BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON PUBLIC HEALTH AND DEVELOPMENTAL SERVICES
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    SBX2 7    
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          |AUTHOR:        |Hernandez                                      |
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          |VERSION:       |July 16, 2015                                  |
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          |HEARING DATE:  |August 19,     |               |               |
          |               |2015           |               |               |
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          |CONSULTANT:    |Alex Norring                                   |
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           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  







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            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.  








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            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.








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          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  








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            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.








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            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  








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            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








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                    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
                    
          
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