Science and common sense tell us that the teenage brain is more vulnerable to peer pressure and susceptible to nicotine addiction than at any other stage of development.

That’s why California legislators recently voted to raise the legal age to buy cigarettes and tobacco products from 18 to 21. If Gov. Jerry Brown signs the bill, California will become the second state, after Hawaii, to raise the age limit on the unhealthy products.

Yet while more than 100 cities around the country have adopted such laws — including New York, Boston and Cleveland — New Jersey Gov. Chris Christie in January vetoed such a bill, despite strong bipartisan support from his state legislators.

Health policy advocates see the Christie veto as a setback in what they believe is an otherwise accelerating movement toward “Tobacco 21” laws as a new tool for curbing young people’s potential addiction to tobacco products and e-cigarettes.

Michelle Mello, a Stanford professor of law and health research and policy, and colleagues from Harvard University and Baylor College of Medicine argue in this New England Journal of Medicine article that there is new evidence to suggest these laws are effective, have great public support and have minimal economic impact in the short term.

“The vast majority of smokers begin smoking during adolescence, a period when the brain has heightened susceptibility to nicotine addiction,” they write. “Nearly everyone who buys cigarettes for minors in the United States is under 21 years of age; raising the sale age prevents high school students from buying tobacco products for their peers.”

In 2013, only eight U.S. municipalities had adopted Tobacco 21 laws. By March 2016, at least 125 localities and the state of Hawaii had done so, and California is on the cusp of following suit. In September 2015, the first federal Tobacco 21 legislation was introduced (Tobacco to 21 Act, S. 2100) by U.S. Senator Brian Schatz (D-HI).

The authors note an analysis of the effects of one such law adopted in Needham, MA, revealed a 47 percent reduction in the smoking rate among high school students, along with a reported decline in area retail tobacco purchases. The decreases were significantly greater than those in 16 comparison communities without Tobacco 21 laws.

And a 2015 report by an Institute of Medicine (IOM) committee provided evidence from two different simulation models that increasing the minimum age to 21 would lead to a 12 percent reduction in smoking prevalence. Another simulation study predicted that there would be an even larger effect: a nearly 60 percent reduction in adolescent smoking within seven years after nationwide implementation of a Tobacco 21 law.

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Two national public opinion studies published in 2015 found that 70 to 75 percent of Americans — including a majority of current smokers — support raising the minimum purchase age to 21. The authors themselves conducted a national survey of 1,125 American adults regarding their attitudes toward various public health laws.

“We found that three in four Americans support the adoption of a federal Tobacco 21 law,” they write. “Majority support extends across all major socio-demographic groups, including 68.3 percent support among young adults 18 to 24 years of age.”

Opponents of the federal and state bills — namely Tobacco interests, convenience store owners and e-cigarette manufacturers — say that states should not be in the business of policing public choice. Store owners contend raising the age limit would hurt sales, as snacks and soft drinks are typically ancillary purchases with cigarettes.

And some veterans’ organizations and Republican legislators have said it is wrong to take away the decision on whether to smoke from young people who are nevertheless old enough to marry, vote and join the military.

But Mello and her coauthors, Stephanie R. Morain, PhD, MPH, and Jonathan P. Winickoff, MD, MPH, say the long-term benefits of raising the age limit far surpass the near-term economic concerns, which they believe are overstated.

Research indicates that in the short term, raising the tobacco-purchasing age to 21 would result in a 2-3 percent annual decrease in total tobacco sales.

“Over the longer term, the revenue loss from decreased smoking prevalence will be substantial,” they concede. “But allowing future generations to become addicted to nicotine in order to preserve tobacco revenue fails the red-face test as an argument against Tobacco 21.”

If a federal law raising the legal age of purchasing cigarettes were implemented today, the Institute of Medicine estimates that would result in 249,000 fewer premature deaths, 45,000 fewer deaths from lung cancer, and 4.2 million fewer lost-life years among Americans born between 2010 and 2019.

“Local and state efforts have succeeded in extending Tobacco 21 protections to more than 16 million Americans,” the authors write. “We believe the time has come to expand this effective, broadly supported approach to a much greater share of the population.”

