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Raise Smoking Age to 21, U.S. Pediatricians Urge

And regulate e-cigarettes the same way as other tobacco products, doctors add

By Tara Haelle
HealthDay Reporter

MONDAY, Oct. 26, 2015 (HealthDay News) -- The minimum age to purchase tobacco products and e-cigarettes should be raised to 21 across the United States, according to a new policy recommendation released Monday by the American Academy of Pediatrics.

The strong statement by the nation's leading pediatricians group was among more than two dozen recommendations aimed at tightening regulations on cigarettes, e-cigarettes and other tobacco and nicotine products, to reduce youth smoking and nicotine addiction.

The group also called for the U.S. Food and Drug Administration to regulate e-cigarettes the same way it regulates other tobacco products.

"Most adolescents don't use just one nicotine product but will commonly use or experiment with several," said Dr. Harold Farber, lead author of two of the statements and a pediatric pulmonologist at Texas Children's Hospital. "Research to date shows that adolescents who experiment with e-cigarettes and conventional cigarettes are much more likely to go on to become regular cigarette smokers and less likely to stop cigarette smoking."

The new policies were presented Monday at the group's national conference and published online simultaneously in the journal Pediatrics.

Currently, only Hawaii and about 90 cities and communities in several other states have a law requiring a minimum age of 21 to purchase tobacco products, according to the Campaign for Tobacco-Free Kids.

"As the brain matures, the ability to make decisions with important health consequences should likewise improve," said Dr. Danelle Fisher, vice chair of pediatrics at Providence Saint John's Health Center in Santa Monica, Calif. "Thus, slightly older young adults may choose to forgo tobacco products," suggested Fisher, who was not involved with the new policy recommendations.

In addition, older teens often buy tobacco products for younger ones, Farber said. He added that communities requiring buyers to be at least 21 have seen youth smoking rates drop.

Another policy recommendation aimed at reducing adolescents' attraction to smoking, using hookah pipes or "vaping" (the term for using e-cigarettes), would outlaw all flavors used in tobacco or nicotine products, including menthol in cigarettes and the various flavors in e-cigarettes.

"With flavors like peach, grape, cotton candy, gummy bear and so on, what you have is essentially highly addictive candy," Farber said. "Other flavors, such as menthol, decrease the natural harshness of tobacco smoke, and flavored products introduce youth to a lifetime of tobacco dependence."

More youths used e-cigarettes than any other tobacco product in 2014, according to the U.S. Centers for Disease Control and Prevention.

In addition to calling for FDA control of e-cigarettes, the AAP recommended that smoke-free laws expand to include e-cigarettes. The group recommends that use of any tobacco or nicotine products, including e-cigarettes, be banned in all workplaces, schools, dormitories, bars, restaurants, health care facilities, sidewalks, parks, recreational and sports facilities, entertainment venues and multi-unit housing.

"The jury on e-cigarettes remains out, but it is clear that carcinogens and potentially harmful substances are nonetheless present in this alternate nicotine delivery system," said Dr. Jack Jacoub, director of thoracic oncology at Orange Coast Memorial Medical Center's MemorialCare Cancer Institute in Fountain Valley, Calif.

Jacoub, who was not involved with the policy recommendations, said that these bans "would highlight that using e-cigarettes is a potentially harmful thing to do and hopefully will emphasize to teens, young adults and parents that one should not be reassured that it is safe."

Other policy recommendations include a ban on Internet sales of e-cigarettes, a tax on e-cigarettes at the same rate as traditional cigarettes and a requirement for adult ratings on any entertainment depicting e-cigarette use.

The AAP also recommended banning advertising of tobacco products and e-cigarettes in all media, including television, radio, print, billboards, signs and online, and in stores where children and teens might see them.

Another major recommendation called for child-resistant packaging for liquid nicotine. Poison control centers receive more than 200 calls per month for accidental ingestion of nicotine for e-cigarettes, the AAP noted, and one toddler died last year from swallowing some.

"Toddlers and young children love to explore new things and to put things in their mouths, so it is imperative that packaging and childproofing be done to enhance the safety of their environments," Fisher said. "This is analogous to having childproof caps on pill bottles."

More information

Visit the AAP for more about e-cigarettes.

SOURCES: Harold J. Farber, M.D., pediatric pulmonologist, Texas Children's Hospital, and associate professor of pediatrics, pulmonary section at Baylor College of Medicine, Houston; Danelle Fisher, M.D., vice chair of pediatrics, Providence Saint John's Health Center, Santa Monica, Calif.; Jack Jacoub, M.D., medical oncologist and director of thoracic oncology, Memorial Care Cancer Institute, Orange Coast Memorial Medical Center, Fountain Valley, Calif.; November 2015, Pediatrics

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