When the survey numbers came out, Amy Bush Stevens, vice president at the Health Policy Institute of Ohio, said it “threatens to undo all of the progress that’s been made” lowering teen tobacco use.

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Jeff Stephens, the group’s Ohio director of government relations, stated the group was encouraged by the proposal to raise the age.

“ACS CAN is encouraged by Governor DeWine’s intention to raise the age of sale for tobacco in Ohio from 18 to 21. Nationally, 95 percent of adults who smoke start before they turn 21. Restricting youth and young adult access to tobacco products promises to be a critical component to reducing initiation and a lifelong addiction,” he said.

However, Stephens said the state government missed some opportunities to reduce tobacco use by not increasing the state’s cigarette tax and tax on other tobacco products such as e-cigarettes.

More than half of Ohioans support taxing e-cigarettes like a pack of cigarettes, according to a 2018 survey by Ohio Health Issues Poll. Those numbers also represent bipartisan support, with 61 percent of Democrats and 56 percent of Republicans polled saying they favor placing an excise tax on e-cigarettes.

American Cancer Society Cancer Action Network had also wanted the state to increase funding for prevention and cessation programs.

Related: A decade after voters approved the indoor smoking ban, 20 percent of Ohioans smoke

Ohio spends $12.5 million on cessation and prevention efforts each year, down from $35 million a decade ago. And while the state places a sales tax and a $1.60 per pack excise tax on a pack of 20 cigarettes, e-cigarettes don’t face an excise tax and other tobacco products, such as chew and snuff, are taxed at 17 percent of wholesale.

The state’s adult smoking rate — 21.1 percent compared with 15.5 percent for the U.S. — is not just a quality of life issue but also is a cost driver for Medicaid and employers.

A 2014 surgeon general's report estimated that 15 percent of all Medicaid expenditures are attributable to smoking. It also costs employers an estimated $5,816 more per year to employ a smoker than a non-smoker, including health care and other costs.

Even without a state-level policy raising the purchase age to 21, local governments have been adopting ordinances to raise age.

The Preventing Tobacco Addiction Foundation reports there are now 17 local communities who have adopted such policies in the state of Ohio, representing 17.5 percent of the state population, the foundation reports. This includes major cities like Columbus, Cleveland and Cincinnati.

A Juul spokesman said in a statement that “Tobacco 21 laws have been shown to dramatically reduce youth smoking rates, which is why we strongly support raising the minimum purchase age for all tobacco products, including vapor products like JUUL, to 21 in Ohio.”

State looks to fine drivers who smoke with kids in vehicle

Ohio lawmakers are also considering a bill banning drivers from smoking if there’s a passenger in the car under the age of six.

Senate Bill 78, sponsored by state Sen. Tina Maharath, D-Canal Winchester, proposes a $500 fine for violators of the law, and for subsequent violations be fined $500 plus $250 for each additional violation.

Similar bills have been considered in the last session and the session before that. The law has been promoted as a way to protect children from the health consequences of second hand smoke, which can lead to asthma, ear infections and other health problems.

Ohio has a poor record when it comes to children exposed to the health risks of second hand smoke. Ohio ranked 49th out of 50 when it comes to states with the highest percent of children who live in a home where someone uses tobacco and smokes inside the home, according to Health Policy Institute of Ohio's 2017 Health Value Dashboard.

Other states such as Arkansas, California, Louisiana, Maine, Oregon, Utah and Vermont have already adopted restrictions on smoking with minors in vehicles.

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