Hillary Clinton, former Secretary of State and current presidential candidate, delivered a policy address on March 23 at the Freeman Spogli Institute for International Studies.

"It's a great treat not only for me to be at the university, but at this particular institute as well,"  said Clinton in her opening remarks. "You have made Stanford a center for national security scholarship, and that is the principal reason why I am here today."

Responding to the recent attacks in Brussels, which she called a "brutal reminder" of the ongoing global struggle with radical terrorism, Secretary Clinton laid out a set of counter-terrorism policy proposals that emphasized adaptability, diplomacy, and cooperation with other countries, intelligence services and Muslim communities.

"We face an adversary that is constantly adapting and operating across multiple theaters,” she said. “Our response must be just as nimble and far reaching. We need to reinforce the alliances that have been pillars of American power for decades.”

FSI Director Michael McFaul, former US ambassador to Russia, introduced Secretary Clinton, reminding the audience of her personal connection to Stanford (daughter Chelsea and son-in-law Marc Mezvinsky both attended the University). Former Secretary of State George Shultz and former Defense Secretary William Perry were in attendance. A sample of media coverage is listed below:

• C-SPAN (full remarks)
• Stanford News Service
• PBS News Hour
• New York Times
• NBC Bay Area

Nearly 100 health economists from across the United States signed a pledge urging U.S. presidential candidates to make chronic disease a policy priority. Karen Eggleston, a scholar of comparative healthcare systems and director of Stanford’s Asia Health Policy Program, is one of the signatories. 

The pledge calls upon the candidates to reset the national healthcare agenda to better address chronic disease, which causes seven out of 10 deaths in America and affects the economy through lost productivity and disability.

Read the pledge below.

On February 12, 2016, the Stanford Program on International and Cross-Cultural Education (SPICE) and Stanford Live (in collaboration with the National Consortium for Teaching about Asia) co-hosted a teacher professional development seminar that focused on the Silk Road. The seminar was held just prior to a Stanford Live performance by the Silk Road Ensemble at Stanford Bing Concert Hall on February 24, 2016 and a student matinee on February 25, 2016. Made up of performers and composers from more than 20 countries, the Silk Road Ensemble was formed under the artistic direction of Yo-Yo Ma in 2000.

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Jonas Edman (SPICE) and Ben Frandzel (Stanford Live) organized the day-long seminar. The morning featured a two-part lecture by Professor Emeritus Albert E. Dien, Stanford University. Part one focused on a general overview of the history and geography of the Silk Road and part two focused on a specific introduction to the religions along the Silk Road. Dr. Dien highlighted religion as an example of the many ways that the Silk Road helped to facilitate cultural exchange for millennia, resulting in the tremendous diversity one witnesses today in the region.

The afternoon featured a presentation and performance by composer and santur player Faraz Minooei, and a curriculum demonstration by SPICE staff. Minooei gave an overview of how the Silk Road played a role in the transmission of musical tradition, and also shared his personal story from his birth and childhood in Tehran, his immigrant experience in the United States, and his musical discoveries along the way. In particular, he shared his reflections on his deep spiritual desire to study music, seeing music as an “unexplainable souvenir from the eternal truth.”

Reflecting on Minooei’s presentation, Frandzel commented, “Faraz’s presentation really embodied the ways in which the Silk Road’s tradition of cultural exchange is a living story that continues to this day. His performances of Persian classical music and of his own compositions were entrancing, ear-opening experiences. As Faraz discussed his background and the musical forms that feed into his current work, his personal history and music seemed to encapsulate, in a fast-moving way, the kinds of cultural mixing that would have happened along the historic Silk Road. In our teacher workshops, we aim to provide teachers with arts-based teaching tools, and also to provide a larger social and cultural context for the art forms under discussion. The wonderful opportunity to partner with SPICE on the workshop, and the presence of this fascinating and brilliant musician, made this so much more possible.”

