The TSET Better Health Podcast
Tobacco 21

Tobacco 21

March 6, 2020

Health communication consultant James Tyree and intern Cate Howell co-host this episode about Tobacco 21, the new federal law restricting sale of tobacco products to people under the age of 21. After taking a look at the research behind how and why the law originated, Cate shares an interview with Dr. Amy Cohn of the Oklahoma Tobacco Research Center. Dr. Cohn explains why this is the first step toward a broader movement in limiting tobacco use and how it affects youth and young adults. Then, James shares a conversation he had with Nancy Packwood, owner of Norman convenient store Alameda Market and Tackle, who discusses her perspective on how the new law has affected her business and why she supports it. Cate closes out the episode by sharing how and why she came up with the TSET podcast and how the TSET team hopes our listeners will benefit from it. 

Transcript:

TSET Better Health Podcast Episode 1:  Tobacco 21

JAMES TYREE: Hello and welcome to the first ever TSET Better Health Podcast! This is your host JT Tyree, health communication consultant here at TSET, and I am joined by today's co-host CH Howell, our TSET health communication intern and the driving force behind launching this podcast.

CATE HOWELL: Hi everyone. It's great to be here for the launch of this podcast. I am really excited about it. And thank you very much to James for agreeing to host it.

JT: Thank you! You know, we're excited about it too, and later, we will hear more about how and why you came up with this idea.

The subject for this first episode is Tobacco 21, which is the term for raising the legal age to buy tobacco products from 18 to 21. It's a timely topic because this became federal law this past December. I will end the suspense right now and say that TSET and our partners including the Oklahoma State Department of Health are very happy about this. Why? Because, again, cutting to the chase, raising the legal tobacco age to 21 could prevent more than 220,000 tobacco-related deaths among people born between 2000 and 2019, including the reduction of lung cancer deaths by about 50,000 people. We realize this can be a sudden and major adjustment for those who are most directly affected, namely 18- to 20-year-old tobacco users and retailers, but we will address that in this podcast. But it remains important to explain how and why raising the legal age for tobacco will make a positive impact on the physical and financial health of Oklahomans.

CH: That's right, James, and I recently got the chance to interview Dr. Amy Cohn, an associate professor of pediatrics at the OU College of Medicine and the faculty member of the Oklahoma Tobacco Research Center. It was really interesting to hear her perspective on not only how raising the tobacco age will lower tobacco use and addiction, but also how tobacco consumption seriously affects the cognitive and behavioral development of youth and young adults. It was a really informative interview and we'll play that later on in the episode.

JT: And after that, we will hear from Nancy Packwood, owner of Alameda Market and Tackle in Norman. Nancy will talk about the adjustments she had to make at her store when this law took effect and share her own views on Tobacco 21.

CH: But before we get to that, James, can you explain what the law actually says?

JT: I can and will! This comes directly from the U.S. Food and Drug Administration website: “On December 20th, 2019, the president signed legislation amending the Federal Food, Drug and Cosmetic Act and raising the federal minimum age of sale of tobacco products from 18 to 21 years. It is now illegal for a retailer to sell any tobacco product including cigarettes, cigars and E-cigarettes to anyone under 21. Effective immediately, retailers must not sell tobacco products to anyone under the age of 21.”

CH: In addition, the FDA on January 2nd issued new rules saying flavored cartridge-based tobacco products would be unauthorized for sale as well. And that's even more good news, because vaping had become so popular so quickly among middle and high school students and young adults.

JT: You know, the federal law may have seemed to come on suddenly, but the idea really had been brewing and gaining momentum over the past few years. In June 2015, Hawaii became the first state to raise its tobacco legal age to 21. That Landmark law became effective on January 1st, 2016, and only a few months later, California became the second state to adopt Tobacco 21. Three more states followed suit in 2017, and by 2019, before the federal law took effect, 19 states and the District of Columbia and at least 530 local governments had all passed Tobacco 21 laws. This information according to the Center for Tobacco-Free Kids. Here in Oklahoma, TSET has been a leading voice for raising the age to 21 through our Tobacco Stops With Me campaign. Tobacco 21 is one of seven policies that, when enacted, can collectively cut our state’s smoking rate in half while protecting many thousands of kids from future addiction.

