Local Laws to Raise the Minimum Legal Sale Age for all Tobacco Products 21 Years of Age in the North Country Frequently Asked Questions

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1 Local Laws to Raise the Minimum Legal Sale Age for all Tobacco Products 21 Years of Age in the North Country Frequently Asked Questions It s Time to Clear the Air in the North Country Tobacco use remains the largest cause of preventable diseases and premature death in NYS. As many as 28,000 New Yorkers die as a result of tobacco use each year. The percentage of adult cigarette smokers in the North Country (21.4%) significantly exceeds the national and NYS percentages (15%). Studies show that 95% of smokers begin smoking before the age of 21 and that smokers frequently transition from experimentation to addiction between the ages of 18 and 21. Something can be done to help reduce the high use of tobacco products in the North Country. By raising the minimum legal sale age for all tobacco products to 21 years of age in each county in the North Country, we can take a significant step toward improving the region s health, reducing suffering and premature deaths, and lowering the substantial health care costs required to treat people with tobacco-related conditions. This document attempts to answer the questions that typically arise when communities are considering implementing local laws to increase the sale age for tobacco products to 21 years of age. How Many Young People in the North Country Use Tobacco? Cigarette Smoking Data from the New York State Department of Health show that in 2014 more than 21% of young adults (age 18 to 24) in the North Country smoked cigarettes (compared to 13% of all New Yorkers in that age range). More than 26% of North Country males in this age category smoked cigarettes in 2014 (compared to 15% of all young adult males in NYS). The NYS Department of Health does not report tobacco use by teens by county of residence. However, since research shows that almost all (96%) adult smokers started smoking before they were 21, it is safe to assume that most of the young adult smokers in the North Country were smoking in their teen years. According to the 2015 US Census, there are a total of 58,300 young people between the ages of 0 to 17 years of age residing in the six counties in the North Country region. If cigarette 1

2 smoking rates in these counties remain at current levels, then more than 13,000 of these young people will be cigarette smokers as adults. A study from the Institute of Medicine found that an increase of the minimum legal sale age for tobacco products to 21 will reduce smoking rates by 12%. Raising the sale age in the North Country to 21 would result in approximately 1,575 fewer cigarette smokers among these future smokers. E-Cigarettes According to a recent report from the Surgeon General, tobacco use among teens and young adults in any form, including e-cigarettes, is not safe; nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain. The NYS Department of Health has noted that while cigarette smoking among high school youth in NYS declined significantly between 2006 and 2014, the use electronic nicotine delivery systems (ENDS), which includes e-cigarettes, doubled among NYS high school students between 2014 and 2016 (from 10.5% to 20.6%). This makes electronic nicotine delivery systems the most commonly used tobacco products among teens, surpassing cigarettes, cigars, smokeless tobacco and hookah. What are the health benefits of raising the sale age for tobacco products? The health benefits that would result from raising the sale age to 21 are clear and indisputable. Simply stated, raising the sale age will save lives. The negative impact of tobacco use in the North Country is evidenced by the following: Three of the top five leading causes of premature death in the North Country are cancer, heart disease and chronic lower respiratory diseases; all are closely associated with tobacco use. Between 2012 and 2014, these causes of death resulted in a total of 2,039 premature deaths in the North Country. The incidence rates for lung and bronchus cancer, and lip, oral cavity and pharynx cancer in the North Country exceed the rates for all of New York State. The percentage of preterm births in Franklin and Washington counties, which have large percentages of female smokers, exceed the NYS percentage. A 12% reduction in smoking prevalence resulting from increasing the sale age to 21 (as found by the Institute of Medicine) would have dramatic effect on health. Nationally, an increase in the sale age to 21 would result in: 249,000 fewer premature deaths; 45,000 fewer deaths from lung cancer; 4.2 million fewer lost life-years among Americans born between 2010 and 2019; 286,000 fewer preterm births; 438,000 fewer low-birth-weight babies; and 4,000 fewer cases of sudden infant death syndrome. 2

