Burlington voters will have an opportunity to express their support for a measure that promises to improve the health of all Vermonters on Town Meeting Day. A ballot item will allow us to advise our state government that we strongly support raising the age for the purchase of tobacco products to 21.

I am a cardiologist at UVMMC, and I perform procedures to treat heart disease. Last year, we performed 1291 stent procedures and over 400 heart surgeries to treat life-threatening coronary artery disease.Smoking or being exposed to secondhand smoke contributes to the risk of developing heart disease. For example, although fewer than 20% of all Vermonters smoke, about 55% of all patients presenting with a heart attack are current smokers. I see patients long after their heart attacks in clinic, and many cite family members or friends who continue to smoke around them at home, at work, or when socializing as the reason they can’t stop.

So why pass Tobacco 21?

-Biologically, one’s brain is still developing before the age of 21 and is more susceptible to nicotine addiction.

-More than 90% of adult long-term smokers started their habit before the age of 21.

-The Institute of Medicine estimates that Tobacco 21 will reduce the rate of smoking in 15-to-17-year olds by 25%. This is because 90% of teens in this age range receive their tobacco products from their near-peers who are younger than 21, including their fellow high school students who can currently legally purchase tobacco when they turn 18.

-One in four pregnant teens in Vermont smokes. Sudden Infant Death Syndrome (SIDS) is associated with smoking during pregnancy and with infants’ exposure to secondhand tobacco smoke.It is estimated that Tobacco 21 will lower the rate of SIDS by 16%.

Everyone recognizes that smoking is bad and leads to poor health. No one expects that Tobacco 21 will completely stop the initiation of the smoking habit. But the idea here is to decreasethe rates of smoking by making it that much harder to start.

What are the arguments against Tobacco 21? Here are two, and my counterarguments:

-“If you are given the responsibility to vote, you should be able to make a decision about smoking.” There is inconsistency in this argument. Alcohol 21 passed nationwide more than 3 decades ago. The statistics since then show that there has been a dramatic decrease in alcohol-related mortality in the United States precisely because of that change. More recently, the state of Vermont passed a law that allows individuals to possess and consume marijuana, but only starting at the age of 21, again citing research that shows increased risk of multiple public and individual health issues for a younger age cutoff. You aren’t eligible for low car insurance rates until you are 25. In the U.S.Constitution, one cannot serve in Congress until 25 for the House, 30 for the Senate, or 35 for the Presidency. There is no line in the sand for maturity or the age of rational decision-making.

-“If someone can be drafted or serve in the military, then they should have the freedom to smoke if they want.” Our military has something to say about this. Rear Admiral John Fuller stated in 2015, “If someone is young enough to fight for their country, they should be free from addiction to a deadly drug. [Being tobacco-free] is one of the best things we can do to improve fitness and readiness.” The Air Force bans tobacco in recreation facilities, and the Navy banned tobacco on all submarines. Hawaii passed Tobacco 21 in 2015. The law does not exempt the military, but Hawaii Joint Command aligned with the state and Tobacco 21 is also the rule on all bases in Hawaii. The Vermont National Guard also stated that they would abide by Tobacco 21 legislation if it passed, again citing readiness and fitness.

The state of Vermont came very close to passing Tobacco 21 last year, but several holdouts in the Senate voted against it, citing some of the arguments above.

We have a chance to tell to our state government that we care about the health of all those affected by smoking. Please join me in voting “YES” on Town Meeting Day.