Tobacco Control Policies: The National Picture and where Virginia stands

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Tobacco Control PoliciesThe National
Pictureand where Virginia stands
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Evidence-Based Tobacco Control

• Tobacco Taxes
• Smoke-free Laws
• Comprehensive Prevention Cessation Programs
• Limits on Industry Behavior (e.g., FDA)
• TO BRING ABOUT
• Social Environmental Change

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THE TRIFECTA
Smoke-Free
Tax
Program Funding
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Tobacco Taxes
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TOBACCO EXCISE TAXES

• A win for public health
• A win for state budgets
• A win among voters

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Cigarette Pack Price Trend vs. Youth Smoking
Prevalence, 1991-2007
Sources Tax Burden on Tobacco, 2007 Youth
Behavioral Risk Surveillance System, 2007 U.S.
Bureau of Labor Statistics.
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• Calls to Wisconsin Tobacco Quit Line Break All
  RecordsDate Posted  February 28, 2008As
  February winds down, the Wisconsin Tobacco Quit
  Line today announced that in the first two months
  of 2008 it has fielded a record-breaking 20,000
  calls from Wisconsinites looking for help to
  quit. To put this in context, during a typical
  year, the quit line provides services to about
  9,000 state residents. This unprecedented
  success in assisting Wisconsin smokers through
  1-800-QUIT-NOW breaks all previous state
  records, said Dr. Michael Fiore, director of the
  University of Wisconsin Center for Tobacco
  Research and Intervention, which manages the quit
  line. National peers who provide quit services
  in other states report they have never before
  seen such a successful state effort to help
  smokers quit. Three factors led to this
  increase in quit attempts by Wisconsin smokers
• A 1 increase in the states tobacco excise tax
• New Years resolutions
• Free coaching and medication provided through the
  Wisconsin

As February winds down, the Wisconsin Tobacco
Quit Line today announced that in the first two
months of 2008 it has fielded a record-breaking
20,000 calls from Wisconsinites looking for help
to quit. To put this in context, during a typical
year, the quit line provides services to about
9,000 state residents.
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Impact of Federal Tobacco Tax Increase
Time Period Percent Increase in Quit Line Calls
March 08 compared to March 09 148
Monday, March 31, 2008 compared to Monday, March 30, 2009 124
Tuesday, April 1, 2008 compared to Tuesday, March 31, 2009 179
Average calls per day in 2008 compared to the last nine days in March 2009 129
April 1, 2008 compared to April 1, 2009 752 calls compared to 3530 369
Statistics Call volume to 17 states (tobacco
users registered) Source Free and Clear, Inc.
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Cigarette Tax Rates, December 2009(cents per
pack)State Average 1.34 Per Pack
VA ranks 49th
WASHINGTON 202.5
MONTANA 170
MAINE 200
NORTH DAKOTA 44
VT224
MINNESOTA 156
OREGON 118
VT
IDAHO 57
NH 178
NH
WISCONSIN 252
SOUTH DAKOTA 153
NEW YORK 275
MA
MA251
WYOMING 60
MICHIGAN 200
CT
RI346
CT300
IOWA 136
PENNSYLVANIA 160
NJ270
NEBRASKA 64
NEVADA 80
OHIO 125
DELAWARE160
UTAH 69.5
IN 99.5
ILLINOIS 98
WV 55
MARYLAND200
30 VIRGINIA
COLORADO 84
KANSAS 79
MISSOURI 17
DC250
87
KENTUCKY 60
CALIFORNIA
45 NORTH CAROLINA
TENNESSEE 62
OKLAHOMA 103
ARKANSAS 115
ARIZONA 200
NEW MEXICO 91
SOUTH CAROLINA 7
GEORGIA 37
ALABAMA 42.5
MS 68
TEXAS 141
36 LOUISIANA
ALASKA 200
HAWAII 260
FLORIDA 133.9
States that have not passed tax increases since
1999
States that have recently passed or implemented a
cigarette tax increase (since 1999)
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The Virginia Tax ExperienceFrom 2.5 to 20 on
9/1/04 from 20 to 30 on 7/1/05
Packs Sold
Revenues Collected
- 15.6
968.9
Orzechowski Walker, The Tax Burden on Tobacco,
2009
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Benefits of a 1.00 Tax Increase in Virginia

• 66,800 fewer kids become smokers
• 45,100 adult smokers quit
• Saving 30,600 premature deaths from tobacco in
  Virginia
• 1.5 billion in lifetime health care savings
• 348 million in new revenue for the state

