BILL ANALYSIS Ó SENATE COMMITTEE ON PUBLIC HEALTH AND DEVELOPMENTAL SERVICES Senator Ed Hernandez, O.D., Chair BILL NO: SBX2 7 --------------------------------------------------------------- |AUTHOR: |Hernandez | |---------------+-----------------------------------------------| |VERSION: |July 16, 2015 | --------------------------------------------------------------- --------------------------------------------------------------- |HEARING DATE: |August 19, | | | | |2015 | | | --------------------------------------------------------------- --------------------------------------------------------------- |CONSULTANT: |Alex Norring | --------------------------------------------------------------- SUBJECT : Tobacco products: minimum legal age. SUMMARY : Increases the minimum legal age to purchase or consume tobacco from 18 to 21 and makes additional conforming changes to restrictions and enforcement mechanisms in current law. Existing law: 1)Prohibits any person, firm, or corporation from selling, giving, or in any way, furnishing tobacco products to any person under the age of 18, including in person and through mail or telephone. 2)Requires all persons engaging in retail sale of cigarettes and tobacco products to check the identification of tobacco purchasers to establish age if the person appears to be under the age of 18. 3)Establishes that California fully complies with federal regulations, including the "Synar Amendment," that prohibits the sale or distribution of tobacco products to individuals under 18, requires strict enforcement, and conditions federal Substance Abuse Prevention and Treatment Block Grant funding upon compliance. 4)Requires the Department of Public Health (DPH) to establish programs to reduce the availability of tobacco products, establish requirements for retailers of tobacco products to post conspicuously a notice that selling to minors is illegal, and enforce the laws set forth in the Stop Tobacco Access to Kids Enforcement Act (STAKE Act). 5)Creates the STAKE Act to reduce the availability of tobacco SBX2 7 (Hernandez) Page 2 of ? products to minors through specified sales restrictions and enforcement activities, including using 15 and 16 year olds for onsite random sting inspections. 6)Authorizes DPH to assess civil penalties ranging from $400 to $6,000 against any person, firm, or corporation that sells, gives, or in any way furnishes tobacco products to another person who is under the age of 18 depending on the number of infractions. 7)Establishes a fine of $75 or 30 hours of community service work for those persons under age 18 who purchase, receive, or possess any tobacco product, unless participating in STAKE Act activities. This bill: 1)Raises the minimum legal age (MLA) to purchase and consume tobacco products to 21 and makes all conforming changes in current law. 2)Extends the applicability of the 21 years of age restriction to provisions of the STAKE Act. FISCAL EFFECT : This bill has not been analyzed by a fiscal committee. COMMENTS : 1)Author's statement. According to the author, an estimated 90 % of tobacco users start prior to age 21, and 80 % of lifetime users start before the age of 18. By increasing the MLA to 21, this bill intends to prevent or severely restrict youth access to these highly addictive and deadly products. The consumption of tobacco products leads to a lifetime of adverse health effects and remains the leading cause of preventable death in the nation and California. This bill aims to achieve better health outcomes for Californians, while lowering the immense cost on the health care system of tobacco-related disease. UC San Francisco (UCSF) reported tobacco use cost a staggering $18.1 billion in California alone, with $9.8 billion in direct health care expenditures. In 2013, to address the burden of tobacco, the federal Food and Drug Administration (FDA) commissioned the Institute of Medicine (IOM) to study the effectiveness of raising the MLA. The IOM concluded that raising the MLA to 21 would cause the smoking prevalence to decline by 12 % more than existing control policies. SBX2 7 (Hernandez) Page 3 of ? California already has a 21 year age restriction for other dangerous activities; it is time for tobacco to be added to that list. This bill will help California be a leader in tobacco control and take steps towards eliminating the addictive, costly, and deadly habit of tobacco use. 2)Toll of tobacco. The Surgeon General issued a report in 1964 that linked smoking and poor health outcomes, including lung cancer and heart disease. Over the ensuing 50 years since that report, research solidified the link between tobacco and poor health outcomes, both directly and indirectly caused. According to the Center for Disease Control and Prevention (CDC), tobacco use causes cancer, heart disease, stroke, lung diseases, and diabetes and remains the leading cause of preventable death in the United States, resulting in over 480,000 deaths annually. A study conducted by UCSF estimated that, in 2009, 34,000 deaths in California were attributable to smoking. In addition to tobacco-related diseases, like cancer, heart disease, and lung disease, there are a number of physiological effects. Low infant birth weight is associated with mothers who smoke or are exposed to secondhand smoke, and increased hospitalization and inability to heal wounds are both linked to tobacco users. There is also a financial toll as a result of these impacts. Tobacco use