The curriculum demonstration was led by Rylan Sekiguchi, Naomi Funahashi, and Johanna Wee, who introduced both print- and web-based materials from the curriculum unit, Along the Silk Road, which were developed in collaboration with the Silk Road Ensemble and Dr. Dien. The 20 teachers in attendance interactively engaged with the materials and each received a complimentary copy of the curriculum unit as well as a large wall map of the Silk Road. The development of such materials has been a hallmark of SPICE for 40 years. The materials help to make content from teacher professional development seminars accessible to students.

Following the seminar, Edman reflected, “It is always such a pleasure to share with teachers the curriculum we produce here at SPICE. And to be able to collaborate with Stanford Live on a professional development workshop in conjunction with the Silk Road Ensemble’s visit to Stanford was a wonderful opportunity and experience. The Silk Road—with its themes of cross-cultural communication, exchange, and understanding—seems like an ideal topic for middle school students trying to understand today’s globalized world. We hope the speakers and pedagogical strategies and materials shared at the workshop will help teachers bring the topic to life in the classroom!”

"What do I do about the chickens?"

When assistant professor of medicine Eran Bendavid began a study on livestock in African households to determine impact on childhood health, he'd already anticipated common field problems like poorly captured or intentionally misreported data, difficulty getting to work sites, or problems with training local volunteers.

But he'd never gotten that particular question from a fieldworker before. It didn't occur to him that participating families, in reporting their livestock holdings, would completely omit the chickens running around at their feet, thereby skewing the data.

"They didn't consider chickens to be livestock," recalled Bendavid. Along with Scott Rozelle, the Helen F. Farnsworth Senior Fellow at FSI, and associate professor of political science and FSI senior fellow Beatriz Magaloni, Bendavid spoke to a full house last week on lessons learned from fieldwork gone awry. The return engagement of FSI's popular seminar, "Everything that can go wrong in a field experiment” was introduced by Jesper Sørensen, executive director of Stanford Seed, and moderated by Katherine Casey, assistant professor of political economy at the GSB. The seminar is a product of FSI and Seed’s joint Global Development and Poverty (GDP) Initiative, which to date has awarded nearly $7 million in faculty research funding to promote research on poverty alleviation and economic development worldwide.

Rozelle, co-director of the Rural Education Action Program, spoke of the obstacles to accurate data gathering, especially in rural areas where record-keeping is inaccurate and participants' trust is low. Arriving in a Chinese village to carry out child nutrition studies, said Rozelle, "we found Grandma running out the back door with the baby." The researchers had worked with the local family planning council to find the names of children to study, but the families thought the authorities were coming to penalize them for violation of the one-child policy.

Cultural differences make for entertaining and illuminating (if frustrating) lessons, but Beatriz Magaloni, director of FSI's Program on Poverty and Governance at the Center on Democracy, Development and the Rule of Law had a different story to tell. Over the course of three years, her GDP-funded work to investigate and reduce police violence in Brazil - a phenomenon resulting in more than 22,000 deaths since 2005 - has encountered obstacle after obstacle. Her work to pilot body-worn cameras on police in Rio has faced a change in police leadership, setting back cooperation; a yearlong struggle to decouple a study of TASER International’s body worn cameras from its electrical weapons in the same population; a work site initially lacking electricity to charge the cameras or Internet to view the feeds; and noncompliance among the officers. "It's discouraging at times," admitted Magaloni, who has finally gotten the cameras onto the officers' uniforms and must now experiment with ways to incentivize their use. "We are learning a lot about how institutional behavior becomes so entrenched and why it's so hard to change."

Experimentation is a powerful tool to understand cause and effect, said Casey, but a tool only works if it's implemented properly. Learning from failure makes for an interesting panel discussion. The speakers' hope is that it also makes for better research in the future.

The Global Development and Poverty Initiative is a University-wide initiative of the Stanford Institute for Innovation in Developing Economies (Seed) in partnership with the Freeman Spogli Institute (FSI). GDP was established in 2013 to stimulate transformative research ideas and new approaches to economic development and poverty alleviation worldwide. GDP supports groundbreaking research at the intersection of traditional academic disciplines and practical application. GDP uses a venture-funding model to pursue compelling interdisciplinary research on the causes and consequences of global poverty. Initial funding allows GDP awardees to conduct high-quality research in developing countries where there is a lack of data and infrastructure.