Just a few weeks ago, some Midwest state legislatures were aiming to raise the legal age for smoking. But Congress moved first, setting a new national age limit of 21. Now, some anti-smoking advocates say that’s not enough.
The federal rule was tucked into a budget bill, and came as Americans were prepping for the holidays, so it didn’t get a lot of media attention. But the law made a sweeping change to the country’s tobacco policy, raising the minimum age to buy cigarettes and e-cigarettes.
"This is not going to prevent every single incident," Senate Majority Leader Mitch McConnell said in in mid-2019, "But it’s going to make it a lot harder for 18-year-olds to purchase these delivery devices and redistribute them to younger kids."
Now, health advocates and state officials are considering what else needs to be done. The goal is to curb high rates of teens using these products and mitigate health issues.
"It's been a lot harder road than we had originally thought," the Indiana Chamber of Commerce's Mike Ripley says.
The chamber has been pushing for the age increase and other tougher tobacco regulations since 2014. But Ripley didn’t initially foresee 2020 being the year it got done.
"It's just like the sea has changed all of a sudden on this issue," Ripley says.
Last year, issues surounding e-cigarettes exploded into the national stage. There’s been a sharp increase of high school students using these products; last year 25 prcent reported using e-cigarettes. And since August, there have been more than 2,500 vaping-related hospitalizations and more than 50 deaths nationwide.
Now that the federal age limit has taken effect, some health advocates want more.
Bryan Hannon from the Indiana chapter of the American Cancer Society says they’re currently working with state lawmakers. "We're going to have to take it a few steps further if we want to actually comprehensively and effectively address the problem."
He says these extra steps include stricter penalties for retailers that sell e-cigarettes or tobacco products to people under 21.
A similar conversation is happening in Iowa, where health advocates are pushing for anti-vaping legislation.
"We know what works in tobacco prevention and control, and what works is really kind of a multi-pronged strategy," says Danielle Oswald-Thole of the American Cancer Society's Iowa chapter.
Oswald-Thole wants to see an increase in the tax on tobacco products and more money invested in prevention efforts. She says Iowa only spends a fraction of what the Centers for Disease Control recommends.
"We currently fund our tobacco prevention and control program at $4.02 million. And the CDC recommends we fund that program at $30.1 million," she says.
Iowa Senate President Charles Schneider, a Republican, had plans to introduce legislation raising the smoking age. Now considering whether to take any action.
Schneider says he’d support shifting money from the tobacco prevention budget into vaping. But he was unsure about increasing the prevention budget overall.
"I'm not a believer in just throwing money at a problem," he says. "I want to see how we're currently using it and whether it could be deployed differently to better address the situation."
Shannon Lea Watkins is a public health professor at the University of Iowa. She says states also need to look at other efforts that discourage teen smoking, like increasing the tobacco tax.
"Youth and young people are particularly price-sensitive," she says. "Which means that if you increase the price of something a little bit, it will impact young people more. They'll be less likely to purchase it."
Watkins also suggests adding vaping to public smoking bans. "Clean Indoor Air laws are huge ones that takes smoking out of public places, and with that contributed to the de-normalization of smoking."
Iowa’s Department of Public Health has filed a bill that would add vaping to the state’s Smokefree Air Act, which bans smoking in restaurants and bars.
The legislative sessions in Iowa and Indiana started this month.
This story was produced by Side Effects Public Media, a news collaborative covering public health.