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Raising tobacco age of sale to 21 would prevent thousands of premature deaths in Michigan

New findings look at the potential impacts of a “Tobacco 21” law in Michigan

Restricting sales of tobacco products to people 21 and older could keep 11,000 Michiganders from starting to smoke, potentially avoiding premature deaths in two-thirds of that population, according to a University of Michigan study.

The change would translate into 17,000 fewer smoking-related deaths and 198,000 fewer smokers in five years, according to U-M researchers who analyzed the potential impact if Michigan were to pass what’s often called “Tobacco 21” legislation. Seven states and more than 400 municipalities have already enacted such laws, and a measure was introduced in Michigan’s House of Representatives in January.

“Passing a Tobacco 21 law in Michigan has the potential to save lives, but only if the law is carefully implemented in a way that supports, rather than stigmatizes, the people it affects,” said Holly Jarman, assistant professor at U-M’s School of Public Health.

Researchers say tobacco use remains a major public health concern in Michigan, causing more than 16,000 deaths each year. Compared to the national average, 20 percent more Michigan 12th-graders have smoked a cigarette or cigar, used smokeless tobacco or vaped an e-cigarette in the last month.

Jarman and colleagues conducted a comprehensive analysis of the potential effects of a statewide policy that would limit tobacco sales to people 21 or older, instead of the current age limit of 18. The team examined how smoking habits would change over the next 80 years if the legislation reduced smoking initiation by 10 percent.

In addition, they examined existing implementation of such a policy in four Ohio cities, and conducted a national survey to understand attitudes and opinions toward such a law.

When Columbus, Ohio, passed its Tobacco 21 law in 2016, it was the sixth city to do so in the state. At that time, Jarman says, the policy was paired with the creation of a citywide tobacco retailer license, funding to implement the policy and educate retailers, and clear delegation of enforcement authority to the Public Health Department.

Other cities passing Tobacco 21 laws in the state, like Cleveland, Dublin and Euclid, did not initially enact these policies and found it difficult to match the results delivered by the Tobacco 21 law in Columbus.

To be effective, the researchers say, Tobacco 21 legislation should be part of a comprehensive approach to tobacco control, including unit price increases for tobacco products, strong support for smoking cessation services and prevention activities for affected young people.

“Rather than thinking about Tobacco 21 in isolation, it is very important to think about the best ways to support those who will be affected by any such law, and provide resources to help young people quit if already smoking,” said Rafael Meza, associate professor at U-M’s School of Public Health and a member of the research team.

To avoid tax revenue losses from lower tobacco sales, the researchers suggest setting the tobacco tax rate to stay in line with inflation.

Jarman said because young people would be affected by the implementation of a Tobacco 21 law, they should be included in the policy discussion.

The team conducted a national survey of 800 people ages 14-24 in September 2018 via SMS text message. The survey was part of the MyVoice project led by Tammy Chang, assistant professor of family medicine at the U-M Medical School.

About 60 percent of Michigan youth surveyed supported the adoption of a Tobacco 21 policy, mirroring nationwide responses.

Among national respondents:

•    Half of those under age 18 said people their age obtain tobacco from social sources, such as friends and family, despite the current law.
•    About 75 percent of respondents over 18 said people their age obtain tobacco from brick-and-mortar retailers.
•    Among those who expressed support for Tobacco 21 laws, about 40 percent thought young people are not responsible enough to buy tobacco and roughly 60 percent are concerned about tobacco’s health effects.
“A rapidly increasing number of cities, counties and states around the country are passing Tobacco 21 laws,” said Jarman, adding that in Michigan, some elected officials have expressed strong support for enacting a Tobacco 21 law.

“If our legislators decide that we should join other states like Virginia and New Jersey in passing Tobacco 21, we urge them to do it in a way that supports young people and communities in our state. That means implementing Tobacco 21 as part of a comprehensive tobacco control policy.”

The team’s work was funded by the U-M Institute for Healthcare Policy and Innovation, as part of its inaugural Policy Sprint initiative.

County eyes crackdown on underage tobacco sales

LINCOLN COUNTY –– With at least half of youths saying they have no problem acquiring cigarettes, local officials are considering possible licensing requirements for retailers in Lincoln County.

A proposal to curb tobacco purchases and consumption by Lincoln County youth is making the rounds among public health officials, with members of the county’s public health advisory committee strongly supporting the licensure and monitoring of local tobacco retailers here.

“One of the benefits of this is that the penalties are stronger,” said Lincoln County Public Health Advisory Committee member Faire Holliday. “What we’re seeing in other communities is that fines and the cost of a license might not be enough to make them stop selling or change their ways if they are selling to youth.”

Fear of losing a tobacco license, she added, might be motivation enough for many local tobacco retailers to comply with any licensure requirements imposed by the county.

“Especially with stores in which there is a big portion of their revenue, that could help them change their habits so at least they’re not selling to youth,” Holliday said. “Even if they are still selling products, this does have a couple of other benefits.”

According to Holliday, the rate of tobacco use among adults in Lincoln County is among the highest in the state. One in three adults in Lincoln County smoke, and Holliday found that youth smoking, while not as high, is still fairly prevalent. As of the end of November, 7.5 percent of 11th graders smoked cigarettes, 1.9 percent used a tobacco product of some kind and 9 percent smoked e-cigarettes.

