In the past year the Tobacco 21 has experienced a tremendous amount of momentum due to work at the grassroots level by local activists. Here are their stories. Will you be the next success story?
The Tobacco 21 movement in Cleveland arose from the Breathe Free committee of our local Health Department Initiative- Healthy Cleveland. This committee’s goal is to ensure cleaner airways for our citizens through policy, advocacy and awareness. Our committee is comprised of a cross sector of stakeholders including hospital systems, doctors, residents, youth, nonprofits, research institutions and more. We have been steadily advocating for the introduction and passage of this legislation since February 2015. We found a great partner in our Cleveland City Council Health and Human Services chairman, Councilman Joe Cimperman. He has a history of willingness to stand up for what is right for the health of our citizens even when it is not popular, back in 2011 he introduced legislation that would ban local restaurants from cooking with transfats, was challenged by the state- and won! Through the collaboration of our partners we were able to introduce the piece in June 2015 and held a series of 4 public hearings to present the evidence and hear testimony from our health professionals, residents, research institutions, and concerned store owners. In total, we spent over 17 hours in public hearings to ensure that all of the questions and concerns related to the piece were addressed. On December 7th 2015, the Cleveland City Council voted 13-3 in favor of increasing the sales and purchase age of tobacco products to 21. We thank everyone who has been key to making this happen and expect we will see improved health outcomes for our youth and future adults as a result!
Program Manager, Healthy Cleveland Initiative
Cleveland Department of Public Health
Kansas City, Missouri and Kansas
The Tobacco 21|KC effort was launched by Healthy KC, a partnership of the Greater Kansas City Chamber of Commerce, Blue Cross and Blue Shield of Kansas City, the Health Care Foundation of Greater Kansas City and countless regional organizations including business, health care organizations, hospitals, nonprofits, government, and more.
Healthy KC convened local health experts to recommend the most promising strategies for reducing the burden of tobacco in our community. Tobacco 21 quickly rose to the forefront as an important strategy, not only because of its ability to reduce youth smoking by up to 25%, but also because it was a change that could be enacted at the local level. The Tobacco 21|KC effort focuses on the entire Greater Kansas City region, which encompasses more than five counties and 85 municipalities, all spread between the two states of Kansas and Missouri.
We approach this as a regional effort that is supported by health and business leaders from throughout our community. Extensive use of organization and individual endorsements, earned media, legislative champions, and local municipal leaders led to some early success. On November 19, 2015, the Kansas City, Missouri City Council passed Tobacco 21 with only one dissenting vote. Only hours later, the County Commission of the Unified Government of Wyandotte County/Kansas City, Kansas did the same. We are grateful to all of our partners for this success and look forward to continuing to educate communities in the KC region, and beyond, about Tobacco 21.
Scott Hall, Greater KC Chamber of Commerce
Jessica Hembree, Health Care Foundation of Greater Kansas City
As pediatricians, we started working together to raise the tobacco purchasing age to 21 because we were frustrated with the difficulty of helping our patients quit tobacco once they have started. As doctors, we knew that tobacco remains the leading cause of preventable disease and death, killing 480,000 Americans yearly. However, we also understood that the vast majority of tobacco use begins before the age of 21 when the brain is especially susceptible to nicotine addiction. Raising the age of sale to 21 had only been done in one town in the entire United States, Needham MA. When we looked at the data from Needham, we saw that the youth smoking rate was dropping much faster than in surrounding communities! We wanted all children to have the benefits of a non-smoking life in Massachusetts and across the nation. Despite resistance from the tobacco industry, we have been delighted with the fact that over 50 towns, cities, and counties have already adopted this life-saving idea. Under the direction of just a few of our many collaborators (Patrick McKenna, Henry Philofsky, Matthew Reynolds, and Ken Farbstein), we have launched this newsletter to spread state-of-the-art knowledge on raising the tobacco purchasing age to 21 in your community. Let us know if your community needs help!
