Young people concerned about their own health and the well-being of their generation propelled passage of legislation that has Hawaii poised to be the first state in the country to limit tobacco sales to people 21 and older. The change is expected to impede smoking among youths 15 to 17 most especially, and if enacted nationwide would add 4.2 million years to the lives of U.S. residents born between 2000 and 2019, according to an analysis by the Institute of Medicine, the health arm of the National Academy of Sciences.

Jessica Yamauchi, executive director of the nonprofit Hawaii Public Health Institute, which includes the Coalition for a Tobacco-Free Hawaii (CTFH) as a main program, credits many partners, advocates and "legislative champions willing to put public health first" for passage of significant tobacco-control measures that apply to conventional and electronic smoking devices. She lauds young CTFH volunteers "whose commitment is impressive and inspiring" with special praise.

"For passage of Senate Bill 1030, the youth were absolutely amazing and it was critical to have their voices be heard and to let the legislators know that they were interested in protecting their generation, because they are the ones who are directly impacted by a law like this passing," said Yamauchi, referring to the bill raising the smoking age from 18 to 21. "So we had University of Hawaii students, as well as high school students from Kapolei and Campbell, and it was a really great opportunity for them to learn about the legislative process, and then to also have legislators hear from the youth."

Engaging with young people is among Yamauchi’s favorite parts of the job, which she has held since 2012. Prior to that she was policy director of the CTFH and previously worked at the University of Hawaii Cancer Center, the UH Office of Public Health Studies and the state Legislature.

She grew up in Mililani, where she graduated from Mililani High School, and later earned bachelor’s and master’s degrees in speech from the University of Hawaii, focused on health communications. At 42, Yamauchi is busy at work and at home, as mom of two busy adolescents, a son in sixth grade and a daughter in ninth. She and husband Ryan, who specializes in business development and marketing, spend their free time at their children’s basketball games.

"It’s fun, it’s exercise, it’s healthy! We all enjoy that."

QUESTION: Let’s start with the legislative session. It was a busy one for you folks, with quite a bit of success. … Could you talk specifically about passage of SB 1030 (which raises the legal age of tobacco sales to 21, including electronic smoking products), House Bill 940 (which includes electronic smoking devices in the statewide smoke-free indoor air law) and House Bill 525 (which prohibits the use of tobacco products, including electronic smoking devices, in state parks).

ANSWER: Absolutely. … For a few years now, we’ve really been trying to get electronic smoking devices, which are commonly referred to as e-cigarettes, included in our smokefree air law. Last year it had gotten until conference committee and then died. So we were really pushing to get that done (via HB 940). We have seen an increase in the number of businesses interested in it, trying to adopt their own policies. We really felt that it was important to have a statewide law. The Big Island recently had done it for the county and the mayor had signed that in January of this year.

Q: And it’s been successful over there?

A: It has been. It was effective immediately. Our statewide law won’t go into effect until January 1, which will give us some time to inform and educate our local merchants …

Q: Also, raising the smoking age to 21. The Big Island also paved the way there, but (SB 1030) is statewide. Why do you think it was important to do that?

A: It was done first by the Big Island, which was great. They were able to pass it without much controversy at all. It passed unanimously every single reading back in 2013. It went into effect July 1, 2014. And we felt it was important statewide for the health improvements, obviously, and that it was best to do it at the state level. We tried it here in Honolulu and there was actually pretty good support for it here as well; however, we ran into issues where the Honolulu Council felt that there was a pre-emption issue and felt that it needed to be done at a statewide level and so we really couldn’t push the bill any further. …

Q: So it didn’t pass at the county level in Honolulu, but now Honolulu will be included in the statewide law?

A: Correct. By having a statewide law, it provides great uniformity and consistency. There won’t be different rules for retailers that have stores on the different islands. …

Q: Reading this Institute of Medicine Report, it says that the biggest effect of these 21-and-over laws is expected to be in impeding smoking among 15 to 17 year olds. … Why that age group?

A: … Our takeaway from it has been that when you’re in that age category of 15 to 17, you do have relationships and access to those who are 18. You’re on the same high school campuses a lot of time, and those kids have legal access to the products. And so it’s much easier for kids who are 15 to 17 to obtain access to these products, through their friends and their peers who are 18. … You’re much less likely to be on a high school campus or to be in the same social circles as those who are 15 to 17 when you’re 21. …

Q: Getting this far in the Legislature has been years in the making on some of these issues. … Now that (these bills) have passed, are you confident that Gov. Ige will sign them?