“You may have also seen in the news that the use of e-cigarettes is going up sort of exponentially,” Holliday said in a December county public health advisory committee meeting. “I think it was 77 percent in the last year, so these numbers are certainly higher over the course of the year.”

Holliday also said it’s easy for teens to get cigarettes, with 52 percent of 11th graders across the country saying cigarettes are easy to acquire and 57 percent said the same of e-cigarettes. Almost three-quarters of youth who responded to the survey said they got tobacco products from a retail outlet.

“We also know youth obtain it from other youth, so really targeting in on the retail locations, if someone is buying it, can really help reduce the rate,” Holliday said.

Mixed response to previous proposals

While numbers weren’t immediately available regarding the number of local youth who buy or use tobacco products, Holliday’s efforts to target local business that sell cigarettes and similar products will crack down on the retailers selling such merchandise to local teens.

Her proposal would require local businesses to obtain a tobacco-selling license, just as liquor stores, restaurants and grocery stores are required to get a liquor license or dispensaries have to get a license to sell cannabis. The license, once awarded, would not be transferable if the business is sold.

An added benefit of requiring tobacco retailers to sell tobacco products, Holliday added, is that the county would have a way of keeping inventory of which businesses in the area are selling tobacco. The county currently does not keep such a list.

To get a tobacco license, retailers would have to fill out and submit an application and pay a fee which has yet to be determined. Holliday suggests between $150 and $400, although in other communities across the state the fee is as low as $125 annually or as high as $580 a year.

“The fee has to be enough to cover enforcement, but it can’t exceed the cost of the program or else it’s considered a tax,” Holliday said. “That’s something we’d be figuring out on the county level to determine what would be appropriate.”

According to chair of the Lincoln County Board of Commissioners, Doug Hunt, the county does not currently impose a fee for the sale of tobacco products. The proposal of regulating and licensing tobacco retailers came before the board of commissioners in years past, with some in the community supporting the effort and some against it.

“It has been discussed before the board of commissioners,” Hunt said during the December public health advisory committee meeting. “And as I remember, there was mixed response.”

With Lincoln County being one of the highest tobacco-consuming counties in the state, the proposition to license tobacco retailers was met with considerable support from other members of the county’s public health advisory committee.

“It would not only be advisable in my mind to have a fee that pays for some sort of monitoring program, but it also is high enough that it would somehow reduce the sales opportunities,” said committee chair Gary Lahman. “There may be small retail places that if the fee was too high, they would say, ‘Well, I don’t want to sell cigarettes.’ To me, anytime you reduce the availability of sales, you might reduce usage.””

Democratic senators calling for ban on menthol cigarettes

Democratic senators urge FDA- More than a dozen Democratic U.S. senators said the FDA needs to follow through after pleding last month to try to ban menthol cigarettes and flavored cigars.  FDA Commissioner Scott Gottlieb also pledged to work to tighten rules governing the sale of most flavored versions of electronic cigarettes.

In a letter dated December 20, 2018 (downloadable via pdf link below) the senators urged Gottlieb to finalize the regulations quickly.



Waseca latest city to raise tobacco sales age to 21

Tuesday night, Waseca city council members voted to raise the city’s tobacco sales age to 21.

“I started smoking when I was 13 years old; I had no support back then,” Waseca Council Member Daren Arndt said Tuesday. “I stopped smoking 25 years ago, but I wish I’d never started. Tobacco 21 is all about supporting our young people and leading our community and state to a healthier tomorrow.”

The vote in Waseca Tuesday followed on the heels of the U.S. surgeon general’s calling for urgent action in response to a surge in e-cigarette use among teens.

The surgeon general reported new federal data shows e-cigarette use among American youth is rising at an alarming rate.

“Minnesota leaders should do more to combat the epidemic of youth nicotine addiction,” Molly Moilanen, vice president at ClearWay Minnesota and co-chair of Minnesotans for a Smoke-Free Generation, said in a statement. “Raising the tobacco age to 21 is a common sense way to keep addictive tobacco products away from kids and prevent young people from ever starting.”

Surgeon General Warns Youth Vaping Is Now An ‘Epidemic’

“Vaping by U.S. teenagers has reached epidemic levels, threatening to hook a new generation of young people on nicotine.

That’s according to an unusual advisory issued Tuesday U.S. Surgeon General Jerome Adams about the the dangers of electronic cigarette use among U.S. teenagers.

“I am officially declaring e-cigarette use among youth an epidemic in the United States,” Adams said at a news conference. “Now is the time to take action. We need to protect our young people from all tobacco products, including e-cigarettes.”

The surgeon general’s advisory called on parents and teachers to educate themselves about the variety of e-cigarettes and to talk with children about their dangers. Health professionals should ask about e-cigarettes when screening patients for tobacco use, the advisory said. And local authorities should use strategies, such as bans on indoor vaping and retail restrictions, to discourage vaping by young people.

The advisory was prompted by the latest statistics on vaping among youth, which found e-cigarette use among high school students has increased dramatically in the past year.

“We have never seen use of any substance by America’s young people rise this rapidly,” Health and Human Services Secretary Alex Azar said at the briefing. “This is an unprecedented challenge.”

Federal officials singled out JUUL electronic cigarettes for fueling the epidemic, noting that the sleek devices are by far the most popular electronic cigarettes among young people.

The company defended its products, saying it has taken steps to prevent young people from using them. For example, the company has stopped distributing some flavorings to retail stores and has taken other steps to make sure young people don’t buy the devices online.”