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Federal Cigarette Excise Tax Average State
Cigarette Tax
federal rate (1.01) current state average
(1.34) 2.35 per pack
1996 federal rate (24) state average (33)
57 per pack
November 2009
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Despite more states taxing all tobacco products

• There is still a big discrepancy between tax
  rates for OTPs and cigarettes

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Smoke-Free
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Effects of Smoke-free Laws

• Protect everyone from secondhand smoke
• Prompt more smokers to try to quit
• Increase the number of successful quit attempts
• Reduce the number of cigarettes that smokers
  consume
• Discourage kids from starting
• Do NOT hurt business

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Smoke-Free Restaurant and Bar Laws
VAs smoke-free law does not cover ____.
State Smoke-free Laws Including Restaurants Bars
Local Smoke-free Laws Including Restaurants
Bars

• MI law effective 5/1/10, WI law effective 7/5/10,
  KS law effective 7/1/10.

March 2010
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Percent of Population Covered By Smoke-Free Laws
(Including Bars)

2010 62 28 states and hundreds of communities
are smoke-free
11/27/2002 13 DE becomes 2nd smoke-free state
1/1/1998 12 CA becomes 1st smoke-free state
1996 lt 1 Smoke-free laws in 13 communities
nationwide
Includes state and local laws passed by March 15,
2010
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State-wide Smoke-Free Laws

• Number of state laws including restaurants and
  bars 28 (62 of the population covered)
• California, Delaware, New York, Maine,
  Connecticut, Massachusetts, Michigan, Rhode
  Island, Vermont, Washington, New Jersey,
  Colorado, Hawaii, Ohio, Arizona, New Mexico, New
  Hampshire, Minnesota, Illinois, Maryland, Iowa,
  Utah, Oregon, Nebraska, Montana, North Carolina,
  Wisconsin, Kansas
• Number of state laws including restaurants but
  not bars 4 (9 of the population covered)
• Florida
• Idaho
• Louisiana
• Nevada
• Number of restaurant laws with significant
  exemptions 8 (14 of the population covered)
• Arkansas - Smoking prohibited in restaurants,
  except those that prohibit entry to persons under
  21.
• Georgia Smoking prohibited in restaurants,
  except for those that deny access to minors.
• North Dakota Restaurants may permit smoking in
  separately enclosed bar areas.
• Oklahoma Restaurants must either be non-smoking
  or have separately ventilated rooms.
• Pennsylvania Restaurants may permit smoking in
  separately ventilated attached bars.
• South Dakota State law prohibits smoking in
  restaurants, except those licensed to sell
  alcohol.
• Tennessee Smoking is prohibited in restaurants,
  except those that prohibit entry to persons under
  21.
• Virginia - Restaurants must either be non-smoking
  or have separately ventilated rooms.

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Funding for Tobacco Prevention
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• Evidence Base

.
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If every state funded TP at CDC minimum, states
would prevent nearly two million kids alive today
from becoming smokers, save more than 600,000 of
them from premature, smoking-caused deaths, and
save 23.4 B in smoking-related HC costs.
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If every state funded TP at CDC minimum, states
would prevent nearly two million kids alive today
from becoming smokers, save more than 600,000 of
them from premature, smoking-caused deaths, and
save 23.4 B in smoking-related HC costs.
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States with best funded and most sustained
tobacco prevention programs during the 1990s
AZ, CA, MA and OR, reduced cigarette sales more
than twice as much as the country as a whole
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Best Practices 2007

• State and Community Interventions
• Media Interventions
• Cessation Interventions
• Surveillance/Evaluation
• Administration/Management

