BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 151
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|AUTHOR: |Hernandez |
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|VERSION: |January 29, 2015 |
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|HEARING DATE: |April 8, 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
products to minors through specified sales restrictions and
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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 yet been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, an estimated 90
percent of tobacco users start prior to age 21, and 80 percent
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 percent more than existing
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control policies. 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.
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 percent
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 raising the minimum age above 18
at a federal level. The Act required the FDA to convene a
panel to examine the ramifications of raising 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 raising 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 percent additional decrease; raising the age
to 21, a 12 percent additional decrease; and raising the age
to 25, a 15 percent 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 percent 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
chemicals known to cause cancer, birth defects, and other poor
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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 none have yet been
signed 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 raised their tobacco
purchase age to 21.
8.Related legislation. 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 is currently set for hearing in
the Senate Health Committee on April 8, 2015.
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 is currently pending hearing in
the Senate Governance and Finance Committee.
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
treatment programs. This bill is currently pending hearing in
the Assembly Health Committee.
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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 hearing in the
Assembly Governmental Organizations Committee.
AB 48 (Stone), would prohibit the furnishing of single-use
filter cigarettes to any Californian. This bill is currently
pending in the Assembly Governmental Organizations Committee.
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. Kaiser Permanente states
that the serious and negative health effects of smoking are
well known and a costly burden to society; anything that can
be done to restrict access to young people to prevent
addiction is worth doing.
11.Opposition. The Cigar Association of America (CAA) writes
that no state has made a similar move to restrict the age to
purchase tobacco to 21. CAA argues that an individual can be
eligible to vote, serve in the military, and enter into
contracts at the age of 18 and therefore should be able to
make decisions about purchasing tobacco products. Further, CAA
states this bill will result in a decrease in tax revenues to
the state, which could jeopardize ongoing fiscal obligations.
Legal Services for Prisoners with Children writes that
addressing public health concerns through criminal law is
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counterproductive and should be resolved with treatment and
education, not criminal sanctions.
12.Policy comments.
a. SB 140 (Leno), would bring electronic cigarettes
under the definition of a tobacco product and regulate
them accordingly. Current law prohibits the sale of
electronic cigarettes to minors. If this bill and SB 140
are both signed into law, electronic cigarettes would be
subjected to the same age 21 restriction. The author may
wish to consider adding language to subject electronic
cigarettes to the same age restriction in line with SB
140's intent.
b. If signed, this bill would go into effect on January
1, 2016, which would make it illegal overnight for 18 to
20 year olds to purchase tobacco. That population,
already addicted to tobacco, will be forced to quit or
could seek to purchase tobacco products illegally.
SUPPORT AND OPPOSITION :
Support: American Academy of Pediatrics
American Cancer Society Cancer Action Network
American Federation of State, County and Municipal
Employees, AFL-CIO American Heart Association/American
Stroke Association
American Lung Association in California
California Black Health Network
California Chapter of the American College of
Cardiology
California Chapter of the American College of
Emergency Physicians
California Medical Association
Campaign for Tobacco-Free Kids
El Monte/South El Monte Chamber of Commerce
Kaiser Permanente
March of Dimes California Chapter
1 individual
Oppose: Cigar Association of America
Legal Services for Prisoners with Children
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