costs the nation billions in direct health care expenditures and lost productivity annually. The Campaign for Tobacco-Free Kids estimates that tobacco use in California results in $3.5 billion in costs to Medi-Cal. 3)Youth and tobacco. The CDC states that nearly all tobacco users begin during their youth, with 3,200 adolescents trying their first cigarette each day. DPH estimates that 64 % of smokers in California start before age 18. According to DPH, California has one of the lowest teenage smoking rates in the nation. But the prevalence of smokeless tobacco use among youth has greatly increased, and there has been a slowing decline in rates of cigarette smoking among youth. Through implementation of the STAKE Act, California also has seen a steady decline in illegal sales to minors, although there has been a slight increase in recent years. Research shows that nicotine exposure has a dynamic impact on developing brains in smaller doses and leads to increased vulnerability to addiction, impulsivity, and mood disorders. Tobacco use for youth is also associated with reduced lung function, reduced lung growth, and early cardiovascular damage. SBX2 7 (Hernandez) Page 4 of ? 4)IOM report. The FDA is granted broad authority over tobacco products by the Family Smoking and Tobacco Control Act of 2009 (Act), but is prohibited from increasing the minimum age above 18 at a federal level. The Act required the FDA to convene a panel to examine the ramifications of increasing the minimum tobacco purchase age. The FDA tasked the IOM with investigating this issue. The IOM recently released a report, Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products, which examined the impacts of increasing the age to 19, 21, and 25. The IOM determined that relative to status quo projected decreases, raising the age to 19 would result in a three % additional decrease; raising the age to 21, a 12 % additional decrease; and raising the age to 25, a 15 % additional decrease. The IOM concluded that the age group most impacted by raising the MLA would be 15 to 17 year olds for any of the three ages studied. The IOM argued that increasing the age for tobacco purchase will result in delayed use of such products, which in turn will decrease the prevalence of users. From a health perspective, the impacts of decreased prevalence would be short- and long-term. Reductions in tobacco-related diseases will take decades to realize, but there would be immediate reduction in adverse physiological effects and poor infant health outcomes. The IOM report stated that raising the age to 21 would result in 200,000 fewer premature deaths and potentially millions of years of life gained for those born between 2000 and 2019. 5)Alternative tobacco products. According to DPH, prevalence of smokeless and other tobacco products have increased among high school students, which often do not have the same regulations placed upon them as cigarettes. In recent years, sales of smokeless tobacco and nicotine products, like snus, have risen dramatically. Hookah, popular with teens and young adults, has been shown to contain the same cancer-causing chemicals as secondhand smoke. Smokeless tobacco has been linked to oral cancer, pancreatic cancer, and gum disease. DPH recently released a report on electronic cigarettes, which stated that teen use of electronic cigarettes has surpassed the use of traditional cigarettes and marketing of these products has increased 1200 % in the last three years. Electronic cigarettes deliver nicotine to the user, which, research from the IOM shows, can be harmful to brain development in adolescents. The DPH report asserts that the aerosol emitted from electronic cigarettes is toxic and contains at least ten SBX2 7 (Hernandez) Page 5 of ? chemicals known to cause cancer, birth defects, and other poor health outcomes. 6)Age restrictions. Federal and state laws have set various standards for age restrictions. For example, at age 16, an individual can obtain a driver's license. At age 18, an individual gains the right to vote, can join the military, enter into binding contracts, and be tried as an adult in the criminal courts. At age 21, an individual can purchase and consume alcohol, purchase certain firearms, and gamble. Minimum age restrictions can be established at a federal level, and states may opt to make restrictions more stringent. 7)Other states. A number of other states have attempted to enact legislation or have measures pending that would increase the purchasing age for tobacco to 21, but Hawaii has been the only state thus far to adopt the increase into law. Alabama, Alaska, New Jersey, and Utah currently have an age restriction of 19 for tobacco, which is higher than the national standard of 18. In the absence of federal and state action, tobacco control has been undertaken at a local level. New York City, a number of municipalities in Massachusetts, and Healdsburg, CA, have increased their tobacco purchase age to 21. 