CH: Yes, and the research shows that 95% of adult smokers started using tobacco before age 21. So, of course, fewer youths and young adults will start smoking, vaping or dipping if they cannot legally buy the products. The Center for Tobacco Free Kids cites a 2015 report from The Institute of Medicine which found “that increasing the tobacco age will significantly reduce the number of adolescents and young adults that start smoking, reduce smoking-caused deaths and immediately improve the health of adolescents, young adults and young mothers who would be deterred from smoking, as well as their children.” As we know, nicotine is very addictive to people of all ages, but especially for kids and young adults who are younger than 25. Nicotine is especially dangerous for younger people because their brains are still developing. Dr. Amy Cohn explains this and more during a conversation that I had with her.

JT: Yeah, let's listen to that right now.

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CH: So tell me your name and your title and what you do a little bit?

DR. AMY COHN: Amy Cohn, associate professor in the department of pediatrics at the Oklahoma Tobacco Research Center at the University of Oklahoma Health Sciences Center. My work focuses on mental health and substance use factors related to tobacco use and reasons for appeal for flavored tobacco products in youth and young adults.

CH: How long have you been doing this?

AC: Oh, let's see, since 2013, so about seven years I've been focusing specifically on tobacco regulatory science. I've been doing work in mental health and substance use factors since 2007.

CH: What kind of progress and evolution have you seen in the legislative side and the impact side since you started here?

AC: So, I was just having a conversation with one of my colleagues about this yesterday, that we are seeing so much rapid movement in policies the last several weeks, in particular with the changes in Tobacco 21, with the changes in e-cigarettes and flavors. It is moving very quickly. Since I started working very specifically in this field of tobacco regulatory science in 2013, I have seen a huge increase in interest in understanding e-cigarette use in youth and young adults, and we’ve seen that because of the rise in e-cigarette use in this age group. There's also been a significant increase in alternative tobacco use in youth and young adults, and we've seen a lot of interest in that area from the research side as well, and the Food and Drug Administration Center for tobacco products increasing their interest in terms of regulating these products. Previously, these alternative tobacco products, like e-cigarettes, little cigars, cigars, were not regulated by the FDA. But now they do come under the FDA regulation, and that happened only a few years ago. So, one of the things that we do see a lot in this field are, you know, FDA indicates their interest in moving towards the policy, but we find that it can take several years for any action to happen. So, it's great to see that Tobacco 21 is happening. It is great to see that there's been movement on e-cigarettes and flavors. I think we can continue to go a little bit further in those areas to focus on menthol as well and other alternative tobacco products.

CH: So, you focus pretty specifically on youth, right, and flavoring? Can you tell me about the mental health relationship between tobacco use and youth?

AC: Yeah, so my work focuses on youth and young adults, and one of the reasons why I focus on young adults is that substance use is highest in that age group. Alcohol, tobacco, marijuana use is highest in that age group compared to any other group. Why I focus on youth is because youth are just learning and coming into their own substance use patterns.

And so, I focus on individuals who may be initiating substance use, but also that group of individuals who may have already started using and deterring progression of substance use. And so, what we see overall is there's a very high correlation between tobacco use with mental health and substance use. So, I've done research looking at different patterns of alcohol, tobacco, marijuana use in youth and young adults. Overwhelmingly, we see alcohol is the most popular pattern of use, and that's probably because it's easiest to get. People see it as this low-hanging fruit. But, we also see alcohol is prevalent in a variety of other patterns of use. So, we see alcohol and cigarette use is very common and alcohol and marijuana use is very common.

