Health Policy Analysis Paper

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Overview of the Problem

Smoking and vaping is a highly prevalent issue in the U.S.A. It is particularly a problematic concern among youth under the age of 21 years. A large number of middle and high school youth have or continue to use a wide variety of tobacco-related commodities, including electronic cigarettes, cigars, smokeless tobacco, cigarettes, and pipe tobacco (CDC, 2019). The Campaign for Tobacco-Free Kids (2020) posits that the usage of these chemicals contributes to a toxic mixture of over 7,000 chemicals, 69 of which are linked to cancer. As a result, the prevalent smoking among the youth not only endangers the lives of smokers but also that of non-smokers, making it a concerning health crisis. In light of the increasing prevalence, numerous legislations and policies have been proposed and even enacted to control smoking among American young adults. The latest legislative attempt is the S. 1258: Tobacco to 21 Act. On the overall, the bill seeks to increase the minimum age requirement for one to purchase and use tobacco to 21 years with a view to reducing usage among the youth under this age limit (S. 1258: Tobacco to 21 Act, 2019). Notably, on December 20, 2019, President Donald Trump signed the bill into law, officially raising the smoking age from 18 to 21 in the United States (Nilsen, 2019).

Severity of the Problem

In 2019, and estimated 12.5% of middle school American youths and 31.2% of their high school counterparts were found to be ongoing smokers of one or more tobacco products (CDC, 2019). On the same note, 24.3% of middle school youth and 53.3% of high school students agreed to have consumed a tobacco product (CDC, 2019). Among high school students, 30.6% s and 31.8% of girls and boys, respectively, were ongoing users of tobacco products in 2019 (CDC, 2019). These rates have been on a steady rise since 2017, where Hammond et al. (2019) report an overall increase in smoking among adolescents from 11.7% in 2017 to 20.8% in 2018. The figures were just 9.3% in 2015 (American Lung Association, n.d.). Tobacco use in the American population below 21 years is particularly severe because about 2,500 children under the legal smoking age are introduced to the habit daily. As high as 400 of these new entrants become regular and long-term smokers, and 50% of them will succumb to conditions related to the vice (American Lung Association, n.d.). Experts reckon that young age smoking is likely to persist into adulthood because of nicotine addiction; thus, many adult smokers most likely began much earlier. Intervening on this issue could, therefore, reduce the percentage of adult smokers in the U.S.A. Otherwise, over 5.6 million American youths will undoubtedly die from complications related to smoking at the current rate (American Lung Association, n.d.). In light of these statistics, healthcare providers, policymakers, and public health officials spanning across governmental and non-governmental sectors have expressed concerns and willingness to seek a proper intervention.

Overview of the Bill and Stakeholders

The S. 1258: Tobacco to 21 Act of 2019 proposes a raft of interventions to curb the problem. The major one is that it will be illegal to sell tobacco products to anyone below the age of 21 years under any circumstances. It also prohibits their sale to individuals below the age of 30 years unless it has been indeed verified through proper identification documents. The Act bestows on the Secretary of Health and Human Services authority to enforce the prohibition through appropriate means (S. 1258: Tobacco to 21 Act, 2019). The main stakeholders include anybody under the age of 21 and 30 years who will be required to either desist from purchasing tobacco products or provide credible verification information. Dealers and manufacturers of tobacco products must, since the onset of the law, restrict such sales per the provisions; otherwise, they may face prosecution. Currently existing related legislation is the Family Smoking Prevention and Tobacco Control Act of 2009, which, among other interventions, restricts tobacco marketing and sale to underage youths (U.S Food and Drug Administration, 2018). It also mandates manufacturers and retailers of the products to provide proper labels.

Promises/Expected Outcomes

Senator Brian Schatz, the sponsor of the bill, should be in charge of promoting the law. Promoters and supporters of the law believe that it will primarily protect the public, especially secondhand smokers from suffering related illnesses and deaths. Considering the statistics above, the bill will potentially reduce the population of new young smokers and significantly improve a situation that is continuously growing out of hand. The government, parents, and healthcare providers may be for the law. The government is in charge of protecting its citizens from harmful and destructive habits such as smoking. At the same time, parents may support the bill for the benefits of their children and themselves, especially considering the effects of passive smoking. The healthcare providers and policymakers who have witnessed the growth and foreseen an impending healthcare crisis will support the law for public health reasons.


The primary potential opponents of the law will be tobacco companies, including manufacturers, wholesalers, and even retailers. In the past, the point-of-sale restrictions had the companies and lobbyists file a lawsuit to lift the ban (National Cancer Policy Forum, Board on Health Care Services, & Institute of Medicine, n.d.). Also, tobacco companies and the entire industry deploy a wide range of tools to oppose bills and laws banning the marketing and sale of tobacco. Some of them include challenging timelines for the implementation of statutes using the legal system, bankrolling the governments to favor their operations, and influencing legislators (Zeltner et al., n.d.). In particular, opponents (smokers) of this bill argued that it is excessively intrusive given that anyone above the age of 18 is old enough to make their own decisions (S. 1258: Tobacco to 21 Act, 2019). The tobacco industry is mostly opposed to the law because it could reduce its profits by discouraging sales and use.

Unintended Consequences

The main unintended consequence of the law could be an increase in the usage of tobacco without reporting. Even with the restrictions, individuals under the age of 21 years can still smoke privately. The youths are ingenious and highly creative; thus, they may find other ways, some even more dangerous, to consume tobacco products. The major problem with this secretive usage is the lack of reporting for fear of prosecution. As a result, many youths will be, for instance, suffering in silence, and the deaths may increase. Moreover, without reporting and actual figures, the government and concerned stakeholders may not come up with effective and proper interventions because the severity of the problem would be grossly underestimated.


Primarily, the ban should be accompanied by policies that discourage tobacco advertising and marketing as well as those that increase the prices of associated products; for instance, extremely high taxations (CDC, 2019). Increasing the cost of tobacco will ensure that fewer youths can afford the products, even if they could get and use them secretly. Advertisement ban will ensure that the younger generation lacks knowledge of these products, as they get information from the media, including movies (American Lung Association, n.d.). The overall impact is a holistic system of laws with all loopholes sealed and able to tackle the problem from all angles.

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GradShark (2023). Health Policy Analysis Paper. GradShark.

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