8)Related legislation. SBX2 5 (Leno)/AB X2 6 (Cooper) recast and broaden the definition of "tobacco product" in current law to include electronic cigarettes as specified; extend current restrictions and prohibitions against the use of tobacco products to electronic cigarettes; extend current licensing requirements for manufacturers, importers, distributors, wholesalers, and retailers of tobacco products to electronic cigarettes; and, require electronic cigarette cartridges to be child-resistant. SB X2 5 will be heard on August 19, 2015 in this committee and AB X2 6 is pending in the Assembly. SBX2 6 (Monning)/AB X2 7 (Stone) prohibit smoking in owner-operated businesses and remove specified exemptions in existing law that allow tobacco smoking in certain workplaces. SB X2 6 will be heard on August 19, 2015 in this committee and AB X2 7 is pending in the Assembly. AB X2 8 (Wood) would increase the minimum legal age to purchase or consume tobacco from 18 to 21. AB X2 8 is pending in the Assembly. SBX2 7 (Hernandez) Page 6 of ? SBX2 8 (Liu)/ABX2 9 (Thurmond and Nazarian) extend current tobacco use prevention funding eligibility and requirements to charter schools; broaden the definition of products containing tobacco and nicotine, as specified, and prohibit their use in specified areas of schools and school districts, regardless of funding; and require specified signs to be prominently displayed at all entrances to school property. SB X2 8 will be heard on August 19, 2015 in this committee and AB X2 9 is pending in the Assembly. SBX2 9 (McGuire)/ABX2 10 (Bloom) allow counties to impose a tax on the privilege of distributing cigarettes and tobacco products. SB X2 9 will be heard on August 19, 2015 in this committee and AB X2 10 is pending in the Assembly. SBX2 10 (Beall)/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 wholesaler license fee from $1,000 to $1,200. SB X2 10 will be heard on August 19, 2015 in this committee and AB X2 11 is pending in the Assembly. SB 151 (Hernandez), is substantially similar to this bill and would increase the tobacco purchase age to 21. SBS 151 is currently pending in Assembly Governmental Organizations Committee. SB 140 (Leno), would change the definition of a tobacco product to include electronic devices that deliver nicotine or other substances, make providing such a product to minors a misdemeanor, and update the restrictions of using tobacco products to reflect the inclusion of electronic devices. This bill was held in Assembly Governmental Organization Committee. SB 591 (Pan), would, among other provisions, impose an additional tax of $2.00 on each pack of cigarettes sold and require the funds generated to be deposited in the California Tobacco Tax Act of 2015 Fund to be expended for specific outlined purposes. This bill was placed on the Senate Inactive File. AB 1162 (Holden), would establish tobacco cessation services as covered benefits under Medi-Cal, and require the services to include unlimited quit attempts comprised of counseling and SBX2 7 (Hernandez) Page 7 of ? treatment programs. This bill is currently pending hearing in the Senate Appropriations Committee. AB 1278 (Gray), would allow the use of a United States Armed Forces identification card for age verification, as long as it contains date of birth and photo, to purchase tobacco products. This bill is currently pending on the Senate Floor. 9)Prior legislation. AB 221 (Koretz, of 2003), was substantially similar to this bill. AB 221 failed passage in the Assembly Governmental Organizations Committee. SB 1821 (Dunn, of 2003), was substantially similar to this bill. SB 1821 was held on the Senate Appropriations Committee suspense file. AB 1453 (Koretz, of 2002), was substantially similar to this bill. AB 1453 was subsequently amended to a different subject. 10)Support. The American Lung Association in California (ALA) argues that delaying the age when youth first use tobacco can reduce their likelihood of transitioning to regular tobacco users. ALA states that California has a rich history of tobacco control that has helped to reduce smoking rates, but tobacco companies continue to find replacement smokers. The American Cancer Society Cancer Action Network writes that this bill is an important component in a comprehensive strategy to reduce youth consumption of tobacco. 11)Opposition. Various veterans groups write in opposition that this would be unfair to men and women in the armed forces because if they can serve in our military they should be allowed to buy a legal product and there is nothing to justify raising the age to 21. They argue further that this is not about smoking being right or wrong, but about protecting liberty and personal freedom. SUPPORT AND OPPOSITION : Support: American Cancer Society Cancer Action Network (co-sponsor) American Lung Association in California (co-sponsor) American Academy of Pediatrics, California American Heart Association/American Stroke Association Association of Northern California Oncologists SBX2 7 (Hernandez) Page 8 of ? California Black Health Network California Chronic Care Coalition California Dental Association California Pan Ethnic Health Network California Academy of Preventive Medicine California Primary Care Association California Society of Addiction Medicine First 5 Association Health Access California Kaiser Permanente Medical Oncology Association of Southern California, Inc. Planned Parenthood Affiliates of California Santa Clara County Board of Supervisors Service Employees International Union California Oppose: American Legion-Department of California AMVETS - Department of California Association of the United States Army California Distributors Association Fleet Reserve Association Jewish War Veterans, Department of California Military Officers Association of America, California Council of Chapters Military Order of the Purple Heart, Department of California Vietnam Veterans of America - California State Council -- END --