Students who think access to booze and butts is one of the pleasures of college life should know that some legislators and health experts disagree.

Hawaii Governor David Ige recently made his state the first in the nation to raise the smoking age to 21, following the lead of nonstate jurisdictions such as New York City. Ige declared it his goal to “reduce tobacco use among our youth and increase the likelihood that our keiki [children] will grow up to be tobacco-free.”

The law, effective next January 1, also prohibits e-cigarette use by Hawaiians under 21. Some states are thinking about following the path Hawaii took; most, including Massachusetts, have a legal smoking age of 18, although more than 50 Bay State municipalities ban tobacco sales to those under 21. A few states set their legal age at 19.

William DeJong, a School of Public Health professor of community health sciences, applauds the Hawaii law, based on his research into raising the drinking age to 21. While stiff excise taxes on alcohol and cigarettes are the most effective way to curb their use—“Research has shown that underage youth are especially price-sensitive,” he says—alcohol excise taxes in particular have not kept pace with inflation for decades, meaning that “in effect both the federal and state governments have made alcohol more accessible.”

Hence the Plan B approach of raising the legal age for use, which DeJong discussed with Bostonia.

Bostonia: Your first expertise is alcohol and drug abuse, not tobacco, but do you agree with Hawaii’s raising the smoking age to 21? 

DeJong: Hawaii has taken an important step to reduce the incidence of smoking. We know that the vast majority of people who become addicted to cigarettes began smoking when they were adolescents, and that the older people are when they begin to experiment with smoking, the less likely they are to develop a lifelong habit. Hence, any policy that can serve to discourage youth smoking is a big plus, and for that reason I am confident that this policy will prove to be effective.

What light does your research into alcohol and drinking shed on the notion that Hawaii may dissuade young smokers?

First, the fact that Hawaii passed this law is a strong signal to youth that people living there believe tobacco is a dangerous product and strongly disapprove of its use. Smoking is now stigmatized, and passage of this law reinforces that. Second, one of the law’s purposes is to make it even more difficult for younger adolescents to purchase the products illegally. With the minimum legal purchase age at 18, clerks waiting on a 15- or 16-year-old may not always remember to check IDs, but with the age set at 21, they are more likely to think that the customer is too young and then remember to check.

Could you summarize the research suggesting a legal drinking age of 21 saves lives? 

Research has shown that the current law has served to reduce alcohol-related traffic crashes and alcohol consumption among youth, while also protecting drinkers from long-term negative outcomes they might experience in adulthood, including alcohol and other drug dependence, adverse birth outcomes, and suicide and homicide. In 1999, New Zealand reduced its legal purchase age from 20 to 18 and then saw an upswing in traffic crashes and injuries among 15- to 19-year-olds. The United States tried the same thing after the voting age was set at 18 years, with the same result, and that is what led to the current federal law that incentivizes the states to have a minimum legal drinking age of 21.

If higher legal ages work in theory, is enforcement a problem in practice? How many retailers ignore the drinking or smoking age?

Enforcement will never be perfect, so there is always the possibility that some young people will get access to alcohol and tobacco despite the state ban on sales to minors. We know that the age 21 minimum legal drinking age is widely disobeyed, yet the public health case for keeping that law—based on extensive, rigorous research—is strong and irrefutable.

The research on youth smoking is especially encouraging. The federal Alcohol, Drug Abuse, and Mental Health Reorganization Act, passed in 1992, included the Synar Amendment, which requires the states to enact and enforce laws prohibiting the sale or distribution of tobacco products to people younger than 18 years. With passage of that law, the rate of retailer noncompliance has dropped by nearly a factor of five, down to 8.5 percent in 2011, and the percentage of students under age 18 who smoke has dropped from 38.7 percent to 14 percent. You can find the details here. Hawaii, like every other state, has responded to the Synar Amendment by greatly increasing its enforcement efforts, which the state will now apply to enforce its age 21 minimum legal purchase age.

With both smoking and drinking, is there a case for nationalizing the minimum allowable ages?

The case for nationalizing the minimum legal drinking age is more compelling. When the states had varying age limits, young people would travel by car to nearby states that had a lower minimum age law and then drive back to their home state after drinking, putting both themselves and others at risk. The federal law was strongly pushed by Mothers Against Drunk Driving, which gave the measure an emotional as well as a rational appeal. The use of tobacco products does not create that kind of immediate risk. Nationalizing the minimum purchase age would require a change in federal law, and I don’t see Congress acting on that in the foreseeable future.

Some suggest that there’s a greater stigma attached to smoking than to drinking and that it’s therefore tricky to compare the effects of laws governing one to those governing the other.

The basic principle—that making a dangerous product less accessible reduces its use—is axiomatic, and it will apply whether use of the product is stigmatized or not. More to the point is that adolescent smoking rates have dropped substantially over the past several years, so that the youth who presently start smoking may be an especially hard-nosed group that is determined to do so despite the loud public opprobrium, the restrictions on smoking in restaurants and other public spaces, the higher excise taxes now being imposed, and even an expanded ban on sales. Unfortunately, they do not fully appreciate how quickly they can become addicted and how difficult it can be for many people to quit.