Transcript Slide 1

Tobacco Control Policies:
The National Picture
and where Virginia stands
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
THE TRIFECTA
Program
Funding
Tobacco Taxes
TOBACCO EXCISE TAXES
• A win for public health
• A win for state budgets
• A win among voters
Total Cigarette Prices and Cigarette Sales
$4.25
30000
Sales (million packs)
$3.25
26000
$2.75
24000
22000
$2.25
20000
$1.75
18000
$1.25
1970
1973
1976
1979
1982
1985
1988
1991
Year
Sales
Price
1994
1997
2000
2003
2006
Price (Jan. 2007 dollars)
$3.75
28000
Cigarette Pack Price Trend vs. Youth Smoking
Prevalence, 1991-2007
Youth Smoking Prevalence
40%
34.8%
36.4%
Cigarette Pack Price (in 2007 dollars)
$4.19
34.8%
35%
27.5%
$4.00
$3.50
28.5%
$3.00
25%
20%
$3.93
$3.65
30.5%
30%
$4.50
$3.97
21.9%
20.0%
$2.71
$2.64
$2.39
$2.33
23.0%
$2.39
$2.50
$2.00
15%
$1.50
10%
$1.00
5%
$0.50
0%
$0.00
1991
1993
1995
1997
1999
2001
2003
2005
2007
Sources: Tax Burden on Tobacco, 2007; Youth Behavioral Risk Surveillance System, 2007; U.S. Bureau of Labor Statistics.
Calls to Wisconsin Tobacco Quit Line Break All Records
Date Posted: February 28, 2008
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.
As February winds down, the Wisconsin Tobacco Quit Line
“This unprecedented
successthat
in assisting
1-800-QUIT-NOW
today announced
in the Wisconsin
first two smokers
monthsthrough
of 2008
it has
breaks all
previous
state records,” said 20,000
Dr. Michael
Fiore,
director
of the University of
fielded
a record-breaking
calls
from
Wisconsinites
Wisconsin
Centerfor
for Tobacco
and this
Intervention,
whichduring
manages
the quit line.
looking
help to Research
quit. To put
in context,
a typical
“National peers who provide quit services in other states report they have never before
year, the quit line provides services to about 9,000 state
seen such a successful state effort to help smokers quit.”
residents.
Three factors led to this increase in quit attempts by Wisconsin smokers:
•
•
•
A $1 increase in the state’s tobacco excise tax
New Year’s resolutions
Free coaching and medication provided through the Wisconsin
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.
Cigarette Tax Rates, December 2009
(cents per pack)
State Average: $1.34 Per Pack
VA
ranks
49th
WASHINGTON
202.5
MONTANA
170
OREGON
NORTH DAKOTA
44
156
IDAHO
118
57
WYOMING
64
UTAH
87
COLORADO
84
CALIFORNIA
ARIZONA
200
200
136
KANSAS
MISSOURI
79
17
OKLAHOMA
ARKANSAS
103
115
91
98
TEXAS
200
HAWAII
260
141
160
36
IN
125
99.5
WV
55
KENTUCKY
60
TENNESSEE
62
MS
ALASKA
PENNSYLVANIA
OHIO
ILLINOIS
NEW MEXICO
275
MICHIGAN
IOWA
NEBRASKA
NEVADA
69.5
NEW YORK
252
153
60
80
VT
WISCONSIN
SOUTH DAKOTA
68
States that have recently passed or
implemented a cigarette tax increase
(since 1999)
NH
NH: 178
MA
MA:251
CT
RI:346
CT:300
NJ:270
DELAWARE:160
MARYLAND:200
VIRGINIA
DC:250
45
SOUTH
CAROLINA
7
37
LOUISIANA
FLORIDA
133.9
States that have not passed tax
increases since 1999
200
30
NORTH CAROLINA
ALABAMA GEORGIA
42.5
MAINE
VT:224
MINNESOTA
The Virginia Tax Experience
From 2.5¢ to 20¢ on 9/1/04; from 20¢ to 30¢ on 7/1/05
800
Packs Sold
Revenues Collected
- 15.6%
+ 968.9%
719.6
million
617.6
million
700
$172.1
million
$200
597.2
million
600
$150
$111.6
million
500
400
$100
300
200
$50
100
0
$16.1
million
$0
FY 2004
FY 2005
FY 2006
Orzechowski & Walker, The Tax Burden on Tobacco, 2009
FY 2004
FY 2005
FY 2006
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
Federal Cigarette Excise Tax + Average
State Cigarette Tax
$2.50
Federal Cigarette Tax
State Cigarette Tax
$2.00
federal rate ($1.01)
+ current state
average ($1.34):
$2.35 per pack
$1.50
1996 federal rate (24¢)
+ state average (33¢):
57¢ per pack
$1.00
$0.50
$0.00
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
November 2009
Despite more states taxing all
tobacco products…
There is still a big discrepancy between
tax rates for OTPs and cigarettes
Smoke-Free
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
Smoke-Free Restaurant and Bar Laws
VA’s 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
Percent of Population Covered By
Smoke-Free Laws (Including Bars)
2010: 62%
28 states and hundreds of
communities are smoke-free
70%
60%
11/27/2002: 13%
DE becomes 2nd
smoke-free state
50%
40%
1/1/1998: 12%
CA becomes 1st
smoke-free state
30%
20%
1996: < 1%
Smoke-free laws in 13
communities nationwide
10%
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
0%
Includes state and local laws passed by March 15, 2010
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.
• Number of states with no law addressing restaurants and bars: 11 (15% of the population
NOT covered by statewide law)
– Alabama, Alaska, Indiana, Kansas, Kentucky, Mississippi, Missouri, South Carolina, Texas, West
Virginia, Wyoming
Funding for Tobacco
Prevention
Evidence Base
.
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.
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.
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
Best Practices 2007
• State and Community
Interventions
• Media Interventions
• Cessation Interventions
• Surveillance/Evaluation
• Administration/Management
