This Use,” 2017). A report published by the

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Last updated: July 18, 2019

This bill addresses the sale and distribution of tobacco productsto individuals under the age of 21 years. Tobacco is sold in many differentforms broadly categorized as smoke and SmokelessTobacco (“TYPES OF TOBACCO PRODUCTS,”2009). Bidis, thin hand-rolled cigarettesmade in India and other Southeast Asian countries; cigarettes, cigars, cigarillos,little cigars, kreteks, electronic cigarettes, hookah, and pipes are categorized assmoke tobacco products. Whereas, dissolvable tobacco, available as strips,sticks, orbs and compressed tobacco lozenges, dip, and chewing tobacco andsnuff are categorized as smokelesstobacco products (“TYPES OF TOBACCO PRODUCTS,” 2009). According to the Center for Disease Control and prevention,cigarettes and electronic cigarettes are currently the most common forms oftobacco used by the youth in the United States. The CDC reported, after asurvey conducted in 2016, that about 2.2% of middle school students and 8.

0% ofhigh school students stated that they had smoked cigarettes in the past 30 days(“CDC – Fact Sheet – Youth and Tobacco Use – Smoking & Tobacco Use,” 2017). TheCDC also found that about 4.0% middle school students and 10.0% high schoolstudents reported that they had used electronic cigarettes in the past 30 days.The same survey also found that about 2.0% middle school students and 5.

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0% highschool students reported that they had smoked hookah in the past 30 days(“CDC – Fact Sheet – Youth and Tobacco Use – Smoking & Tobacco Use,”2017). A report published by the MMWR in 2017 showed the use ofsmokeless tobacco among middle and high school student was rising steadily aswell (Jamal et al., 2017). Additionally, the report stated that middle and highschool students were also using multiple tobacco products at any given time (Jamalet al., 2017).Tobacco Products Causing Health ProblemsCigarette smoke carcinogens result from inhalation of tobaccosmoke can be found in the urine of smokers. The metabolic activation ofcarcinogens by cytochrome P-450 enzymes has a direct effect on the formation ofDNA segments that are bound to cancer-causing chemicals (Benjamin, 2010). Thereis substantial evidence that acombination of differences in specificgenes leads to a higher number of DNA segments that are bound to cancer-causingchemicals in smokers and higher relative risks for lung cancer than in thosesmokers without this genetic profile.

Exposure to carcinogens causes damage to DNAobserved in smokers resulting in numerous chromosomal changes seen in lungcancer patients (Benjamin, 2010). Smoking also increases the frequency of DNAadducts of cigarette smoke carcinogens and tobacco-specific nitrosamines in thelung and other organs of smokers. Exposure to these carcinogens leads to DNAdamage and subsequent mutations in TP53 and KRAS genes (Benjamin, 2010). There is substantial evidencethat smoking leads methylation of tumor suppressor genes such as P16 in lungcancer and other smoking-caused cancers and that ingredients such as nicotineand others in the smoke can activate signal transduction pathways directlythrough receptor-mediated events, allowing damaged epithelial cells to survive (Benjamin,2010). Inherited susceptibility to lungcancer is another cause of carcinogenicity. Smoking cessation, however, is theonly confirmed approach to reduce the pathogenic processes leading to cancer asthe specific contributions of many tobacco carcinogens, alone or incombination, to the development of cancer have yet to be identified (Benjamin,2010).


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