When Ohio Gov. Mike DeWine announced his plan last month to raise the state tobacco age to 21 as part of his state budget proposal, he joined what has become a critical mass of states and localities trying to stem an epidemic of underage e-cigarette use.
The numbers are shocking: Between 2017 and 2018 alone, e-cigarette use increased 78 percent among high school students and 48 percent among middle school students, according to the Food and Drug Administration.
According to smoking data from the 2019 Summit County Youth Risk Behavior Survey, traditional high school cigarette smoking fell from 13.5% to 5.8%, while high school e-cigarette use is at 25%. And 16% of middle-schoolers have tried an e-cigarette at least once.
A total of 15 states passed bills raising the age to 21 as of May 1. Twelve have enacted those laws and three are awaiting a governor’s final approval, according to the Campaign for Tobacco-Free Kids. More than 450 localities have passed similar laws as well.
Even the federal government is getting involved. Sen. Sherrod Brown, D-Ohio, has co-sponsored a bill that would raise the tobacco age to 21. And Senate Majority Leader Mitch McConnell, a Kentucky Republican who counts the tobacco industry as a major force in his state, signaled he, too, plans to put a bill on the Senate floor that would increase the purchase age to 21.
The FDA, meanwhile, recently closed a comment period on regulations that would require flavored tobacco products to be in age-restricted sections of retail stores.
The products have become omnipresent in high schools, where kids sneak hits off of such popular products as Juul all day long. The products are largely odorless and easy to hide. Some companies have gone so far as to sell hoodies or backpacks designed to allow e-cigarette users to stealthily take a hit. To a less street-smart parent, they might look like a USB device.
Marketed as a safer alternative to cigarettes, the devices were initially targeted at adults who were trying to quit cigarettes. But critics say they’ve evolved into a lure aimed at creating a new generation of nicotine addicts.
“This is a huge public health concern,” said Sarah Denny, attending physician in the Division of Emergency Medicine at Nationwide Children’s Hospital. “Nicotine is highly addictive — especially in the developing brain of a teenager.”
Linda Richter, director of policy research and analysis for the Center on Addiction, said the dosage is far higher — one pod is the equivalent of a pack of cigarettes’ worth of nicotine.
“Kids are using it basically all day long,” she said. “The amount of nicotine they’re ingesting is huge.”
Prolonged vaping, she said, can affect memory and cognition, making kids more irritable and hurting their ability to concentrate. And because the doses are so high, it’s all the more difficult to get them to quit. Nicotine patches and gum, she said, do little to satisfy the appetite of teenagers addicted to sky-high doses of nicotine.
They’re even more harmful to small children. Henry Spiller, director of the Central Ohio Poison Center said nationally, two children have died from ingesting the products over the past five years.
Nicotine, he said, is classified as a nerve poison. Up until 1980, it was a registered pesticide.
“For little kids, because of two things — the small body weight and the high amount of nicotine — they can get in trouble pretty quickly,” he said.
Summit County Public Health has led a months-long push to get communities to enact "Tobacco 21" legislation, preventing businesses from selling tobacco products, including cigarettes and electronic smoking devices like e-cigarettes and vape pens, to anyone under 21.
Akron, Green, Mogadore, Norton, Richfield village, Tallmadge and Twinsburg city have approved the measure, and Summit County Council approved it for nine county townships: Bath, Boston, Copley, Coventry, Northfield Center, Richfield, Sagamore Hills, Springfield and Twinsburg.
Cuyahoga Falls, Stow, Barberton and Lakemore have rejected it, while Fairlawn is considering it. Hudson previously rejected it, but the measure is now back on the table.
“We would totally be in support of statewide T21, just like statewide smoking bans in restaurants,” Summit County Public Health Commissioner Donna Skoda said. “The only concern we would have is just that there would be enforcement with it because I think if you pass these rules without any enforcement, then there is no incentive for vendors to comply.”
In the 16 Summit County communities that passed the legislation, Summit County Public Health is responsible for compliance checks of businesses selling tobacco products and enforcement, with violations resulting in civil fines.
But Skoda said in some communities with similar legislation, police departments enforce it. Which agencies enforce statewide legislation would need to be worked out, she said.
“Whether it was us or not, we would want some enforcement with some teeth with it,” Skoda said.
Summit County Public Health director of population health Cory Kendrick said he’d want to see e-cigarettes and vaping included in statewide legislation. He’d also wouldn't want any state legislation to prevent individual communities from passing more restrictive laws if they wanted.
According to Summit County Public Health data, 95 percent of adult smokers begin smoking before they turn 21. In Summit County, about 15 percent of people ages 18 to 20 smoke.
“We’re doing this because it isn’t about taking away somebody’s rights or trying to pass over-the-top, restrictive rules,” Skoda said. “It’s really to protect the health of individuals, youngsters, that are making poor choices.”
The growing movement to raise the legal age for tobacco purchase to 21 is only one of a handful of efforts that anti-tobacco groups are using to stem the epidemic.
John Schachter, director of state communications for the Campaign for Tobacco-Free Kids, said he also supports the idea of banning flavors that clearly market to the young. For their part, JUUL, which controls 75 percent of the market, has stopped selling fruity flavors in retail stores, opting only to sell them online, Richter said.
Gregory Conley, president of the American Vaping Association, an advocacy group for e-cigarettes, said while his organization doesn’t love the idea of raising the legal age of tobacco purchase to 21, “there are far worse proposals in the world than Tobacco 21.”
Still, he said, his organization will only back it if existing 18– to 21-year-olds are grandfathered into being able to use the products legally.
One thing they’ll fight, he said, is any effort to ban the flavors. “Flavors are very important to smokers looking to quit,” he said.
Even raising the age, he said, won’t stop youth who are determined to vape.
“The reality is just as with alcohol, cigarettes and marijuana, if youth are determined to get their hands on it, they will get their hands on it,” he said. “Regardless of what you try to do.”
Dispatch staff reporter Kevin Stankiewicz contributed to this story.