Smoke to Live Vapor Shop employee Taylor Morris stands outside Liber-T Gift Shop as he promotes his merchandise to walking traffic.
The chemicals in e-cigarettes cause similar damage to the lungs as those contained in cigarettes. Credit: Scott Ball / San Antonio Report

When the recommendation to raise the legal age to purchase tobacco from 18 to 21 goes before City Council on Dec. 6, the proposal will include all nicotine delivery systems, including e-cigarettes, San Antonio Metropolitan Health District Director Colleen Bridger said.

The Tobacco 21 proposal includes e-cigarettes, hookahs, and chewing tobacco, Bridger said. Smoking cessation products that contain nicotine and are approved by the U.S. Federal Drug Administration will not be impacted by the change.

In September, Metro Health conducted an online survey, distributed through neighborhood and community organization email lists, to gauge community support for raising the purchasing age. Almost 5,500 people responded, with 77.5% supporting the change.

Youth ages 18-20 purchase only 2% of cigarettes, but are 90% of the supply of addictive tobacco to younger youth. Bridger said that’s because kids in high school are often at the age to provide tobacco products to their friends. “Increasing the distance” that they have from the products is key.

“While there are fewer high school students who are taking up the habit of smoking combustible cigarettes, that is being more than offset by the number of high school students who are starting to use e-cigarettes,” Bridger said.

Smoke to Live Vapor Shop employee Taylor Morris stands outside Liber-T Gift Shop as he promotes his merchandise to walking traffic.
Smoke to Live Vapor Shop employee Taylor Morris stands outside Liber-T Gift Shop as he promotes his merchandise to walking traffic. Credit: Scott Ball / San Antonio Report

Largely due to the increased availability of e-cigarettes, overall tobacco use has increased among high school students in the U.S. for the first time in decades. In Texas, 12,300 youth under the age of 18 become new daily smokers each year, according to a 2017 report from the Campaign for Tobacco Free Kids, with more than 14% using e-cigarettes.

Of Bexar County high school students, 12.6% of males, and 9.9% of females currently smoke, according to the San Antonio Metropolitan Health District.

The prevalent use of e-cigarettes among under-18 youth has local and national health advocates pushing to educate the public on the dangers of e-cigarette aerosol. The Centers for Disease Control and Prevention (CDC) reports that most e-cigarettes contain nicotine, which is highly addictive and toxic. Besides nicotine, e-cigarettes can contain other substances that harm the body, and have been known to cause unintended injuries.

E-cigarettes – also called e-cigs, vapes, tank systems, or vape pens – produce an aerosol by heating liquid that usually contains nicotine, flavorings, and other chemicals. Users inhale the aerosol into the lungs. E-cigarettes are marketed as beneficial for smoking cessation, but the federal Food and Drug Administration has not approved them as medication for smoking cessation.

Because e-cigarettes are fairly new, scientists are still learning about their long-term health effects. But Bridger said that in many cases nicotine has been found in e-cigarettes that are marketed as nicotine-free.

“E-cigarettes are not safe, particularly for young adults and pregnant women,” said Dr. Amelie G. Ramirez,  said professor of epidemiology and biostatistics and director of the Institute for Health Promotion Research at UT Health San Antonio. “And for people who don’t smoke – why would you want to be ingesting any kind of nicotine into your body at all?”

Ramirez said she is concerned about younger kids, in both middle and high school, trying e-cigarettes.

“Young people are interested in experimenting, they think it makes them look cool, [and] it’s available in different flavors,” Ramirez said. “There are concerns that vaping is a gateway to regular smoking” and that the use of e-cigarettes normalizes smoking.

Ramirez cited a recent study from Canada reporting that teens who use e-cigarettes are twice as likely to become regular tobacco smokers, and said that young people are significantly more likely to try conventional cigarettes within a year of experimenting with vaping.

“Raising the [age to purchase tobacco products] to 21 would work to reduce the source of [nicotine] consumption in younger teens,” Ramirez said.

Victor has been smoking e-cigarettes for four years. Now 22, he told the Rivard Report that he began using them to cut down on the amount of combustible tobacco – regular cigarettes – he was smoking.

“I started smoking when I was around 12 years old,” said Victor, who declined to give his last name. “My grandmother passed away from lung cancer and that was a huge eye-opener for me.”

Victor turned to e-cigarette use after what he called an unsuccessful attempt to reduce his nicotine intake with the help of cessation patches. He credits e-cigarettes for his ability to eliminate combustible tobacco altogether, but when it comes to e-cigarettes, he still chooses products containing nicotine. However, because e-cigarettes allow you to select the amount of nicotine in a given product, he feels he has more control over his intake.

Bridger said that the primary reason for Metro Health’s effort to raise the purchase age is that 95% of people who start smoking do so before the age of 21, a time when their brains are still developing.

“We know that when the developing brain is exposed to addictive substances, it alters the structure of the brain,” Bridger said. “Not only are you more likely to become addicted to [nicotine], but it also puts you at higher risk for addiction to other substances like drugs or alcohol.”

Before formally recommending Tobacco 21 to City Council, Bridger will hold a community stakeholder meeting on Nov. 13, followed by a community town hall forum to discuss tobacco 21 and receive additional feedback from the community.

Bridger said that Metro Health is notifying by mail all 2,000 Bexar County businesses registered to sell tobacco about the town hall.

If Council votes to raise the age, Metro Health would recommend a three-month “soft launch” before the law would go fully into effect. During that time “there would be no consequences, just reminders,” as businesses and consumers adjust to the policy change. If passed, it would legally go into effect in June 2018.

“It’s not about fines and it’s not about penalizing people or criminalizing behavior,” Bridger said. “It about telling people this isn’t smart, you shouldn’t do this, how can we help you.”

Roseanna Garza

Roseanna Garza

Roseanna Garza reports on health and bioscience for the San Antonio Report.