BILL ANALYSIS                                                                                                                                                                                                    Ó



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          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  








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            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.








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          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  








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            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  








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               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  








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               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.








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            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.










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             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  








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               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:
          








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            In SEC. 1, Section 104420(n)(2) of the Health and Safety Code  
            is amended to read:

             All   Require that all  school districts  , charter schools , and  
            county offices of education that receive funding pursuant to  
            paragraph (1)  shall  adopt and enforce a tobacco-free campus  
            policy no later than July of each fiscal year. The policy  
            shall prohibit the use of  products containing  tobacco   
            products,   and nicotine, including, but not limited to,  
            smokeless tobacco, snuff, chew, clove cigarettes, and  nicotine  
            delivery devices, such as    electronic 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  district  property   property,  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 school  property.   
             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 by  July 1,   July 1   
            shall not be eligible to apply for funds from the Cigarette  
            and Tobacco Products Surtax Fund for that fiscal year.


















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          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








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          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