Last month, Massachusetts became the sixth state to boost its legal smoking age to 21. While two dozen other states considered similar bills this legislative session — and many likely will do so again in 2019 — much of the groundswell of activity isn’t happening in state capitols.
A growing number of local governments are acting on their own to ban the sale of tobacco products to anyone under 21. At least 340 towns, cities and counties in 21 states have taken action, compared with about 200 in 14 states in 2016.
They include not only major cities such as Minneapolis, New York City and San Antonio, but also small communities such as Basalt, Colorado, and Holcomb, Kansas.
Anti-tobacco advocates point out that raising the buying age would save lives and cut long-term health care costs — most smokers begin the habit before age 19 — while opponents fear the hits on retail sales and local tax revenue. The push for change continues as cigarette use among teens has declined in recent years, according to the Centers for Disease Control and Prevention. And the use of electronic cigarettes, or vaping, has become much more popular.
The actions by local boards of health, city councils and county commissions to raise the smoking age are making legislators in some state capitols take notice.
“It springs up spontaneously, like little wildfires,” said Rob Crane, a medical doctor and president of Tobacco 21, a Dublin, Ohio-based advocacy group that supports raising the minimum age to 21. “These are folks who are your neighbors. When you approach city council members in a small town in California or Ohio or New Jersey, they listen.”
Massachusetts has joined California, Hawaii, Maine, New Jersey and Oregon, which all have hiked the smoking age to 21 within the past three years. Illinois lawmakers this spring passed a bill on a largely party-line vote, but Republican Gov. Bruce Rauner vetoed it Friday. He said it would limit consumer choice and push residents to buy products in neighboring states or from nonlicensed vendors.
In some of those states, advocates say local action spurred legislative action.
Hawaii lawmakers became the first to vote to raise the smoking age to 21 in 2015. But Hawaii County, the Big Island, led the way, after a grassroots effort by health care advocates, anti-smoking groups and local high school students prompted the county council to pass an ordinance in 2013.
In Illinois, more than two dozen villages and cities, including Chicago, hiked the smoking age before the Legislature acted.
And in Massachusetts, 179 towns and cities, representing about 70 percent of the state’s population, already had raised the smoking age before lawmakers voted overwhelmingly to approve the measure in July, according to Crane’s group.
“The fact that so many cities and towns had done it certainly made it a lot easier to get the law passed,” said state Sen. Jason Lewis, a Democrat and the bill’s lead sponsor in the Senate. “I think it helped us make the case.”
In most states, the legal age to buy tobacco products is 18. Alabama, Alaska and Utah have set the minimum at 19.
Tobacco 21 supporters say boosting the legal age to 21 will help keep the products out of teens’ hands. They point to a 2015 report by the Institute of Medicine that predicted that raising the age to 21 would cut smoking by 12 percent by the time today’s teens are adults.
It also would result in about 223,000 fewer premature deaths for those born between 2000 and 2019.
Additionally, the report supported advocates’ argument that preventing or delaying teens and young adults from experimenting with smoking would stop many of them from ever taking up the habit. It found that about 90 percent of adults who become daily smokers started before age 19.
“With tobacco use, it’s incredibly high risk and no reward,” said John Schachter, state communications director for the Campaign for Tobacco-Free Kids, an advocacy group that promotes reducing tobacco use. “More importantly, by raising the age to 21, you’re cutting off the potential supply to those who are even younger.”
He said high school kids often supply their younger friends and siblings with tobacco products, so raising the age to 21 would help prevent that.
And as vaping has become increasingly popular among young people, state tobacco 21 laws and most of the local regulations are including not just cigarettes, but e-cigarettes.
Opponents say raising the smoking age hurts small businesses, such as convenience stores, reduces tax revenue and violates the personal freedom of young adults who are legally able to vote and join the military at 18. Smokers’ rights groups and some libertarian-thinking lawmakers are among those who’ve opposed tobacco 21 legislation.
Tobacco giant Altria said in a statement that it supports the current minimum age of 18 for the sale of all tobacco products and continues to share its perspective with state policymakers.
But the industry has been focusing much of its efforts on other tobacco-related measures, such as opposing tobacco tax hikes.
Massachusetts state Rep. Paul McMurtry, a Democrat who was the primary sponsor of the House bill that passed, said he was surprised the tobacco industry wasn’t a major player during the debate.
“I thought I would hear from Big Tobacco, and I never did,” he said. “It was sort of telling that the industry was accepting of these changes and aware of them, and that this was imminent.”
The biggest opposition to tobacco 21 laws typically comes from convenience store operators and other retailers, who say cutting the number of people who buy tobacco products has a chain effect.
“Any time you take a portion of the population out of the stores,” said Ryan Kearney, general counsel for the Retailers Association of Massachusetts, a trade group, “not only are you losing direct sales of that product, but the indirect sales of other items that they might buy.”
Some retailers say they prefer a nationwide standard rather than states taking the matter into their hands. And they are especially concerned about local governments doing it themselves because the result creates a patchwork of regulations under which stores in one town can sell cigarettes to 18-year-olds, but those in the next town over can’t.
“It’s a very difficult landscape to navigate,” said Jonathan Shaer, executive director of the New England Convenience Store and Energy Marketers Association, which represents convenience stores and gas stations. “It creates cross-border markets and black markets, and that hurts retailers.”
The new Massachusetts law takes effect at the end of the year, but will not apply to youths who turn 18 by Dec. 30. They will be grandfathered in, although higher limits could still apply to them in cities that passed their own tobacco 21 laws without grandfathering.
Shaer’s group wasn’t happy that Massachusetts raised the smoking age, but didn’t formally oppose the bill. Kearney said his group did, yet concluded it was a lost cause.
“There’s been a growing momentum of the cities and towns passing this. You get to a point where enough of the representatives and senators voting for it know that it’s already been passed by their local government,” Kearney said. “It just took the opposition’s wind out of its sails.”
Although Massachusetts state lawmakers just passed their law this summer, the state is a kind of ground zero for a smoking age of 21. In 2005, Needham, a town of about 30,000 outside of Boston, became the first government — local or state — to act when the local board of health passed tobacco 21 regulations.
That prompted two Massachusetts pediatricians concerned about teen smoking to begin advocating at the local level, said Crane, of the Tobacco 21 group.
Needham phased in its regulations over a few years, according to the assistant town manager, Christopher Coleman, and now has a “very strong” program that includes training and education for retailers and regular compliance checks.
Coleman points to a 2015 study in Tobacco Control, an academic journal, that found smoking and cigarette purchases by high-schoolers "declined significantly more" in Needham than in 16 nearby communities from 2006 to 2010.
Smoking in Needham fell from 13 to 7 percent, students reported, while in other communities it dropped from 15 to 12 percent.
Crane, who also is a professor of family medicine at Ohio State University, said what happened in Massachusetts shows how effective it can be to push for change at the local level.
“We couldn’t fight in the statehouses,” he said. “We had to go where the powerful moneyed interests were not. We went local. That was the secret sauce.”
Schachter, of the Tobacco-Free Kids group, said while the organization supports the grassroots movement in local communities, it favors statewide action because it protects the most children.
“It also helps make enforcement more consistent,” he said, “and eliminates the issue of people crossing the border of one town to get tobacco from another.”
Whatever the approach, advocates and legislators who support tobacco 21 laws say the time has come.
“I have no doubt this will continue to sweep across the country, because it makes so much sense,” said Lewis, the Massachusetts state senator. “It’s good public health policy that will save lives and tens of billions of dollars in health care spending.”