FY2010 Funding for State
Tobacco Prevention Programs
ND is only state to meet
CDC Recommendation
WASHINGTON
MONTANA
OREGON
NORTH
DAKOTA
MAINE
MINNESOTA
VT
IDAHO
MICHIGAN
WYOMING
NEBRASKA
NEVADA
UTAH
KANSAS
ARIZONA
IOWA
ILLINOIS
COLORADO
CALIFORNIA
NH
MA
NEW YORK
CT RHODE
ISLAND
PENNSYLVANIA NEW JERSEY
WISCONSIN
SOUTH DAKOTA
OKLAHOMA
NEW MEXICO
MISSOURI
IN
OHIO
WV
KENTUCKY
TENNESSEE
VIRGINIA
NORTH CAROLINA
SOUTH
CAROLINA
ARKANSAS
MS
ALABAMA
DELAWARE
WASHINGTON, DC
MARYLAND
GEORGIA
VA
ranks
32nd
TEXAS
LOUISIANA
ALASKA
HAWAII
FLORIDA
States that are spending 50% or more of CDC
recommendation on tobacco prevention
programs.
States that are spending 10% - 24% of CDC
recommendation on tobacco prevention
programs.
States that are spending 25% - 49% of CDC
recommendation on tobacco prevention
programs.
States that are spending less than 10% of CDC
recommendation on tobacco prevention
programs.
December 2009
History of Tobacco Prevention Funding
in Virginia (State Dollars)
(in millions)
$25
$22.2
$19.2
$20
$15
$17.4
$13.1 $12.6
$13.0 $12.8 $13.5
$14.5
$12.7 $12.3
$10
$5
$0
FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10
Virginia: Tobacco Money for Tobacco
Prevention, FY 2010
$350
$307
Million
$300
$134 Million
Estimated Tobacco
Settlement Revenues
$250
$173 Million
Estimated Tobacco
Tax Revenues
$200
$150
$103.2 Million
$100
$50
$13.4 Million
$0
Total State Tobacco
Revenues
CDC Recommended
Annual Investment
Actual State Tobacco
Prevention Spending
Virginia’s Tobacco Control Spending vs.
Tobacco-Related Healthcare Cost
$2.08 Billion
$2,000
$1,500
$1,000
$500
$13.4 Million
$0
Tobacco Control Spending
Tobacco-Related Healthcare Costs
Virginia’s Tobacco Control Spending vs.
Tobacco Industry’s Marketing Spending
$450
$411.3 Million
$300
$150
$13.4 Million
$0
Tobacco Control Spending
Tobacco Industry Marketing Spending
U.S. Cigarette Advertising and
Promotional Expenditures 1996 - 2006
(thousands of dollars)
$15.15
Billion $14.15
Billion
$16,000,000
$14,000,000
$12.47
Billion
All Others
$13.11
Billion $12.49
Billion
$11.22
Billion
$12,000,000
$8.24
Billion
$6.73
$5.66 Billion
$5.10 Billion
$6,000,000
Billion
Internet
Direct Mail
$7.9b
$8,000,000
Coupons*
Telephone
$9.59
Billion
$10,000,000
Retail Value Added
price
discount
$10.8b
$10.9b
price
price
discount discount
$9.8b
$9.2b
price
discount
price
discount
Sponsorships
Public Entertainment
Specialty Item Dist.
Sampling Dist.
Promotional Allowance
Point of Sale
$4,000,000
Transit
Outdoor
$2,000,000
Magazines
Newspapers
$0
1996 1997
1998 1999
2000
2001 2002
* Before 1997, Coupons and Retail Value Added were combined into one category.
Source: Federal Trade Commission Cigarette Report for 2006
2003 2004
2005 2006
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 VA’s cigarette tax rate by just a nickel
would generate more than enough revenue to offset a
15% decrease in funding.
Federal Activities
• Stimulus Funds
• Health Care Reform
• FDA regulation
Stimulus Bill Provides Funding Opportunity
for Tobacco Control
$400
$373 Million
$350
$300
Millions
$250
$200
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.
$150
$100
$45 Million
$50
$30 Million
$44.5 Million
$0
Community
Initiative
State Noncompetitive
* $5.5 million will support national quitline efforts
State Competitive
State Quitlines
Health Care Reform
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.
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
FDA Regulation of
Tobacco:
What Does it Mean?
What Happens Now?
15 YEARS IN THE MAKING

79 – 17
Senate Vote (June 11)

307 -- 97
House Vote (June 12)
June 22, 2009
Key Substantive Elements
1. Require the Industry to provide
information to the Gov’t that allows Gov’t
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
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
Limitations on FDA Authority
• FDA can’t 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.
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
44
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-background restriction
goes into effect);
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.
Implementation
3 months:
•No candy-flavored cigarettes
47
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
48
Implementation
In the slightly longer term….
• Larger, stronger graphic warning labels on
cigarettes
-- Rule issued within two years
-- Implementation – 15 months later
49
Cigarette pack now
Cigarette pack under
FDA Regulation
Front
Front
WARNING
LABEL
WARNING
LABEL
Back
Back
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
51
Magazine Ad for Camel No. 9 Stiletto, Fall 2007
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 smoker[s] and
inhaler[s]”
* Suggests 100 mm "to facilitate
lighting”
* “Reasonably firm" rod
“[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
Challenges to the Law:
Court 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
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
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
For more information
www.tobaccofreekids.org
Amy Barkley
Director, Tobacco States and Mid-Atlantic
[email protected]
502-777-8148