3 Who supports raising the sale age for tobacco products? In addition to the active support from the more than 35 organizations that are members of the North Country Tobacco Use Task Force (list attached), there is strong support among NYS residents as documented through the 2014 New York State Adult Tobacco Survey which found that 68% of adults in NYS favor increasing the sale age to 21. The majority (60%) of NYS smokers support raising the sale age. Two 2015 national surveys found that 70% to 75% of Americans support raising the sale age. Why should counties be responsible for raising the sale age? Shouldn t this be a statewide initiative? Ideally, New York State will follow Hawaii and California and raise the sale age for tobacco products to 21. Legislation to raise the sale age has been introduced in the New York State Legislature, but the legislation has not come to a vote in the state legislature. The counties in the North Country have the opportunity to play an essential leadership role in New York State that could result in the adoption of a statewide law. Momentum on this issue is building in the state. To date, local laws to increase the minimum legal sale age for tobacco products to 21 have been adopted in New York City, Albany, Cattaraugus, Chautauqua, Cortland, Orange, Schenectady, Suffolk, Sullivan and Tompkins counties. Adding Clinton, Essex, Franklin, Hamilton, Warren and Washington counties to this list would send a powerful message and would greatly add to the momentum for the adoption of a statewide law. Don t people over the age of 18 have a right to make their own decisions about tobacco use? Is smoking a right or is it an addiction resulting in a burden on society? Nicotine is addictive, and adolescents are more susceptible to its effects because their brains are still developing. Tobacco companies know that nearly all users become addicted before age 21 and intentionally market to young people in order to recruit replacement smokers. Increasing the tobacco sale age to 21 will help counter the efforts of the tobacco companies to target young people at a critical time when many move from experimenting with tobacco to regular smoking. Raising the sale age for tobacco products to 21 will not totally eliminate teen tobacco use. However, similar to the experience resulting from the national alcohol sales law, raising the sale age for tobacco will, over time, change societal norms about teen tobacco use. The national law for alcohol sale resulted in reduced alcohol consumption among youth, decreased alcohol dependence, and has led to dramatic reductions in drunk driving fatalities. Increasing the sale age for tobacco will result in reductions in tobacco use, dependence, disease and premature deaths. 3

4 If people under the age of 21 can serve in the military shouldn t they also be allowed to choose to use tobacco? Military leaders recognize the toll tobacco use takes on troop readiness and on the military health care system and are taking steps to reduce tobacco use in the military. Easy access to cigarettes has led to a 33.6% smoking rate among active duty military. Years of studies, including a comprehensive study on 9.3 million military health care beneficiaries, have revealed that lung cancer mortality rates are double among veterans in comparison to non-veterans. In 2014, the US Department of Defense (DoD) issued a memo to all branches of the military stating DoD s goal to dramatically reduce the use of all tobacco by The memo states: Tobacco undercuts military readiness and harms individual performance. Lung function is reduced, physical capabilities are diminished, hearing loss is increased, and acute medical conditions are more likely. Wounded warriors who smoke suffer from increased surgical complications and delayed would healing. Tobacco use costs DoD an estimated $1.6 billion annually in medical costs and lost work time. Raising the sale age to 21 throughout the North Country will support DoD s efforts to reduce tobacco use among military recruits and service members. What will be the impact on revenue for businesses that sell tobacco products? A 2014 study, Retail Impact of Raising Tobacco Sale Age to 21 Years, published in the American Journal of Public Health, found that raising the sale age for tobacco products to 21 would result in a maximum immediate 2% loss of cigarette sales nationwide. The authors of the article argue that, similar to raising the sale age for alcohol, retailers will adjust to the changing market conditions and will not go out of business due to decreased tobacco sales revenue. The authors cite the experience of retailers in Needham, MA, which was the first town in the country to raise the tobacco sale age to 21 years. Survey data showed a 47% reduction in the smoking rate among Needham high school students in the 4 years after the law was implemented in 2006, but even with this sharp decrease in teen smoking rates, no tobacco retailers in Needham have gone out of business in the more than 10 years since the law was implemented. What will be the impact on sale tax revenue for the county? An analysis prepared by the Preventing Tobacco Addiction Foundation showed an immediate minimal decrease of sales tax revenue (0.24% to 0.48%) due to decreased sale of tobacco products resulting from raising the sale age to 21. The loss of sales tax revenue is calculated based on the accepted 12% reduction in tobacco use among 18 to 20 year olds who account for 4

