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An equal opportunity employer. P rotecting, Maintaining and Improving the Health of All Minnesotans September 6, 2019 Jerry Faust, Mayor City of St. Anthony 3301 Silver Lake Road St. Anthony, MN 55418 Dear Mayor Faust and Council Members: As Commissioner of Health, I strongly support St. Anthony’s proposal to increase the minimum tobacco sales age to 21, a strategy known as Tobacco 21. Nearly all tobacco users start before the age of 21. Tobacco 21 will have a powerful deterrent effect on youth initiation, will reduce youth tobacco use, and protect youth from a lifetime of addiction. I am very concerned about the dramatic increases in youth use of e-cigarettes, cigars, and other tobacco products. As shown by the Minnesota Youth Tobacco Survey, tobacco use among high-school students spiked to 26 percent in 2017; the first increase in 17 years. This dramatic increase is driven in part by a surge in e-cigarette and cigar use. Among high school students, e-cigarette use increased by 50 percent since 2014, with nearly 1 in 5 high school students reporting use. This is likely the result of wide availability and proliferation of flavored tobacco products that are designed to attract and addict youth. Young smokers report choosing flavored tobacco products because they taste better and are perceived to be safer. This is quite alarming as nearly all e-cigarettes contain nicotine, which we know is highly addictive. Research shows youth who use e-cigarettes are two times more likely to start smoking combustible cigarettes. In September 2018, the Minnesota Department of Health issued a health advisory on nicotine and the escalating risk of addiction for youth. No amount is safe for youth as there are negative implications for learning, memory, attention, and future addiction. Teens are especially susceptible to nicotine addiction and the harmful effects it has on the brain as they grow. Raising the minimum tobacco sales age to 21 would limit youth access to tobacco until the portion of the brain responsible for rational decision-making is more fully developed. I applaud St. Anthony for considering this bold action to protect youth from a lifetime of addiction. For more information, contact Laura Oliven, Tobacco Prevention Control Program Manager, at 651-201-5442. Sincerely, Jan K. Malcolm Commissioner P.O. Box 64975 St. Paul, MN 55164-0975 www.health.state.mn.us