Hawaii has become the first state in the nation to raise the legal smoking age to 21 in a possible signal flare for similar legislation in states across the country.
Support for raising the smoking age nationwide has been gaining steam since a report released in March by the Institute of Medicine, a nonprofit public health advocacy group. It suggests that raising the minimum legal age of tobacco use would positively impact public health, decreasing the smoking rate in the United States by about 12 percent and reducing smoking-related deaths by 10 percent. That would mean 249,000 fewer premature deaths and 45,000 fewer deaths from lung cancer, the study found.
The Hawaii bill, signed into law on Friday, prohibits people under the age of 21 from smoking, buying, or possessing tobacco products. It also includes electronic cigarettes, which have become an increasingly popular nicotine delivery system for younger Americans.
E-cigarette use among middle and high school students tripled from 2013 to 2014, according to data published by the Centers for Disease Control and Prevention and the US Food and Drug Administration’s Center for Tobacco Products. The 2014 National Youth Tobacco Survey puts the number of high school and middle school students using e-cigarettes at 2.4 million, outstripping both regular cigarettes and cigars.
The new law has been celebrated by public health officials and antismoking advocates.
"Partners statewide have come together to support this monumental legislation that once again puts Hawaii at the cutting edge of public health policy and protecting the health of our youth," said the state's director of health, Virginia Pressler, in a statement.
But it has also faced criticism among people who feel the choice to smoke is a civil rights issue.
"I can't stand cigarette smoking. It's disgusting," said Hawaii state Rep. Angus McKelvey to The Associated Press. "But to tell somebody you can go and fight for your country and get killed but you can't have a cigarette, that's the thing. You can enter a contract. You're an emancipated adult in the eyes of the Constitution but you can't have a cigarette anymore."
Though some municipal and county councils have passed similar measures, Hawaii is the first state to ban smoking for under-21s statewide. But it may not have that distinction for much longer.
Lawmakers are also pushing to raise the age in Washington State and California, where the state Senate passed a bill to raise the age earlier this month, sending the legislation to the Assembly for a vote.
California state Sen. Ed Hernandez said he introduced the bill because of a concern about the negative health effects of smoking, particularly among young people. Statistics suggest that roughly 9 out of 10 smokers pick up the habit in their teenage years.
"It's time to stop allowing tobacco companies to make the deadly product so readily available to our youth," Senator Hernandez told The Los Angeles Times.
Some data seem to support the claim that raising the legal smoking age corresponds with lower smoking rates.
Four states have raised the smoking age to 19: Utah and New Jersey have some of the lowest smoking rates in the nation, Alaska has one of the most improved smoking rates in the country, and Alabama has a lower incidence of smoking than other states in the region, according to The Washington Post.