General, American Cancer Society and Healthiest Next Gen. As a resident physician, I first testified for the legislation before the House Healthcare Committee and received mentorship from WCAAP on providing effective testimony. WCAAP advocacy also included pediatricians contacting their legislators via hundreds of action alerts and during annual WCAAP Advocacy Days.
Opposition to the law came from independent convenience store owners and state legislators also worried about lost tax revenue from tobacco sales. WCAAP advocacy persisted. Along with other pediatricians, I continued testifying for Tobacco 21 (now as a practicing pediatrician witnessing sharp growth in patients vaping).
Youth vaping significantly increased in the US and in Washington from 2017 to 2018, rapidly negating years of decreases in youth smoking. Since 95% of current smokers began smoking before age 21, Tobacco 21 is an effective policy to decrease life-long nicotine addiction. In the 2019 session, the WCAAP president and I worked with the state Department of Health to educate legislators during committee work sessions about adolescent brain development and the prevalence and dangers of vaping, as well as testifying for the bill. Strong, consistent bipartisan legislative champions were key to the bill’s ultimate success, as well as poised and articulate youth testifying on the popularity of vaping.Stories about the human impact of tobacco use and teens’ accounts of vaping prevalence were essential. From a fiscal standpoint, legislators began to value ultimate health care cost savings over reservations about near-term decreased tax revenue.
Passing Tobacco 21 demonstrates the cumulative impact of a diverse coalition, bipartisan legislative leadership, and youth involvement. Pediatricians can be strong advocates for change, educating legislators in the science of the developing adolescent brain, addiction, and public health trends. Our hope is that sharing lessons learned may help improve tobacco control policy throughout the country.