In one study, we found, we actually looked at the intersection of mental health and menthol tobacco use in young adults, and we found that mental health was actually significantly higher among young adults who used menthol tobacco products compared to those who didn't, and one of my theories behind that is because of this soothing, cooling sensation of menthol might give people who have some sort of mental health problems or anxiety or depression a little, you know, kick, a little boost in their mood, because of that pleasant sensation of menthol. You know, there's still more work to be done in that area, but I'm very interested in finding out what are those kind of psychological cognitive benefits of menthol smoking that may interact with mental health.

CH: So, there are - so, you’ve seen actual improvement in smokers who use menthol, a mental health improvement?

AC: I wouldn't say improvement, because I think improvement would imply that we did some sort of causal, longitudinal study, but we've found a correlation between those who use menthol tobacco products, menthol-flavored tobacco products, and higher symptoms of mental health problems. And the symptoms we were looking at specifically were anxiety and depression, but we don't find that in every group. So, there's other factors that may underlie reasons for use depending on the subpopulation you look at.

CH: Tell me just about how, how you feel about the T21 law, what you think its impact will have, how it will play out.

AC: Yeah. It's a great question. So I think T21 is a great movement in regulating tobacco use and keeping it out of the hands of young people. You know, we know that, as I said before, youth and young adults are just initiating their patterns of use. So, anything that we can do to deter the development of those patterns of use when people are younger will be helpful. And, you know, increasing the age of tobacco purchases is one step towards doing that, and the host of research shows that individuals who are between the ages of 18 and 20 have significantly lower rates of smoking in those areas where Tobacco 21 is in effect. So, we know that it works. I think one thing we need to work on is getting the message out to people, getting the message out to consumers, getting the message out to parents, getting the message out to tobacco retailers about this new policy.

CH: How do you think - let's talk about the relationship between youth smoking – I mean, yeah – young adult smoking and youth smoking. I talked to Paula Lau the other day who works with Jenks Public Schools, and, you know, she was talking about how a lot of times youth get cigarettes, get e-cigarettes from older kids, from young adults. You know, a lot of times 18-year-olds are still in high school. And so, talk about how this law would impact, you know, accessibility for youth.

AC: Yeah. I mean, I think that, like I said, I think the law is a good step, but young people will find a way to get around it. So, you know bumming cigarettes from older individuals, finding ways for individuals who are 21 or older to get them cigarettes is not going to be that difficult. I think people have been doing that, you know, for alcohol for a very long time. In terms of the intersection of youth and young adult smoking, the majority of young people start smoking before the age of 18. Even before Tobacco 21, people who were younger than 18 were finding ways to get cigarettes. So, while like, again, I think this will help reduce cigarette smoking, I think young people will still find ways to get around it by getting cigarettes from their parents, from their siblings, from their siblings’ friends. And unfortunately, there isn't a whole lot we can do about that except, you know, improve prevention campaigns to get messages out to young people about the harms associated with smoking, that it’s not beneficial to them, that it doesn't help them in their social networks, and that peers don't necessarily approve of cigarette smoking these days. Vaping is another issue altogether [laughter].

CH: Well, and it has a negative impact on your mental health, right?

AC: Yes.

CH: I mean, you’ve studied that correlation as well.

AC: Yeah. Yeah, you know that, for me, is a key motivator that I would want young people to know about. That there is a strong intersection of tobacco and other substances and mental health issues, and that if you don't start smoking, you definitely decrease your risk of having those problems develop later on, and there is nothing beneficial to using nicotine and tobacco products. So, for alcohol, there is some research that shows that a little bit of red wine in moderation can be beneficial to your health when you're an adult, but there has been really no research to show that there's beneficial effects to combusting or ingesting nicotine and tobacco products.

CH: Can you talk about the, kind of on that vein, the cognitive impacts that - the disproportionate impacts from youth to adult, like as far as tobacco use, and what that does to your brain as a kid?