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FY2010 Funding for State Tobacco Prevention
Programs
ND is only state to meet CDC Recommendation
WASHINGTON
MAINE
NORTH DAKOTA
MONTANA
MINNESOTA
OREGON
VT
NH
IDAHO
WISCONSIN
SOUTH DAKOTA
MA
NEW YORK
MICHIGAN
CT
RHODE ISLAND
WYOMING
IOWA
PENNSYLVANIA
NEW JERSEY
NEBRASKA
NEVADA
OHIO
DELAWARE
IN
UTAH
ILLINOIS
WASHINGTON, DC
WV
MARYLAND
COLORADO
KANSAS
MISSOURI
VIRGINIA
CALIFORNIA
KENTUCKY
NORTH CAROLINA
TENNESSEE
OKLAHOMA
VA ranks 32nd
ARIZONA
ARKANSAS
SOUTH CAROLINA
NEW MEXICO
GEORGIA
MS
ALABAMA
TEXAS
LOUISIANA
FLORIDA
HAWAII
States that are spending 50 or more of CDC
recommendation on tobacco prevention
programs. States that are spending 25 - 49 of
CDC recommendation on tobacco prevention programs.
States that are spending 10 - 24 of CDC
recommendation on tobacco prevention programs.
States that are spending less than 10 of CDC
recommendation on tobacco prevention programs.
December 2009
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History of Tobacco Prevention Fundingin Virginia
(State Dollars)(in millions)
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Virginia Tobacco Money for Tobacco Prevention,
FY 2010
307 Million
134 Million Estimated Tobacco Settlement Revenues
173 Million Estimated Tobacco Tax Revenues
103.2 Million
13.4 Million
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Virginias Tobacco Control Spending vs.
Tobacco-Related Healthcare Cost
2.08 Billion
13.4 Million
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Virginias Tobacco Control Spending vs. Tobacco
Industrys Marketing Spending
411.3 Million
13.4 Million
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U.S. Cigarette Advertising and Promotional
Expenditures 1996 - 2006(thousands of dollars)
15.15 Billion
14.15 Billion
13.11 Billion
12.47 Billion
12.49 Billion

11.22 Billion
9.59 Billion
8.24 Billion
9.8b price discount
10.9b price discount
10.8b price discount
9.2b price discount
7.9b price discount
6.73 Billion
5.66 Billion
5.10 Billion
Before 1997, Coupons and Retail Value Added
were combined into one category.
Source Federal Trade Commission Cigarette Report
for 2006
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If VA decreased its FY 2010 tobacco prevention
funding by 15...

• Youth smoking rates would increase by 0.4
• 1,720 more kids would become addicted smokers
• 550 more kids would die prematurely from smoking
• Future healthcare costs in VA would increase by
  30.1 million
• State Medicaid program spending would increase by
  3.6 million

• Increasing VAs cigarette tax rate by just a
  nickel would generate more than enough revenue to
  offset a 15 decrease in funding.

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Federal Activities

• Stimulus Funds
• Health Care Reform
• FDA regulation

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Stimulus Bill Provides Funding Opportunity for
Tobacco Control
373 Million
Total of 650 million was made available to HHS
for community-based prevention and wellness
programs to address chronic disease, including
obesity, nutrition, physical activity and tobacco
prevention and cessation. Approx. 500 million
has been made available to states or otherwise
accounted for.
45 Million
44.5 Million
30 Million
5.5 million will support national quitline
efforts
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Health Care Reform
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Health Care Reform Three Key Elements

• Private Health Insurance Both Senate and House
  bills include coverage for tobacco cessation
  services with no cost-sharing requirements.
• Insurance rating
• House bill insurers not permitted to vary
  premiums based on tobacco use
• Senate bill premiums could vary based on
  tobacco use
• Medicaid
• House bill States required to cover tobacco
  cessation services in their Medicaid programs
  with no cost-sharing requirements
• Senate bill States required to cover tobacco
  cessation services for pregnant women with no
  cost-sharing requirements. States are provided a
  financial incentive to cover all preventive
  services recommended by USPSTF and immunizations
  recommended by ACIP, but are not required to do
  so.

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Health Care Reform Three Key Elements

• Prevention Trust Fund
• House bill Public Health Investment Fund total
  of 34 billion for FY2011 FY2015 for community
  health centers, workforce development and
  prevention Prevention and Wellness Trust
  authorized to receive 15.4 billion from Public
  Health Investment Fund for prevention and
  wellness services and research and to build core
  public health infrastructure for state, local and
  tribal health departments and CDC. Community
  Prevention and Wellness Services grants for
  community-based prevention and wellness services
  in HHS priority areas.
• Senate bill - Prevention and Public Health Fund
  total of 7 billion for FY2010 FY2015 and 2
  billion annually thereafter. Funding used for
  programs authorized by the Public Health Service
  Act for prevention, wellness and public health
  activities. New grant programs that could be
  used to reduce tobacco use include Community
  Transformation grants and Healthy Aging, Living
  Well

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• FDA Regulation of Tobacco
• What Does it Mean?
• What Happens Now?

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15 YEARS IN THE MAKING

• 79 17 Senate Vote (June 11)
• 307 -- 97 House Vote (June 12)

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June 22, 2009
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Key Substantive Elements

1. Require the Industry to provide information to
   the Govt that allows Govt to better inform
   consumers
2. Restrict marketing that appeals to kids, misleads
   adults, deceptively encourages tobacco use and
   discourages quitting
3. Strengthen restrictions on sales to youth

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Key Substantive Elements

• 4. More Accurately Inform consumers
• A. Improved warning Labels
• B. More accurate testing of tar, nicotine and
  other harmful substances
• C. Standards to prohibit unsubstantiated health
  claims
• 5. Regulation of the Contents of the Product to
  protect consumers
• 6. Protect and Expand State authority

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Limitations on FDA Authority

• FDA cant ban all cigarettes, all smokeless
  tobacco products, or all roll your own tobacco
  products
• or
• Require the reduction of nicotine yields of a
  tobacco product to zero.

