Hawaii is just a gubernatorial signature away from becoming the first state to ban the sale and possession of tobacco and electronic cigarettes to anyone under the age of 21. Public health advocates declare it another victory in their quest to eliminate smoking in the general population and to save lives.

Such a ban would reduce the number of smokers by 12 percent by the year 2100, according to an Institute of Medicine report. While reports vary, many show that smoking often starts in adolescence for those who become habitual nicotine users.

As a physican, my first inclination is to champion the ban. After all, we know smoking causes cancer, and although it often takes decades to develop, the overall public health concerns outweigh everything else.

But do they really? What happened to freedom of choice?


Smoking is only one of life’s vices. How many should we target legally?

Andrew Magill/Flickr.com

At the age of 18, people are considered adults who can vote, join the military, get married, rent an apartment, buy stocks, buy real estate, sign contracts, drive without license restrictions.

What is the one thing you cannot do? Buy alcohol. But how effective is that ban on 18- to 20-year-olds?

Besides, restricting alcohol makes sense because drunk people have impaired judgment, and those who drive can kill innocent victims. In that regard, smoking is clearly less dangerous, and society has already taken many appropriate steps to cut down on the threat of second-hand smoke.

It’s still dangerous, of course, in terms of the significant long-term health risks for those who make it a habit. Cancer, emphysema — no one smoking today can honestly claim he or she didn’t know smoking is bad.

Even Younger Smokers

Should smoking be criminalized just because society doesn’t think that adults 18-20 can make good choices about their health?

One rationale has to do with age cohorts and how to prevent younger teens from getting cigarettes from their high school counterparts. The IOM says that 18-year-olds might hang out with 14-year-olds, but 21-year-olds aren’t generally spending time with those two-thirds their age. So its conclusion is that a ban until 21 will lead to less availability to teens.

Is that enough of a reason to take away the freedom of choice?

Some people assume that a ban will lead to a direct reduction in the number of chronic smokers. But where’s the data? Even the IOM study states it’s basing its conclusions on a mathematical model of statistical probability. But there are no hard facts on which to base these assumptions. The number of teen smokers has gone down dramatically since the mid-1990s. So do we need a ban when the rates are already in decline?

Maybe only people 21 and older should be able to go to McDonalds and order a burger, fries and a soda? Because in the long run, regular consumption of those foods might be just as dangerous as smoking.

Electronic cigarettes have exploded onto the scene in the past few years, and have actually surpassed the use of tobacco cigarettes in the adolescent population. Although any use of nicotine can lead to addiction, the absence of the other known toxic chemicals in traditional cigarettes has led to the general belief that the risks of lung cancer and emphysema will not be dramatically increased as a result of e-cigarette use. The data is just not there to make any other conclusions, yet.

If underage smoking of either tobacco or e-cigarettes is illegal, how will we enforce the ban? Will police officers approach young people asking for proof of age? Should someone call 911 if they catch an 18-year-old illegally lighting up?

Smoking is already banned on school campuses, public buildings, and now public parks. Where will these closet smokers be found? In their cars at risk of being stopped by HPD?

If tobacco is that bad, why not ban it altogether? Why not take away everyone’s legal right to choose anything that might be bad for them? Take away fast food, soda and a host of other vices. Maybe only people 21 and older should be able to go to McDonalds and order a burger, fries and a soda? Because in the long run, regular consumption of those foods might be just as dangerous as smoking.

Where do we draw the line?

Yes, I think we should try to limit the use of cigarettes by youths. But once people turn 18, we generally need to give them the freedom to make their own choices about their habits. Ultimately, with their higher insurance premiums and their direct costs for the products, they already are paying the price.

Even though a ban makes sense medically, it’s one more governmental restriction. We should all worry about the precedent this will set in taking away our personal freedoms as legally recognized adults to make our own choices, good or bad, about our lifestyle habits.

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