BILL ANALYSIS Ó ABX2 9 Page 1 Date of Hearing: August 25, 2015 ASSEMBLY COMMITTEE ON PUBLIC HEALTH AND DEVELOPMENTAL SERVICES Rob Bonta, Chair ABX2 9 (Thurmond) - As Introduced July 16, 2015 SUBJECT: Tobacco use programs. SUMMARY: Clarifies charter school eligibility for tobacco use prevention program (TUPE) funds; requires the California State Department of Education (CDE) to require all school districts, charter schools, and county offices of education receiving TUPE funds to adopt and enforce a tobacco-free campus policy; prohibits the use of tobacco and nicotine products in any county office of education, charter school, or school district-owned or leased building, on school or district property, and in school or district vehicles; and, requires all schools, districts, and offices of education to post a sign reading "Tobacco use is prohibited" at all entrances. EXISTING LAW: 1)Levies a $0.25 tax on each pack of cigarettes sold in the state through Proposition 99 approved by the California voters in the November 1988 General Election. 2)Establishes the Tobacco Education and Research Oversight Committee (TEROC) charged with overseeing the use of ABX2 9 Page 2 Proposition 99 tobacco tax revenues for tobacco control and prevention education and for tobacco-related research. TEROC provides advice to the State Department of Health Care Services and CDE with respect to policy development, integration, and evaluation of tobacco education programs. 3)Specifies the duties of CDE with respect to tobacco programs administered by local public and private schools, school districts, and county offices of education and requires CDE to award and administer grants for projects directed at the prevention of tobacco use among school age children. 4)Requires all school districts and county offices of education that receive grant funds to provide tobacco-use prevention instruction that addresses all of the following topics: a) Immediate and long-term undesirable physiologic, cosmetic, and social consequences of tobacco use; b) Reasons that adolescents say they smoke or use tobacco; c) Peer norms and social influences that promote tobacco use; and, d) Refusal skills for resisting social influences that promote tobacco use. 5)Requires all school districts and county offices of education that receive funds to adopt and enforce a tobacco-free campus policy which prohibits the use of tobacco products at any time, in district-owned or leased buildings, on district property and in district vehicles. ABX2 9 Page 3 6)Specifies that any school district or county office of education that does not have a tobacco-free district policy is not eligible to apply for funds. 7)Permits a charter school that elects to receive its funding directly to apply individually for federal and state categorical programs to the extent it is eligible for funding and meets the provisions of the program. 8)Permits a charter school that does not elect to receive its funding directly, to, in cooperation with its chartering authority, apply for federal and state categorical programs to the extent it is eligible for funding and meets the provisions of the program. FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee. COMMENTS: 1)PURPOSE OF THIS BILL. According to the author, by mandating tobacco-free campuses and by updating tobacco definitions to include smokeless tobacco and e-cigarettes, this bill will create schools that protect students from tobacco and provide school personnel a smoke-free environment. The author states that only 607 local educational agencies (LEAs) receive TUPE funds, leaving 1,207 LEAs with no obligation to ban tobacco on their campuses. The author points to information from TEROC which shows the number of school districts with a tobacco-free certification has decreased, and also notes that funding for TUPE has decreased over time, rendering a further disincentive to schools to create tobacco-free policies. The author ABX2 9 Page 4 concludes this bill will help reduce tobacco use among our youth by ensuring adult role models do not use tobacco, limiting youth access to tobacco, and discouraging groups from using tobacco on school grounds. 2)BACKGROUND. a) Proposition 99. In November 1988, California voters approved the California Tobacco Health Protection Act of 1988, also known as Proposition 99. This initiative increased the state cigarette tax by $0.25 per pack and added an equivalent amount on other tobacco products. The new revenues were earmarked for programs to reduce smoking, to provide health care services to indigents, to support tobacco-related research, and to fund resource programs for the environment. The money is deposited by using the following formula: 20% is deposited in the Health Education Account (HEA); 35% in the Hospital Services Account; 10% in the Physician Services Account; 5% in the Research Account; 5% in the Public Resources Account; and, 25% in the Unallocated Account (funds in this account are available for appropriation by the Legislature). b) Tobacco prevention in schools. The HEA funds both community and school-based health education programs to prevent and reduce tobacco use and is jointly administered by the California Tobacco Control Program (CTCP) and CDE. Currently, CTCP receives approximately two-thirds of the funding and CDE receives approximately one-third of the funding available in the HEA. CDE administers school-based funding to grades 4 to 8 based on an allocation method and to high schools through competitive grants