Gov. Hogan must sign bill raising Md.'s smoking age

In my work as director of The Johns Hopkins Tobacco Treatment Clinic in Baltimore City, I recently had the pleasure of meeting Jerimiah Kouka, an 18-year-old, high school senior who, like myself, has witnessed smoking’s impact on the health of our community and has vowed to fight the proliferation of tobacco products among teenagers.

Jerimiah told me he is particularly concerned about the use of Juul, an e-cigarette that has become the latest trend among teenagers. Juul is a battery-charged device that vaporizes nicotine stored in plug-in pods and is sold in different flavors like watermelon, mango and mint.


Jerimiah’s friend started vaping once or twice a day last year, and now does it five times a day, a pattern that reflects recent studies on the use of e-cigarettes.

After many years of declining tobacco use among young people, vaping is reversing the trend. According to an article in Medical News Today, vaping is up a whopping 900 percent among high school students from 2011 to 2015. Perhaps most alarming is that young people are not using vaping as a way to quit smoking: 40 percent of users 18-24 years old had not been smokers before using e-cigarettes.


As a pulmonary and critical care physician at Johns Hopkins School of Medicine, I see about a half a dozen people each week who want to quit smoking but struggle with repeated relapse. Each time, the regression breaks their spirit and damages their belief that they can walk away from their tobacco dependence.

It is particularly alarming to me because for many of those who began smoking before the age of 18, quitting is a more difficult process. Based on the National Survey on Drug Use and Health, the majority of adult smokers say they began smoking before they turned 21. Teens who use e-cigarette products are more likely to start using regular tobacco as well.

Furthermore, there are many other concerns about smoking and vaping for young people. Nicotine, the addictive substance in regular cigarettes as well as e-cigarettes, is known to trigger changes in the adolescent brain. The continued use of nicotine can lead to the use of other drugs such as cocaine. The aerosol used in e-cigarettes to transport that nicotine contains solvents, flavorings and toxicants, which the Surgeon General deemed harmful or potentially harmful. Therefore, preventing our youth from starting to smoke or vape will ensure we have healthier adults who are not struggling to quit their tobacco dependence.

For these reasons, we are grateful to the Maryland legislature for passing legislation that would raise the retail sales age of all tobacco products to 21. The legislature has taken an essential step in addressing the need to decrease youth smoking rates and ultimately protecting kids from dying prematurely from tobacco-related illnesses. The National Academy of Medicine found that increasing the minimum sales age for tobacco products to at least 21 years old significantly reduces youth tobacco use and would save thousands of lives.

The Maryland legislature has stepped up and committed to the medical community and all Maryland youth by becoming the latest state to enact this critical legislation. Now, we need this proposal to become the law of the land in Maryland. We call on Gov. Larry Hogan to make that same commitment and sign this important piece of legislation into law. We will save thousands of lives and perhaps children who are now at the edge of adolescence can become part of the first tobacco-free generation.

Dr. Panagis Galiatsatos ( is an instructor of medicine in the Division of Pulmonary and Critical Care Medicine and co-director of Medicine for the Greater Good within Johns Hopkins School of Medicine. Jerimiah Kouka, class of 2019 at the Bard High School Early College, also contributed to this op-ed.