A: He has signed House Bill 940, which includes electronic smoking devices in the indoor air law. … We are cautiously optimistic that he will be signing the other two bills. … We haven’t heard any reason to believe that he won’t sign them. However, we will all be much more comfortable when he does.

Q: The Honolulu Star-Advertiser editorialized in favor (of raising the age), but we do get some letters, reaction. One of the things that people say is, when you’re 18, you can join the Army, you can die for your country, but you can’t buy a cigarette? I’m assuming that you hear that as well.

A: Yes.

Q: What is your response when people make that argument?

A: We remind people that 18 is not a magical age. There are many things that we can’t do once we turn 18. We still can’t gamble. We still can’t drink. In most states you can’t purchase a firearm. So we look at putting tobacco in line with those other types of behaviors as well. One of the things that the Institute of Medicine report talks about is that your brain is still developing until you’re 25 and you’re more prone to addiction during the teenage years. So we’re really trying to help combat a lifelong addiction while kids don’t even realize that they are more prone to that addiction, when they’re experimenting. We understand where people are coming from. We also just want to remind people that there are other laws that already exist. Most rental car companies require you to be 25 before you can rent a car. … We have a lot of 18-year-olds who are still in high school these days. We’ve delayed the age of entry in kindergarten, so more and more kids are 18 on high-school campuses. So I think it’s important to not just put this age as a defining moment that they’re an adult.

Q: The report makes a really strong case from a public health standpoint for raising the age to 21. So … Hawaii is the first, but are you expecting this to be a trend? Or do you think Hawaii will be an anomaly, assuming Gov. Ige signs it?

A: We do expect that this is going to be a trend. We’ve already seen it. When Hawaii County passed their law in 2013, they were the fourth county; there are over 60 municipalities now that have passed it since then. So we’ve already seen at a county level or city level, depending, that this is a growing trend. We know that there are several states currently working on passing the age as well and their (legislative) sessions are still going on. …

Q: Why did your organization consider it so important to include the electronic smoking devices?

A: With raising the age of sale, it was definitely important to include it in there so that there was no loophole, where this industry really would be able to target those who are 18 to 20. We have seen huge, dramatic increases in our youth usage rate of electronic smoking devices here in Hawaii. We are high above the national averages. Through the data collected in the Youth Tobacco Survey, we saw that between 2011 and 2013, our (e-cig usage) rates in middle school quadrupled and our rates in high school tripled, while we’re seeing (conventional) cigarette use decline. So we know that kids are trying these products. They are getting their hands on them. It’s really important that there’s not a loophole. …

Q: You don’t think these young people were using the e-cigs to quit regular cigarettes? …

A: No. The data show that the majority of the kids who try e-cigarettes have never tried a cigarette before.

Q: So it’s more like an entry into smoking, rather than a way out?

A: Right.

Q: They’re smoking nicotine liquid? They’re smoking cannabis oil? What are they smoking exactly in the electronic cigarettes?

A: That’s a big question, I think. Because they are so unregulated. It always varies. And kids also experiment and put other things in them. And because there’s not a smell that comes out of it, it’s hard to know what they’re smoking. So it’s really dangerous. I think that there’s a misconception out there, especially among youth, that these (devices) are completely harmless. They’re experimenting with them. They’re putting their own ingredients in them, and without any type of regulation at any level right now happening. We’re really concerned.

Q: The FDA has not yet issued regulations?

A: No. They have not. … They have put out their (proposed) rules on what they were looking to do with it and they took comments for a period of about six months or so. But it’s getting close to a year since they finished collecting those comments and they have not yet ruled on what they plan to do. … We understand that it’s a long process. So national advocates are really encouraging local municipalities and state governments to take action on their own because we never know at the federal level how long it’s going to take for something to happen.

Q: So that’s what Hawaii has done essentially?

A: Yes, exactly. And so with HB 940, including electronic smoking devices in the smokefree indoor air law, we’re actually the fourth state in the country to do that. There are many municipalities that have taken that action, similar to the Big Island … But as a state, we’re the fourth state in the country to do it.

Q: The other bill that passed was HB 525, right?

A: Yes, tobacco-free parks. … It’s great that it includes the electronic smoking devices, too … We have three out of four counties that have passed either smoke-free or tobacco-free parks or beaches. So this statewide law will help provide even more consistency.

Q: So that’s state parks, but not beaches, right?

A: Yes. We separated the two (in the bill) and we appreciate lawmakers moving forward with the parks. … Overall, looking at all the bills, there was great progress for public health this session around the issue of tobacco control.