that go directly to school districts and charter schools. LEAs, including school districts, county offices of education, and directly-funded charter schools apply directly for TUPE grant funding. Locally-funded charter schools must apply ABX2 9 Page 5 for TUPE funding through its chartering authority. These competitive grants are funded in two tiers. The first tier of funding is $1,500 per year for three years and goes to school districts and charter schools that establish a tobacco-free school policy, complete the healthy kids survey, and post tobacco free signs on the school property. The second tier of funding is for school districts and charter schools that comply with the requirements under tier one, in addition to implementing a more comprehensive tobacco-free school policy including cessation programs and school curriculum. CDE uses Proposition 99 funds to administer TUPE which provides grants to local education agencies as an incentive to implement and enforce tobacco-free campus policies. c) Smoking and youth. California monitors smoking rates among high school students using the California Student Tobacco Survey (CSTS). The 2012 survey showed the percentage of California high school students who reported smoking a cigarette within the previous 30 days was 10.5%, or 297,000 students. Smoking among high school students in California is declining consistently and is lower than for the rest of the United States. Student smoking rates declined 51% from 2000 to 2012; however, there are substantial differences in student smoking prevalence when examined by race or ethnicity. While rates declined for non-Hispanic whites, Hispanics, and Asian/Pacific Islanders, the rate for African-Americans increased by 15.9% over this same time period. d) Health effects of smoking. Smoking is a major cause of many deadly health problems heart disease, aneurysms, bronchitis, emphysema, and stroke. Using tobacco can damage a womans reproductive health and hurt babies. Tobacco use is linked with reduced fertility and a higher ABX2 9 Page 6 risk of miscarriage, early delivery (e)premature birth), and stillbirth. It's also a cause of low birth-weight in infants and has been linked to a higher risk of birth defects and sudden infant death syndrome. Smoking causes 80% of all deaths from chronic obstructive pulmonary disease, and causes stroke and coronary heart disease, the leading causes of death in the United States. Smokers are 30 to 40% more likely to develop type 2 diabetes than nonsmokers, and people with diabetes who smoke are more likely than nonsmokers to have trouble with insulin dosing and with controlling their disease. Smoking causes more than 480,000 deaths each year in the U.S., or about one in five. The average annual smoking-attributable mortality rate in California for the years 2000-04 was 235 per 100,000. The range across states is 138.3 per 100,000 to 370.6 per 100,000. California ranks 6th lowest per capita among all 50 states in deaths attributed to smoking. If nobody smoked it would prevent one of every three cancer deaths in the United States from happening. 3)SUPPORT. The California Medical Association, the Service Employees International Union, the Association of Northern California Oncologists, the Medical Oncology Association of Southern California, the American Lung Association, and others state in support of the bill that it protects students, staff and visitors from the harmful effects of tobacco by requiring that all LEAs adopt and enforce tobacco-free policies on their campuses. Supporters further state that only school districts that receive TUPE funding are required to implement 100% tobacco free policies and that requiring all LEAs to adopt 100% tobacco-free campus policies and by expanding the definition of tobacco products ton include electronic cigarettes, snuff, chew, and other nicotine delivery services, student health will be improved. ABX2 9 Page 7 The First 5 Association of California, the American Heart Association, and the California Dental Association all state in support of this bill, that schools that consistently enforce tobacco-free policies have shown decreased rates of smoking among their students. Supporters argue that evidence shows that comprehensive school-based programs that include tobacco free policies, combined with community and mass-media efforts, can effectively prevent or postpone the onset of smoking by 20 to 40% among U.S. teens. 4)RELATED LEGISLATION. a) SBX2 8 (Liu) is substantially similar to this bill. SBX2 8 was heard in the Senate Committee on Public Health and Developmental Disabilities on August 19, 2015 and passed out with a vote of 9 to 3. SBX2 8 is currently pending in the Senate Appropriations Committee. b) SBX2 5 (Leno) and ABX2 6 (Cooper) define the term smoking for purposes of the Stop Tobacco Access to Kids Enforcement (STAKE) Act; expand the definition of a tobacco product to include e-cigarettes and extends current restrictions and prohibitions against the use of tobacco products to e-cigarettes. Extend current licensing requirements for manufacturers, importers, distributors, wholesalers, and retailers of tobacco products to e-cigarettes. SBX2 5 was heard in the Senate Committee on Public Health and Developmental Disabilities on August 19, 2015 and passed out on a vote of 9 to 3. SBX2 5 is currently pending in the Senate Committee on Appropriations. ABX2 6 is set to be heard on August 25th in this Committee. ABX2 9 Page 8 c) SBX2 6 (Monning) and ABX2 7 (Stone) prohibit