My father, a heavy smoker, died of a massive heart attack in 1964, the same year that the U.S. surgeon general released a controversial report linking cigarette smoking to a host of maladies. During the more than 50 years that have elapsed since that report, we continue to grapple with how we can reduce the use of this legal but addictive substance. Progress has been slow, but Maine, and Portland in particular, have much to be proud of in the fight against big tobacco.
In 1983, when I was an internal medicine resident at what was then Brighton Medical Center here in Portland, patients were allowed to smoke freely in their rooms. And many of them did.
If their roommate was suffering from pneumonia or an asthma flare-up, some of these folks politely smoked down the hallway, but others didn’t. As physicians, we didn’t like it, but we were powerless to stop it. Individual rights to a legal substance trumped health concerns.
The following year, Dr. Phil Slocum, a pulmonary and critical care specialist, convinced Brighton to adopt a controversial policy prohibiting patients from smoking in their rooms. Other hospitals soon followed suit. Smoking was moved to designated lounges on each floor of the hospital.
Over time, as evidence accumulated on the dangers of secondhand smoke, the lounges were closed and smoking areas were eventually moved outside hospitals. Portland, which was the first community in the state to prohibit smoking in restaurants in 1998, prohibited smoking in public parks in 2013.
In 2014, CVS pharmacies announced that they would no longer sell cigarettes. This decision made public health sense: Pharmacies are in the business of health. How can they ethically sell nicotine patches and gum, while at the same time fueling nicotine addiction with the sales of cigarettes?
And in fact, there is some evidence that this strategy is reducing cigarette purchases across all retailers in cities and towns where CVS has a high share of the market. Sales of cigarettes are often an impulse decision at the counter. Why not limit their availability?
I support the Portland City Council’s proposal to increase the minimum age to purchase cigarette products within the city limits from 18 to 21. Here’s why.
Raising the age to purchase another legal substance, alcohol, from 18 to 21 came about because of the carnage on our highways. There were simply too many poor choices on the part of our young men and women to ignore the obvious; a young person’s brain is still developing at age 18. Impulse control is not fully formed, and the longer we wait, the more likely responsible decisions can be made.
In the case of cigarettes, the immediate consequences are less obvious, but the long-term effects are just as dire: increased rates of a multitude of cancers, heart disease and emphysema, leading to premature death.
What is not as well known is that smokers who begin the habit early are less able to quit. Two-thirds of all smokers want to quit, and half of smokers try to quit each year. Unfortunately, only about 20 to 25 percent of smokers succeed. Once you’re hooked, it’s a tough, dirty habit to put down.
At a recent City Council meeting, I was pleased to see the council vote unanimously to direct its Health and Human Services Committee to work on an ordinance to raise the age to buy cigarettes and other tobacco products in Portland. Once drafted, the ordinance will return to the council for a public hearing and vote.
The new proposal would affect tobacco sellers and e-cigarette vendors. Some business owners have been skeptical of the city’s plan, noting that an 18-year-old is old enough to sign up for the military, vote or buy a gun. But this ordinance is consistent with other public health initiatives. When it comes to society’s interest in delaying exposure to addictive substances, 21 is a more reasonable age to make an informed choice compared to our impulsive teenage years.
The new ordinance won’t solve our cigarette addiction problems, but it will decrease the number of young people who start down the road of this powerful addiction. It’s one that many of them regret.
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