AC: Yeah, I think one of the biggest concerns that we all have about youth tobacco use and nicotine uptake is the fact that the brain is still developing and nicotine does have an impact on the brain. But, we do know that nicotine is a stimulant. That's one of the reasons why it does boost people's mood. It does have a mood-enhancing effect. In fact, we also see very high rates of tobacco use in military populations, because nicotine does give that kind of mood-boosting effect. But since the youth brain is still developing, nicotine ingestion is - is only going to impede the healthy development of the brain processes.

CH: Okay. Okay, well, Dr. Cohn, thank you so much, it has been a pleasure, and I look forward to seeing more research that you do. Thank you for talking with us today.

AC: Thank you, I appreciate it.

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JT: That is very good information from Dr. Cohn. Thank you for sharing that.

CH: Yeah, you're welcome, James. I thought it was a really great conversation, especially for her to share her unique perspective as an experienced researcher focusing specifically on how tobacco targets young children, especially with their flavored products and their bright packaging and how they try to hook you when you're young, but nicotine literally does damage to the developing brain, and so that impacts your cognitive abilities. It really, really does a lot more damage to your future than you think.

JT: Yeah. You know, she mentioned something that I am also pleased to see which is the recent movement and momentum on legislation on e-cigarettes, tobacco flavors and T21. These matters, they often take a very, very long time to make progress, and that certainly is true of tobacco policy as well. It can take a decades to really get momentum. So, the movement that we've seen in recent years and weeks in these areas is particularly encouraging. And also, what she said about why she focuses on both youth and young adult tobacco use was also fascinating. You know, they are all young people, but youth and young adults are at different stages of social and physical development and use patterns. So I'm glad that she was able to comment on that a little bit.

You know, we're concerned about kids starting tobacco use because it often leads to addiction. As we have heard, so many tobacco users started using before the age of 18, but it bears repeating that limiting tobacco access from 18, 19 and 20-year-olds is also important because young people of this age group are also susceptible to nicotine addiction and the health and financial detriment that go with it. Now, you have information on that from a recent article from the American Academy of Pediatrics.

CH: Yes, I do, James. The article headlined “Tobacco 21 laws linked to decrease in smoking among those ages 18 to 20” had some very interesting findings. Results from a survey of more than 1,800 18- to 22-year-olds showed about 64% of 18- to 20-year-olds who were not exposed to Tobacco 21 laws reported recent smoking compared to the 46% who were age-restricted. Similarly, half of those who were not age-restricted were regular smokers compared to just over one in four who were restricted.

JT: Those really are some pretty big gaps between those people in that age group who lived in areas where they were restricted and can't purchase tobacco compared to those who are not restricted.

CH: It is.

JT: So, the data really is clear. As we said earlier, a higher purchase age could prevent over 220,000 premature deaths including 50,000 from lung cancer. That cannot be ignored.

CH: No.

JT: We at TSET and many other health and wellness related agencies and organizations have educated and advocated for Tobacco 21 for quite some time. Even so, the new law means major adjustments for adults under age 21 who smoke, dip or vape. We're talking about legal adults who can no longer use a deadly but legal product, and we know that nicotine can be especially difficult to quit.

You know, the other group of people who are most directly affected by Tobacco 21 are store owners and clerks who sell tobacco products. They are on the front lines of applying this federal law, which may also become state law if the Oklahoma legislature this year passes Senate Bill 1423 during the session. Someone may ask, “Why bother making this a state law if it's already the law across the entire nation?” Well, the main answer comes down to law enforcement. If raising the age is also a state law, then the ABLE Commission and other state and local authorities will have the authority to enforce and investigate local Tobacco 21 cases. This, of course, makes it even more important for retailers to comply with Tobacco 21 laws.

I recently discussed this with the store owner in east Norman who also owned a small store for years in Broken Bow down in southeast Oklahoma, and her store was near a school. So let's listen to that conversation.

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JT: Hello. This is James, and we are here with Nancy Packwood who is a store owner here in east Norman, and we appreciate your time on talking about this issue about Tobacco 21. Can you tell us a little bit about yourself and your experience in owning and running stores here in Oklahoma?