Lester J. Hartman, MD MPH FAAP
Jonathon P. Winickoff MD
Columbia, Missouri is city in the heart of the U.S. with 115,000 residents and 38,000 college students. As a community that values health, residents wanted to do something to protect youth and save lives lost due to tobacco use. In the state with the lowest tobacco tax in the nation, no statewide smokefree law, and preemptive language preventing many other local regulations to decrease smoking rates and stop youth initiation, Tobacco 21 was considered.
A coalition who previously worked to pass the city’s indoor air ordinance teamed up with a Public School Board member and a member of the Columbia City Council to gain support of the Board of Health, the Substance Abuse Advisory Commission and the City Council (final vote of 6-1). Tobacco 21 was successfully adopted and implemented immediately on December 15, 2014.
Soon after there was buzz in the local high schools about the difficulty of accessing tobacco products and parents heard their 18-20 year olds complain about their civil liberties being restricted. As freedom doesn’t come from a life of addiction, the coalition knew their achievement was having instantaneous positive implications. Mayor Bob McDavid, a retired obstetrician, said when voting in support of the ordinance, “I spent three decades of my life dealing with the problems of miscarriages, stillbirths, placental abruptions, prematurity, and sudden infant death syndrome, which are dramatically increased in smokers…pleading with patients to quit smoking with mixed success, if this [Tobacco 21] action prevents a couple of 12 year olds in the City of Columbia from smoking this ordinance will be well worth it. Any tax revenue lost would be a great investment in Columbia’s future.”
Working with community leaders and the Evanston Health Department, interventional cardiologist Tim Sanborn recently spearheaded an ordinance to raise the age to purchase tobacco products and e-cigarettes to age 21 on October 27, 2014. With passage of this legislation, Evanston became the first community in the Midwest to adopt a Tobacco 21 policy. Columbia, Missouri followed in December. There are now 58 communities in seven states that have passed Tobacco 21 laws. Putting this initiative in perspective, Dr. Sanborn said the following:
“I can recommend smoking prevention and cessation to my patients; however, these efforts are limited to one-on-one office visits or bedside discussions in the hospital. Promoting smoking prevention policies with local health departments and city councils has the potential for a much greater impact on limiting the health risks of tobacco in the community. In our experience in Evanston, bringing health professionals and government leaders together to implement smoking bans in public places and Tobacco 21 laws has also been a very rewarding endeavor.”
Timothy A. Sanborn MD, MS, FAHA, FACC
I was proud to see our small town of Healdsburg be the first in the state to ban the sale of tobacco products to those under 21; it will take place July 1, 2015. Three years ago I went to the tobacco merchants in our town, which turned out to be mostly gas stations and convenience stores, and asked if they would voluntarily not sell tobacco products on the Great American Smokeout Day in November. Only one agreed to do so, because the owner felt guilty about all the tobacco products he was selling. One place was somewhat supportive but then explained he could not do it because of the financial losses it would cause. So I asked him how much tobacco product did he sell. He hesitated, then said “We sell $2000 to $4000 dollars of tobacco PER DAY*!” I was stunned, shocked, sobered.
So I decided to try other methods, and learned about the success in Needham, Massachusetts, where in 2005 they banned the sale of tobacco products to those under 21, and they have seen a dramatic drop in teen smoking. And other cities have now done the same. I went to two of our city council members, and introduced the concept to them. They were supportive, so I went to the City Council meeting and spoke. I had considerable community support. One of the things I said to the Council that seemed to resonate the most was this: “If we knew the carcinogen that causes breast cancer, it would be banned immediately. Breast cancer kills 38,000 per year. Lung cancer kills 180,000 per year, and we know the carcinogen, and we let our teenagers have it. And it is addicting!”
So the City Council voted 4-1 to adopt a Tobacco Retail Licensing ordinance that bans the sale of all tobacco products to those under 21. One of the council members said that this is the function of small constituencies, to be catalysts for larger places, to set an example, to be leaders. She was right! Several other communities are now considering similar ordinances.
Thank you, Healdsburg!
David Anderson, MD