9.c Tobacco 21 presentation_Am Lung AssociationPresenters
Liz Heimer
Specialist, Health Promotion
American Lung Association in MN
Alex Dusek
Specialist, Health Promotion
American Lung Association in MN
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Vision
A world free from
lung disease
Mission
To save lives by
improving lung health
and preventing lung
disease
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▪95% of current smokers started before
the age of 21
▪Having the first cigarette by age 18 makes
it twice as likely to become a lifelong
smoker
▪1 in 3 high school students have used
tobacco in the past month
The Problem
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Source: MDH MYTS
2017
Teens Statewide
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Source: MDH MYTS
2017
Teens Statewide
Key Findings:
2018 National Youth Tobacco Survey
➢78% increase in e-cigarette use among high school
students between 2017 and 2018.
➢48% increase in e-cigarette use among middle school
students between 2017 and 2018.
➢E-cigarette use surge led to uptick in overall tobacco use,
reverses previous declines.
Flavors Hook Kids
2018 California Department of Public Health www.flavorshookkids.org
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•99.0% of disposable e-cigarettes
•99.7% of rechargeable e-cigarettes
•98.8% of refill sales
Percentage of products that contain
nicotine:
•99.0% of all e-cigarettes products
•98.7% of flavored e-cigarettes
•99.4% of nonflavored e-cigarette products
Percentage that contained nicotine by
product type:
E-cigarettes
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Heroin
Cocaine
Dopamine Pleasure, appetite suppression
Arousal, appetite suppression
Arousal, cognitive enhancement
Memory improvement
Mood modulation, appetite suppression
Reduction of anxiety and tension
Norepinephrine
Acetylcholine
Vasopressin
Serotonin
Beta-endorphin
Nicotine
Epinephrine Adrenaline
The Brain and Nicotine
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Nicotine Addiction and Youth
•Brain development
continues until mid-20s
–Decision making
–Impulse control
–Sensation seeking
–Peer Pressure
•Nicotine primes the
adolescent brain for
future addictions
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The Solution
2009 Family Smoking Prevention & Tobacco Control Act
•Set a federal minimum age at 18 and gave states authority to
have stronger regulations
•Called for a study on
the implications of raising
the minimum sale age
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IOM, 2015
Policy Impact on Initiation
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Needham Case History
•Surrounded by cities in
West-Metro Boston
•Youth can literally walk
across the street and be
in another city
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Needham High School Smoking
Rates
Kessel, S. et al, 2015
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•Chicago reported a 36%
decrease in cigarette
and e-cigarette use
rates among 18 –20
year-olds, from 15.2% in
2016 to 9.7% in 2017.
•In California, statewide
retailer violation rates
to under 18 year-olds
decreased from 10.3%
to 5.9% after
implementation of T21
Current Findings
Chicago DPH, 2018; Zhang. et al, 2018
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Changing the Trend
“Tobacco 21 works by
putting the legal
purchasers outside the
social circles of most high
school students, making
it more difficult for 15 to
17 year-olds to pass as
legal purchasers or have
legal purchasers as a
friend.”
Rob Crane, MD
President
Preventing Tobacco Addiction Foundation
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Tobacco21
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20Promoff, CDC Summer Styles Survey, 2014Winickoff et al, 2015. Social Climate Survey of Tobacco Control.
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Favorability toward Raising the
Legal Minimum Sales Age
King et al, 2015. CDC Summer Styles Survey.
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64.8%
73.2%77.0%
81.4%
35.2%
26.8%23.0%
18.6%
Age 18 - 24 Age 25 - 44 Age 45 - 64 Age 65+
Favo r Opp ose
Favorability toward Raising the
Legal Minimum Sales Age
King et al, 2015. CDC Summer Styles Survey.
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Tobacco 21 Endorsements
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Estimate
Excess Absenteeism $517
Presenteeism $462
Smoke Breaks $3,077
Excess Health Care Costs $2,056
Pension Benefit (if provided)($296)
Total Costs $5,816
Total Annual Excess Cost of a Smoker
to a Private Employer
Berman, M. et al, 2014.
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Common Concerns
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•We want a military force that is physically
ready, and tobacco use impairs that
readiness.
•There are several legal safeguards in
place to protect the health and safety of
our young people –e.g. the drinking age.
National Academy of Medicine, Combating Tobacco in Military and
Veteran Populations, 2009.
“If someone can join the
military at 18, shouldn’t
they be able to buy
tobacco?”
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Tobacco21
The Department of
Defense and every branch
of the Armed Services has
stated a goal of a tobacco-
free military and supports
Tobacco21 policies.
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•Tobacco 21 makes it more difficult for
youth to get tobacco from social sources.
•75% of smokers ages 15-17 get tobacco
from social sources.
•High school students are less likely to be
around a 21-year-old than an 18-year-
old.
“Won’t youth find
ways to get tobacco
regardless of what
we do?”
PATH Study, 2016; Ahmad, S. 2005
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“Will Tobacco 21
hurt our local
stores and
decrease city
sales tax
revenue?”
•18-20-year-olds make up roughly 2-4% of the
tobacco market but are the primary/important
source of underage smokers.
•The goal of T21 is to save kids from a lifetime
of addiction and disease.
Winickoff et. al. 2014.
Star Tribune, 2017
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Since Needham, MA passed in 2005
they’ve seen a 47% decrease in youth
tobacco rates. This decrease did not
occur in neighboring cities where legal
sale age is 18.
“Won’t people just
go to neighboring
towns/cities?”
tobacco21.org, 2017
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•Minnesota has a strong history of local
government acting to protect the health of their
communities before the state legislature takes
action.
•Many communities are leaders in addressing
public health concerns and promoting citizen
well-being. They shouldn’t have to wait for the
state to act. Our kids need protection now.
“Shouldn’t this
be done at the
state level?”
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21Components:
•Strong definition of Tobacco Products, including e-cigarettes
•Setting the SALE age at 21
•Enforcement
•Tobacco Retail License
•Health Department
•Systematic Compliance Checks of All Retailers
•Penalty on Retailer
•Minimum of $300, graduated, ability to suspend or revoke license
•Removal of PUP language –Possession, Use and Procurement.
•No penalty for youth
•Age Verification
•Signage
•Education of Retailers
•Effective Date
TCLC, 2016.
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Penalties against Youth and Young
Adults •Increasing the sales age is
NOT about punishing our
kids and can cause a ripple
effect of harm.
•The tobacco industry
systematically targets our
youth and work to preserve
the penalties.
•Removing penalties has
become the standard in
communities across the state.
•There is no evidence that
penalties reduce youth
tobacco use.
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“If a man has never
smoked by age 18, the
odds are three-to-one he
never will. By age 24, the
odds are twenty-to-one.”
RJ Reynolds, “Estimated Change
in Industry Trend Following
Federal Excise Tax Increase,”
September 10, 1982
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Contact
Alex Dusek
American Lung Association in Minnesota
Alexandra.Dusek@Lung.org
Liz Heimer
American Lung Association in Minnesota
Liz.Heimer@Lung.org