Kicking the habit

From a small office in southeast Chico, in a compact building that the American Lung Association shares with another health nonprofit, Shelly Brantley raises as conspicuous a ruckus as possible about the dangers of tobacco products.

Brantley, the association’s Northern California advocacy director, has a particular concern for youth. A 2015 report from the California Department of Public Health (CDPH) says 63 percent of smokers in the state pick up the habit before age 18 and 97 percent before age 26. Over 10 percent of high school students reported smoking at least one cigarette in a month; while that figure has dropped from over 20 percent in 2000, the number of teens vaping—using electronic cigarettes—has grown by a comparable magnitude.

Vaping is a relatively new phenomenon, so scientific study is correspondingly nascent. Proponents of e-cigs, notably trade groups such as the American Vaping Association, cite evidence that these products are healthier than tobacco and help smokers quit cigarettes. The Lung Association puts forth research findings, including from the U.S. Food and Drug Administration, that state e-cig liquids contain carcinogens—cancer-causing agents—and lung irritants.

Vaping liquids come in an assortment of flavors and different types of packaging; many, though not all, contain nicotine, the addictive chemical in tobacco.

Brantley’s group considers vapes “a tobacco product” and thereby holds e-cig use in the same ill regard as smoking traditional cigarettes, with adverse effects documented for decades.

“What the Lung Association and our public health allies fight for is saving lives,” Brantley said, “and one of the best ways to do that is to keep kids from tobacco. If that’s by raising the price, which taxes really help with; if that’s by raising the purchase age, that just forestalls the amount of time kids have to experiment with the product.”

California voters will have a chance to impact the price of tobacco products in the November election via Proposition 56, an initiative proposing a $2 per pack/package tax to fund educational outreach and public health costs associated with smoking-related illnesses.

The Legislature already has raised the purchase age—since last month, anyone in California (except active military) has had to show ID proving he/she is at least 21. Moreover, state law expanded the definition of tobacco to include e-cigs and vaping products. Gov. Jerry Brown put these changes into force by signing a set of five bills May 4.

The new regulations—particularly the age rule, labeled Tobacco 21—culminated years of effort.

“The Lung Association and our coalition partners were thrilled with the outcome and implementation,” Brantley said. “One of the things that really shows us [the significance] is a 1986 report that Philip Morris put out that said [tobacco executives] were really concerned about changing the minimum age from 18 to 21, because they said effectively it would gut their programs, gut their marketing strategies.

“I feel that anything that tobacco companies are afraid of … that’s a good law to have, because ultimately they are fighting for their bottom line.”

California Public Health officials did not lobby for the new laws, though Dr. Karen Smith, CDPH’s state health officer, testified about e-cigarettes and youth tobacco use at a legislative hearing on public health issues.

Now, CDPH has a key role in putting the legislation into action. The first step is informing the public, especially the retailers who represent the front line of defense in keeping tobacco products out of kids’ hands. The department has produced training materials in seven languages so clerks will understand to treat cigarette and vaping product sales just like alcohol sales.

“The more you can delay the onset of the use of tobacco products, you prevent the regular use of tobacco products and addiction to tobacco products,” said April Roeseler, branch chief of CDPH’s Tobacco Control Program. “So, in the long run, we’ll save lives.”

California is just the second state to raise the tobacco age; lawmakers voted to raise Hawaii’s minimum to 21 last June, effective Jan. 1, 2016. The only long-term track record comes from Needham, Mass., which, until 2012, was the only U.S. community to prohibit tobacco sales to anyone under 21.

Needham passed its ordinance in 2005, and it took effect in 2008. After five years, the local smoking rate for adults dropped to 8 percent, compared to 18 percent statewide, and deaths from lung cancer dropped 24 percent for men and 33 percent for women.

Roeseler cited a 2015 model by the Institute of Medicine forecasting the lives of nearly 275,000 Americans born between 2000 and 2019 would be saved by a nationwide tobacco purchase age of 21.

“It’s up to California now, as the largest state in the nation, to do a great job on the implementation of this law and achieve compliance,” Roeseler said. “So what the Department of Public Health is really focusing on now is giving retailers the tools that they need.”

Brantley and the Lung Association, meanwhile, are also working for the passage of Prop 56. The current tax is 87 cents per pack, the 36th-lowest nationally, and has not gone up in 18 years. Tobacco tax initiatives failed in 2006 and 2012.

“There’s a real cost to addiction and using tobacco: a cost on an individual’s life, which is heartbreaking, and a cost on our community, our county, with tobacco-related illness,” Brantley said. “Let’s do what we can to reduce that.”