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Implementation Milestones

• Immediate
• States can restrict Time, Place and Manner of
  tobacco marketing
• No health claims without review
• Review of new products
• Broader advertising restriction authority

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States may now for the first time, to the extent
permitted under the First Amendment, do such
things as

• Supplement the new FDA requirement that all
  retail ads for cigarettes and smokeless consist
  only of black text on white background by
  applying the same restrictions to cigar and other
  tobacco product ads
• Restrict or eliminate power walls of cigarettes
  being offered for sale at retail outlets (which
  will be the only remaining presentation of
  cigarette brand logos, labels and colors in
  retail outlets after the FDA black-text-on-white-b
  ackground restriction goes into effect)

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Continued

• Limit the number or size of tobacco product ads
  at retail outlets
• Require that all tobacco products or tobacco
  product ads be kept away from cash registers in
  order to reduce impulse purchases by smokers
  trying to quit.

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Implementation

• 3 months
• No candy-flavored cigarettes

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Implementation

• 12 months
• No light, low, mild, descriptors
• Youth access provisions contracts with states
• Marketing restrictions magazines, points of
  sale, sponsorship, etc
• New warning labels on smokeless
• Scientific Advisory Committee appointed within 15
  months

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Implementation

• In the slightly longer term.
• Larger, stronger graphic warning labels on
  cigarettes
• -- Rule issued within two years
• -- Implementation 15 months later

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Cigarette pack under FDA Regulation
Cigarette pack now
Front
Front
Back
Back
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Implementation

• Menthol Study and Report
• 1 Year after Scientific Advisory Committee
  appointed

• Dissolvable Tobacco Products Study and Report
• 2 Years after Scientific Advisory Committee
  appointed

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Magazine Ad for Camel No. 9 Stiletto, Fall 2007
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RJR document Identified the Specific
Characteristics to Be Used in Developing "New
Brands Tailored to the Youth Market."

• Nicotine level of 1.0- 1.3 mg/cigarette
• Nicotine absorption minimized by holding pH
  down
• Tar content of 12-14 mg/cigarette to achieve
  desired taste and "visible" smoke

• Bland smoke to address low
• tolerance for smoke irritation
• of beginning smokers and inhalers
• Suggests 100 mm "to facilitate
• lighting
• Reasonably firm" rod

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It will not kill them as quick or as much
as other brands, Bennett LeBow, CEO, Vector,
Manufacturer of new Omni cigarettes. -- USA
Today 1/11/02
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Challenges to the LawCourt Upheld all Except Two

• The requirement of large graphic health warnings
  on cigarette packs
• The prohibition of tobacco companies making
  health claims about tobacco products without FDA
  review
• The ban on brand name sponsorships of events like
  sports and entertainment
• The ban on tobacco-branded merchandise like caps
  and t-shirts
• the ban on free samples and free gifts with
  purchase
• the authority of the FDA, as well as state and
  local governments, to impose additional marketing
  retrictions on tobacco companies
• Restricting tobacco advertising at point of sale
  and in magazines with high youth readership to
  black and white/text only format
• Prohibition on saying products are FDA approved
  because Court interpreted it to apply to parties
  independent of the tobacco companies as well as
  to tobacco companies

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Both Sides Likely to Appeal

• We believe all of the marketing restrictions can
  be upheld
• We believe opinion misinterpreted the ban on
  statements about FDA approval to suggest even
  non-industry types were banned from talking about
  this
• Even if decision on black and white/text only is
  upheld, the decision seemed narrowly focused on
  use of corporate and brand logos not on banning
  the colors and images used to attract kids, so
  rule should be able to be revised if necessary
• Because of severability clause, challenges do not
  stop other provisions of law from going into
  effect

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What is Our Role?

• Continue with More of What We Know Works
• Tobacco Taxes
• Smoke-free Laws
• Funding for Tobacco Prevention Cessation
• Coverage for Smoking Cessation Services
• FDA is a Complement not a Substitute

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For more information www.tobaccofreekids.org

• Amy Barkley
• Director, Tobacco States and Mid-Atlantic
• abarkley_at_tobaccofreekids.org
• 502-777-8148