Tobacco Control Policies: The National Picture and where Virginia stands

1. Tobacco Control Policies:The National Pictureand where Virginia stands

2. Evidence-Based Tobacco Control • Tobacco Taxes • Smoke-free Laws • Comprehensive Prevention & Cessation Programs • Limits on Industry Behavior (e.g., FDA) TOBRINGABOUT • Social & Environmental Change

3. THE TRIFECTA Smoke-Free Tax Program Funding

4. Tobacco Taxes

5. TOBACCO EXCISE TAXES • A win for public health • A win for state budgets • A win among voters

7. Cigarette Pack Price Trend vs. Youth Smoking Prevalence, 1991-2007 Sources: Tax Burden on Tobacco, 2007; Youth Behavioral Risk Surveillance System, 2007; U.S. Bureau of Labor Statistics.

8. Calls to Wisconsin Tobacco Quit Line Break All RecordsDate Posted:  February 28, 2008As 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. “This unprecedented success in assisting Wisconsin smokers through 1-800-QUIT-NOW breaks all previous state records,” said Dr. Michael Fiore, director of the University of Wisconsin Center for Tobacco Research and Intervention, which manages the quit line. “National peers who provide quit services in other states report they have never before seen such a successful state effort to help smokers quit.” 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 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.

9. Impact of Federal Tobacco Tax Increase Statistics: Call volume to 17 states (tobacco users registered): Source: Free and Clear, Inc.

10. Cigarette Tax Rates, December 2009(cents per pack)State Average: $1.34 Per Pack VA ranks 49th WASHINGTON 202.5 MONTANA 170 MAINE 200 NORTH DAKOTA 44 VT:224 MINNESOTA 156 OREGON 118 VT IDAHO 57 NH NH: 178 WISCONSIN 252 SOUTH DAKOTA 153 NEW YORK 275 MA MA:251 WYOMING 60 MICHIGAN 200 CT RI:346 CT:300 IOWA 136 PENNSYLVANIA 160 NJ:270 NEBRASKA 64 NEVADA 80 OHIO 125 DELAWARE:160 UTAH 69.5 IN 99.5 ILLINOIS 98 WV 55 MARYLAND:200 30 VIRGINIA COLORADO 84 KANSAS 79 MISSOURI 17 87 DC:250 KENTUCKY 60 CALIFORNIA 45 NORTH CAROLINA TENNESSEE 62 OKLAHOMA 103 ARKANSAS 115 ARIZONA 200 NEW MEXICO 91 SOUTH CAROLINA 7 GEORGIA 37 ALABAMA 42.5 MS 68 TEXAS 141 36 LOUISIANA ALASKA 200 HAWAII 260 FLORIDA 133.9 States that have not passed tax increases since 1999 States that have recently passed or implemented a cigarette tax increase (since 1999)

11. The Virginia Tax ExperienceFrom 2.5¢ to 20¢ on 9/1/04; from 20¢ to 30¢ on 7/1/05 Packs Sold Revenues Collected - 15.6% + 968.9% Orzechowski & Walker, The Tax Burden on Tobacco, 2009

12. 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

13. Federal Cigarette Excise Tax + Average State Cigarette Tax federal rate ($1.01) + current state average ($1.34): $2.35 per pack 1996 federal rate (24¢) + state average (33¢): 57¢ per pack November 2009

14. Despite more states taxing all tobacco products… There is still a big discrepancy between tax rates for OTPs and cigarettes

15. Smoke-Free

16. 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

17. 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

18. Percent of Population Covered By Smoke-Free Laws (Including Bars) 2010: 62% 28 states and hundreds of communities are smoke-free 11/27/2002: 13% DE becomes 2nd smoke-free state 1/1/1998: 12% CA becomes 1st smoke-free state 1996: < 1% Smoke-free laws in 13 communities nationwide Includes state and local laws passed by March 15, 2010

19. 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. • NorthDakota – 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. • SouthDakota – 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

20. Funding for Tobacco Prevention

21. Evidence Base .

22. 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.

