In response to the e-cigarette epidemic among young people across the United States, more local entities are adopting policies to raise the tobacco sales age to 21. Carlton County could join the growing list of more than 475 counties and cities, 36 of which are in Minnesota.

Sometime in the upcoming months, the Carlton County Board of Commissioners will vote on a policy drafted by County Attorney Lauri Ketola that would raise the minimum sales age of commercial tobacco products from 18 to 21.

Before the board votes on a policy, commissioners directed county health educators, including Meghann Levitt and Ali Mueller, to help educate the public about the e-cigarette epidemic. Their latest efforts involved hosting Tobacco 21 forums Tuesday, June 25, in Cloquet and Moose Lake.

Amanda Casady of the American Lung Association shared a presentation on the rise in youth tobacco use due to e-cigarettes, its dangers as well as the various marketing tactics tobacco companies use to lure in young people. The Pine Journal covered a similar presentation by Casady on March 26 at the Cloquet Public Library.

Natalie Hemmerich, a staff attorney who provides legal technical assistance with Public Health Law Center in St. Paul, spoke at the forum about the policies state and local governments can adopt to better protect young people from the harms of commercial tobacco products.

“When we’re talking about commercial tobacco, we try to use the word 'commercial' as much as possible to acknowledge that we’re not talking about the traditional or sacred use of tobacco,” Hemmerich said. “That is a practice we respect and we’re not talking about regulating or trying to prohibit it.”

Hemmerich discussed the various ways in which Tobacco 21 policies as well as other polices could be effective in keeping nicotine-packed products out of the hands of young people who are becoming highly addicted, while also acknowledging that there is still much to be learned about the effectiveness of these policies.

Yet, data shows that the number of young people in Chicago between ages 18 and 20 who used cigarettes or e-cigarettes dropped 36% the year after the sales age was raised to 21 in 2016.

One of the reasons raising the minimum sales age works, Hemmerich said, is because youth tend to obtain commercial tobacco products from social sources. By raising the sales age to 21, you’re drastically reducing the number of students in high schools and social circles who are 18 and can purchase tobacco products.

Even if only one community raises the sales age and surrounding communities do not, Hemmerich said that would still likely limit young peoples’ access to tobacco products since youth aren’t as mobile.

“Obviously, it’s great when an entire community comes together, when towns and counties are dedicated to making the change and I think that’s ideal, but we also know from research that youth are not very mobile and they can’t get around as easily,” Hemmerich said.

Smok (left) and Juul (right) are also e-cigarette brands with sleeks device designs. Pine Journal/Andee Erickson
Smok (left) and Juul (right) are also e-cigarette brands with sleeks device designs. Pine Journal/Andee Erickson

Other policies that local governments can look into include restricting the sale of flavored tobacco products, since it’s the wide variety flavors like cotton candy, gummy bears and maple syrup that attracts so many young consumers.

Duluth passed a city ordinance in 2018 that restricted the sales of flavored and menthol tobacco products to adult-only smoke shops. In February, Duluth also raised the sales age to 21. Hermantown raised the sales age to 21 in 2018.

More common than flavor policies are options that restrict the density of retailers selling these products, Hemmerich said. For example, policies could restrict the amount of space required between licensed retailers or local governments could put a cap on the number of retailers in the community. Some communities limit how close retailers can be to youth-oriented facilities like schools and playgrounds.

“We know that the more retailers there are, the more exposure youth have to the advertising and the marketing of the products that happens there at the store, and that’s really impactful to youth,” Hemmerich said. “The more they’re exposed to that, the less it seems like a risky sort of product.”

Another option is to address the price e-cigarette products are sold at, since youth are some of the most price-sensitive purchasers.

Some e-cigarette brands offer discounts for starter kits, which Hemmerich said is concerning since almost 90% of young people who try e-cigarette products become addicted. Local governments can adopt policies to prevent the redemption of these coupons.

While reservations wouldn’t be subject to any of these local or state laws, tribal communities can still implement their own versions of these policies.

Dr. Kenn Ripp, a family practitioner at Raiter Clinic in Cloquet, highlighted some of the repercussions the e-cigarette epidemic, like just how susceptible the teenage brain is to nicotine.

“We're seeing higher rates of depression and anxiety and a lot of them are being linked to nicotine substances,” Ripp said.

San Francisco became the first city to ban the sale of e-cigarettes on Tuesday.