smoking in owner-operated businesses and remove specified exemptions in existing law that allow tobacco smoking in certain workplaces. SBX2 6 was heard on August 19, 2015 in the Senate Committee on Public Health and Developmental Disabilities and passed on a 9 to 2 vote. SBX2 6 is currently pending in the Senate Appropriations Committee. ABX2 7 is set for hearing on August 25th in this Committee. d) SBX2 7 (Ed Hernandez) and ABX2 8 (Wood) increase the minimum legal age to purchase or consume tobacco from 18 to 21. SBX2 7 was heard on August 19, 2015 in the Senate Committee on Public Health and Developmental Disabilities and passed on a 9 to 3 vote. SBX2 7 is currently pending in the Senate Appropriations Committee. ABX2 8 is set for hearing on August 25th in this Committee. e) SBX2 9 (McGuire) and ABX2 10 (Bloom) allow counties to impose a tax on the privilege of distributing cigarettes and tobacco products. SBX2 9 was heard on August 19, 2015 in the Senate Committee on Public Health and Developmental Disabilities and passed with a vote of 9 to 2 and is currently pending in the Senate Appropriations Committee. ABX2 10 is set for hearing on August 25th in this Committee. f) SBX2 10 (Beall) and ABX2 11 (Nazarian) revise the Cigarette and Tobacco Products Licensing Act of 2003 to change the retailer license fee from a $100 one-time fee to a $265 annual fee, and increase the distributor and ABX2 9 Page 9 wholesaler license fee from $1,000 to $1,200. SBX2 10 was heard on August 19, 2015 in the Senate Committee on Public Health and Developmental Disabilities and passed with a vote of 9 to 3 and is currently pending in the Senate Appropriations Committee. ABX2 11 is set for hearing on August 25th in this Committee. g) AB 216 (Garcia) prohibits the sale or furnishing of any vapor products, as specified, to a person under 18 years of age, or under 21 years of age, as specified; exempts drugs or medical devices, as specified; and, makes the violation of the provisions in AB 216 an infraction punishable by specified fines. AB 216 is currently pending a vote on the Senate Floor. 5)PREVIOUS LEGISLATION. a) AB 320 (Nazarian) of 2013 would have required all school districts and county offices of education to adopt and enforce a tobacco-free campus policy; and, changed the allocation of funds under the TUPE program from average daily attendance to enrollment based funding. AB 320 was held in the Assembly Appropriations Committee. b) AB 647 (Salas), Chapter 135, Statutes of 2007, replaces two grant programs and one entitlement formula used for the distribution of tobacco tax revenues for tobacco education programs, with one competitive grant process. 9)TECHNICAL AMENDMENTS. In order to clarify that the provisions of this bill apply to e-cigarette devices whether they contain nicotine or not, the author may wish to consider the following technical amendments: ABX2 9 Page 10 In SEC. 1, Section 104420(n)(2) of the Health and Safety Code is amended to read:AllRequire that all school districts , charter schools , and county offices of education that receive funding pursuant to paragraph (1)shalladopt and enforce a tobacco-free campus policy no later than July of each fiscal year. The policy shall prohibit the use of products containing tobaccoproducts,and nicotine, including, but not limited to, smokeless tobacco, snuff, chew, clove cigarettes, andnicotine delivery devices, such aselectronic cigarettes , which can deliver nicotine and nonnicotine vaporized solutions, at any time, in charter school or school district-owned or leased buildings, on school or districtpropertyproperty, and in school or district vehicles. However, this section does not prohibit the use or possession of prescription products, nicotine patches, or nicotine gum . Information about the policy and enforcement procedures shall be communicated clearly to school personnel, parents, pupils, and the larger community. Signs stating "Tobacco use is prohibited" shall be prominently displayed at all entrances to schoolproperty.property as provided in Section 104559. Information about smoking cessation support programs shall be made available and encouraged for pupils and staff. Any school district, charter school , or county office of education that does not have a tobacco-free district policy implemented byJuly 1,July 1 shall not be eligible to apply for funds from the Cigarette and Tobacco Products Surtax Fund for that fiscal year. ABX2 9 Page 11 REGISTERED SUPPORT / OPPOSITION: Support American Heart Association/American Stroke Association American Cancer Society Cancer Action Network American Lung Association in California Association of Northern California Oncologists California Black Health Network California Chronic Care Coalition California Dental Association California Medical Association California Optometric Association California Pan-Ethnic Health Network California Primary Care Association California Society of Addiction Medicine Community Action Fund of Planned Parenthood of Orange and San Bernardino Counties ABX2 9 Page 12 First 5 Association of California Health Access California Medical Oncology Association of Southern California, Inc. Planned Parenthood Action Fund of the Pacific Southwest Planned Parenthood Advocacy Project Los Angeles Planned Parenthood Affiliates of California Planned Parenthood Mar Monte Planned Parenthood Northern California Action Fund Service Employees International Union Opposition None on file. Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097