NANCY PACKWOOD: Yes, James. I moved here to Norman in July of 2018 and purchased my current store in March of 2019. I had owned a convenient store in Broken Bow area from 2002 until present. The experience in Broken Bow was a small town, very rural experience, but also the experience in Norman has been very, very same, this situation. I'm outside of the city and it's more like a community out here, small community. So, we see a lot of the same people every day, but we also have a tremendous amount of lake traffic, and every degree warmer is more people on Alameda coming to the lake. It's just been a very pleasant experience, and we really enjoy serving the community.

JT: Alright, and what's the name of your store?

NP: The name of my store is Alameda Market and Tackle. We’re at 7500 Alameda Drive in Norman.

JT: Okay, very good. Now, most of your experience was down in Broken Bow, and, from what I understand, you were near schools and such. Did you see a lot of high school students either buying or trying to buy cigarettes or other tobacco products when you were there?

NP: Yes. It was much more prevalent there because of our area when we had a lot of walking traffic, close to the school, the football stadium, the basketball stadium. Yes, we had more attempts to purchase, but we've always had a 100% ID policy where we just checked everybody and praised the ones who looked younger than they were.

JT: [laughter]

NP: But, if you just follow through 100%, then you’re just okay. You hold everybody to the same standard.

JT: Okay. Now, what about here in Norman? It's a different area, you’re not near a school, you’re out near Lake Thunderbird. Do you see many young adults here on their way to or from Lake Thunderbird or different situations in which you see young people?

NP: Yes, it's a very different situation in… our local tobacco buyers that are under 21, we only have to ID them once. They understand that we follow the rules, so they - the majority of them have never tried a second time to buy, you know, being under 21. With the lake traffic that we have, I believe they feel like they're away from home. They can get by with more. But we just follow a 100% ID program, and we just don't allow it. But yes, you do see more of it from the lake traffic, and we do see a lot of young people who will be several in a carload do attempt to buy it more. 

JT: Okay. You mentioned briefly about the program and such. For people who don't own stores or run stores, what kind of protocol do store owners do and clerks do to make sure that the person buying tobacco is of legal age?

NP: The – the rule that we follow is they just have to have a picture ID. I mean, it's just 100% the only way that you can make it happen. And everybody is required. Granted, we have our typical people who are you know, 40 or over, that we know, we do not ID them any longer. But anybody that looks under 40 always gets IDed. And we've trained them. They just walk in the door and lay their driver's license down, or their state ID, because they know they're going to have to see it. And any clerk that would not follow those rules would not continue to be employed.

JT: So, I would be IDed, of course.

NP: Yes, of course. You look only 21, James!

JT: [laughter] Thank you for that!

Well, knowing that, just from your experience in operating stores, what challenges do you see retailers facing now that the law has been raised, the legal age has been raised from 18 to 21 to buy tobacco products. Not just cigarettes, but also e-cigarettes or snuff or whatever else. What challenges do you see them having, and how can those challenges be handled, taken care of?

NP: Personally, I’ve never been a smoker, so I think it's a great rule. Not everybody agrees with that. But the rules are the rules are the rules. That's just how you survive in this business. Every rule has to be followed and there's probably way more rules pertaining to - any time you sell tobacco, any type of alcohol, any type of fuel, there's tremendous amount of state rules. You just follow them. It keeps you safe.

JT: Indeed. Now, rules or laws aside, what are your personal thoughts or feelings about this law to raise the legal age to buy tobacco from 18 to 21? What are your thoughts on it? And, I'm interested in asking you, one, I was going to anyway, but also when I came in here, I saw a sticker on your door that mentioned the Oklahoma Tobacco Helpline and things along those lines, which I thought was great. So, with that in mind, what are your thoughts and feelings?