5 between 2.12% and 4.0% of all cigarettes sold in the US. The analysis noted that money not spent on tobacco products is still spent on other products subject to sales tax. Additional tax advantages for counties may result from increasing the sale age to 21. For example, lowering the smoking population among the county s workforce could positively impact income by increasing the number of hours worked that smokers often lose to illnessrelated absence and reduced productivity. This, in turn, could result in greater income tax revenues. Won t people under the age of 21 travel to purchase tobacco products? Research studies have found that making cigarettes as inconvenient and difficult to obtain as possible for youth reduces both the number of young people who try or regularly smoke cigarettes and the number of cigarettes consumed by youth who continue to smoke. The experience of raising the sale age in Needham, MA suggests that teens do not travel to neighboring towns/counties to purchase cigarettes. Raising the sale age in each county in the North Country will also reduce the likelihood that young people will regularly travel to other places to purchase tobacco products. What will be the impact on the county s share of Medicaid expenses? Statewide data indicate that approximately 10% of all Medicaid expenditures are related to treating health conditions caused by tobacco use. The local share of Medicaid costs among the six North Country counties for 2015 totaled more than $60 million; meaning that approximately $6 million of these counties Medicaid costs go to treat tobacco-related conditions on an annual basis. A reduction in tobacco use in the region will result in a decrease in the number of Medicaid beneficiaries needing treatment for tobacco-related conditions over time. Given the many variables that have to be considered, it is not possible to identify, with certainty, the amount of savings each county would realize from raising the sale age to 21. However, it stands to reason that a reduction in smoking rates among a county s population will lead to a reduction in health care costs associated with treating tobacco-related conditions. The potential amount of savings may be illustrated by the following unscientific exercise. Assuming that a 12% decrease in smoking rates from raising the sale age to 21 (as projected by the Institute of Medicine) results in a 12% decrease in the Medicaid local share costs associated with tobacco use, the estimated regional savings in the counties share of Medicaid costs would be approximately $720,000 (based on 2015 amounts). The potential savings for each county would be as follows: 5

6 County Medicaid Local Share for Tobacco-Related Costs (10% of Total Local Share) Local Share Reduction due to 12% Reduction in Tobacco Use Clinton $1,793,790 $215,255 Franklin $1,032,380 $123,885 Essex $693,730 $83,250 Hamilton $66,375 $7,965 Warren $1,259,150 $151,100 Washington $1,160,870 $139,305 TOTAL $6,006,295 $720,760 What does a local law raising the sale for all tobacco products do? A local law that raises the minimum legal sale age for all tobacco products to 21 years of age prohibits the sale of tobacco products to anybody under the age of 21 by any person operating a place of business where tobacco products are sold. The law does NOT prohibit the possession or use of tobacco products by people under the age of 21. What should be included in a local law that raises the sale age? A strong local law that raises the minimum legal sale age for tobacco products would include the following elements: a comprehensive list of all tobacco and smoking-related products that are prohibited from sale to people under 21. This list should include: cigarettes, cigars, chewing tobacco, powdered tobacco, shisha, bidis, gutka, herbal cigarettes, liquid nicotine, snuff, electronic cigarettes, rolling papers, pipes, other smoking paraphernalia (e.g. hookah, water pipe, vaporizer) and other products which are prohibited from being sold the minors by NYS Public Health Law Article 13-F; a requirement that the purchaser demonstrates through a driver s license or other photographic identification card issued by a government agency or educational institution that the purchaser is at least 21 years of age; a requirement that businesses where prohibited products are sold post a sign in a conspicuous place that contains information about the minimum age requirement for the purchase of such items; authority for the county to inspect businesses for compliance with the law; and laws may impose a civil penalty upon a person who violates the law. 6

7 How will the local law be enforced? Generally, enforcement is the responsibility of the county s Board of Health. If a county does not have a board of health the county legislature or board of supervisors can designate a county officer to be in charge of enforcement. The law can give the enforcement entity the authority to conduct random inspections of locations where prohibited items are sold and/or to investigate complaints regarding violations of the law. For information about the specific language that has been included in local laws by NYS counties that have raised the sale age for tobacco products, please send an to the Population Health Improvement Program at AHI at phip@ahihealth.org. 7