23. 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.

24. 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

25. Best Practices 2007 • State and Community Interventions • Media Interventions • Cessation Interventions • Surveillance/Evaluation • Administration/Management

26. ALASKA FY2010 Funding for State Tobacco Prevention Programs ND is only state to meet CDC Recommendation WASHINGTON MAINE NORTH DAKOTA MONTANA MINNESOTA OREGON VT NH IDAHO WISCONSIN SOUTH DAKOTA MA NEW YORK MICHIGAN CT WYOMING RHODE ISLAND IOWA PENNSYLVANIA NEW JERSEY NEBRASKA NEVADA OHIO DELAWARE IN UTAH ILLINOIS WASHINGTON, DC WV MARYLAND COLORADO KANSAS MISSOURI VIRGINIA CALIFORNIA KENTUCKY NORTH CAROLINA TENNESSEE OKLAHOMA VA ranks 32nd ARIZONA ARKANSAS SOUTH CAROLINA NEW MEXICO GEORGIA MS ALABAMA TEXAS LOUISIANA HAWAII FLORIDA States that are spending 50% or more of CDC recommendation on tobacco prevention programs. States that are spending 25% - 49% of CDC recommendation on tobacco prevention programs. States that are spending 10% - 24% of CDC recommendation on tobacco prevention programs. States that are spending less than 10% of CDC recommendation on tobacco prevention programs. December 2009

27. History of Tobacco Prevention Fundingin Virginia (State Dollars)(in millions)

28. Virginia: Tobacco Money for Tobacco Prevention, FY 2010 $307 Million $134 Million Estimated Tobacco Settlement Revenues $173 Million Estimated Tobacco Tax Revenues $103.2 Million $13.4 Million

29. Virginia’s Tobacco Control Spending vs. Tobacco-Related Healthcare Cost $2.08 Billion $13.4 Million

30. Virginia’s Tobacco Control Spending vs. Tobacco Industry’s Marketing Spending $411.3 Million $13.4 Million

31. U.S. Cigarette Advertising and Promotional Expenditures 1996 - 2006(thousands of dollars) $15.15 Billion $14.15 Billion $13.11 Billion $12.47 Billion $12.49 Billion * $11.22 Billion $9.59 Billion $8.24 Billion $10.8bprice discount $10.9bprice discount $9.8b price discount $9.2b price discount $7.9b price discount $6.73 Billion $5.66 Billion $5.10 Billion * Before 1997, Coupons and Retail Value Added were combined into one category. Source: Federal Trade Commission Cigarette Report for 2006

32. 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.

33. Federal Activities • Stimulus Funds • Health Care Reform • FDA regulation

34. Stimulus Bill Provides Funding Opportunity for Tobacco Control $373 Million 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. $45 Million $44.5 Million $30 Million * $5.5 million will support national quitline efforts

35. Health Care Reform

36. 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.

37. 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

38. FDA Regulation of Tobacco: What Does it Mean? What Happens Now?

39. 15 YEARS IN THE MAKING • 79 – 17 Senate Vote (June 11) • 307 -- 97 House Vote (June 12)

40. June 22, 2009

41. Key Substantive Elements • Require the Industry to provide information to the Gov’t that allows Gov’t to better inform consumers • Restrict marketing that appeals to kids, misleads adults, deceptively encourages tobacco use and discourages quitting • Strengthen restrictions on sales to youth

42. 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

43. 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.

44. 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

45. 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);

46. 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.

47. Implementation • 3 months: • No candy-flavored cigarettes 47

48. 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 Implementation 48

49. Implementation • In the slightly longer term…. • Larger, stronger graphic warning labels on cigarettes • -- Rule issued within two years • -- Implementation – 15 months later 49

50. WARNING LABEL WARNING LABEL Cigarette pack under FDA Regulation Cigarette pack now Front Front Back Back