NP: My thoughts and feelings on that, of course, as I said, I've never been a smoker. Health-wise, I try to coach. I personally had an employee that I could no longer sell tobacco to or allow her to smoke at work because of the age change. She's only 20. But yeah, we try to make sure they have the number for the helpline, we have a lot of postings, we have things on the gas pumps. Just anything to help anybody, because I feel like with the cost of tobacco and everything, I just think it'd be a great idea for everybody to quit.

JT: Thank you Nancy, really appreciate it very much.

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JT: You know, Nancy is such a delightful person. We continued to talk after the interview for a while. Nancy told me that she learned in a class years ago that if you make one exception for someone, that that person will be the one to turn you in later. So, she also said, “I don't look good in orange, so I always follow the rules every time.”

CH: [laughter]

JT: I did mention during the interview, too, I noticed when I first went to the store a sticker on her door Oklahoma Tobacco Helpline.

CH: Oh, nice.

JT: That was very nice. And so, it's another reminder that for people who are ready to quit or may need to, there are free resources available for them. We encourage everyone to take advantage of that.

CH: Yeah, definitely.

JT: You know, I am so glad our first Better Health Podcast addressed Tobacco 21, what it's about, why it's beneficial, but also how the new law will affect some of our friends and neighbors in Oklahoma and throughout the nation. We always invite you to learn more about Tobacco 21 and other efforts to stop premature deaths from tobacco use and secondhand smoke by visiting stopswithme.com.

CH: And we also remind you, as like James said earlier, that if you or someone you know is ready to quit tobacco, we have free help available to you from the Oklahoma Tobacco Helpline at okhelpline.com or by calling 1-800-QUIT-NOW, which is 1-800-784-8669.

JT: Well, Cate, this is the very first "TSET Better Health Podcast," as we mentioned before –

CH: Yes [laughter].

JT: - and I'm so glad you are co-hosting this month, because you are the impetus behind this project. Can you briefly share with us how you came up with the idea, where listeners can hear the podcast and what you hope they will get out of it?

CH: Yes, I can. I was hired on as an intern in August of last year, and I had never heard of TSET before I came across the internship application. I remember seeing the commercials for the helpline and particularly the “no judgments, just help” stop-motion commercials really stuck out to me, because I smoked for about 6 years, so I know how it feels to be judged and to be addicted and to try to quit several times before you actually do it. So, when I saw the application for this position, and I learned more about what TSET does and who we are, I was thrilled to join the team, and I have enjoyed every minute being here and the growth that I've had.

But, when I tell people that I work for TSET, they don't know what that means. They've never heard of us. They don't know all the good stuff that we do, and now I'm really excited about what we do and I want to share it with a broader audience. So, I just had this crazy idea of what if we had a podcast that talks about all the things that we care about? We can talk about issues that are important to us like the T21 law, breakthroughs in wellness initiatives, et cetera. And, we can also talk to our grantees about what they're doing to improve lives and their communities and how they made a difference. I want to show everyone in Oklahoma what we do and what we care about.

So, I drew up a plan and presented it to the team and, to my surprise, everybody was excited about it and eager to make it happen. All of my experiences working here have been so empowering, and I'm really grateful to the team for creating such a collaborative environment here. And it just makes me even more passionate and excited about sharing what we do with Oklahomans.

So, you can find our show on our website at tset.ok.gov/podcast and wherever you listen to podcasts. We'll have new episodes every month, so be sure to follow the TSET Facebook page for updates.

JT: Well, thank you very much. That is fantastic, and we are very grateful to have this new means of communication available now.

So, thank you for joining us today, and be sure to listen to the next month's podcast when the topic will be health care in rural communities. Until next time, this is James Tyree –

CH: - and Cate Howell –

JT: - wishing you all peace –

CH: - and better health.

Announcing the TSET Better Health Podcast

Announcing the TSET Better Health Podcast

March 6, 2020

Welcome to the TSET Better Health Podcast! Executive director Julie Bisbee and host James Tyree share information about TSET's mission and what to expect from the podcast moving forward. Join us for Better Lives and Better Health!