This document discusses policies to prevent youth smoking in Colorado. It notes that tobacco kills over 4,400 people in Colorado each year, and 80-90% of smokers start by age 18. The tobacco industry spends over $12.5 billion annually on marketing, including $170.7 million in Colorado. New nicotine products like e-cigarettes are also increasing in popularity among youth. The document proposes several policy options to reduce youth access and initiation, including increasing cigarette taxes, enacting retailer licensing laws, restricting flavored products and sales near schools, and updating the tobacco-free schools law. There is strong evidence that limiting youth access through these types of policies can effectively reduce smoking rates.

1. Colorado Department of Public Health and Environment Helping Kids Make Healthy Choices

2. Helping Kids Make Healthy Choices About Tobacco What is the problem with youth smoking? How does the tobacco industry & advertising contribute? New Products How is policy part of the solution?

3. Problem: Tobacco is still the leading Cause of Preventable Death in the United States In Colorado, nearly 4,400 deaths each year due to tobacco use.* In the U.S., smoking causes more deaths than HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders COMBINED.† * MMWR (2009), 58 (02); 29-33. †MMWR (2008), 57 (45): 1226 – 1228; CDC (2009), Health, United States, 2008; Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual Causes of Death in the United States. JAMA: Journal of the American Medical Association 2004;291(10):1238–1245 .

4. Problem: 80 - 90% of adult smokers first try tobacco before the age of 18† †Surgeon General’s Report: Preventing Tobacco Use Among Young People, 1994. * CDC: Best Practices for Tobacco Control Programs, 2007.

5. Youth Cigarette Smoking in Colorado

6. Problem:6 out of 10 Colorado high school students attempting to purchase cigarettes were successful.

7. In Which Colorado counties are kids buying cigarettes illegally?

8. Helping Kids Make Healthy Choices About Tobacco What is the problem with youth smoking? How does the tobacco industry & advertising contribute? New Products How is policy part of the solution?

9. Problem:Youth are sensitive to tobacco advertising and placement.

10. Tobacco Industry Spends $12.5 billion annually on marketing* $170.7 million spent in Colorado 90% of marketing $$ spent at point of sale Most of that – nearly 74% – is spent on price discounts and promotions to decrease the price of cigarettes * FTC (2009) Cigarette Report For 2006

11. From presentation by Frank Chaloupka, Ph.D., University of Illinois at Chicago, at CDC meeting, June 8, 2010: Atlanta, Georgia.

13. Dissolvable

14. Requires no spitting

15. Last between 2-30 minutes

17. …and E-Cigarettes,

18. and Hookah…

19. Helping Kids Make Healthy Choices About Tobacco What is the problem with youth smoking? How does the tobacco industry & advertising contribute? New Products How is policy part of the solution?

20. From presentation by Ursula Bauer, Director, National Center for Chronic Disease Prevention and Health Promotion, CDC; June 7, 2010, Atlanta, Georgia

21. Solution: Implement policies to prevent youth tobacco initiation

22. Solution: Implement Policies to Prevent Youth Tobacco Initiation Evidence-based interventions for reducing tobacco initiation among children and adolescents include: enforcement of illegal sales to minors laws *° youth-oriented mass media campaigns *° Strengthening/implementing laws to prevent youth smoking° tobacco price increases * ° *1994 Surgeon General's Report—Preventing Tobacco Use Among Young People °CDC Taskforce on Community Prevention Services, 2005

23. Will limiting youth smoking through policy reduce tobacco initiation? YES! There is very strong evidence that limiting youth access directly impacts tobacco rates.∞ Youth who perceived cigarettes as relatively easy to get were more likely to become regular smokers (Annals of Family Medicine, 2008). Stores located in states with fewer/weaker compliance policy measures were 36 percent more likely to illegally sell tobacco to minors (Food & Drug Administration, 2003). A comprehensive youth access program in Woodridge, Illinois, reduced tobacco use among youth by over 50 percent (Journal of American Medical Association , 1991). ∞Enforcing Laws Prohibiting Cigarette Sales to Kids Reduces Youth Smoking. Campaign for Tobacco-free Kids. 2008

24. Will limiting youth smoking to tobacco through policy reduce tobacco initiation? YES! There is very strong evidence that limiting youth access directly impacts tobacco rates. Results from a study in 14 Minnesota communities showed that an intervention involving local ordinances and enforcement to limit youth access to tobacco significantly reduced adolescent smoking rates (American Journal of Public Health, 1998) A study in Ft. Morgan demonstrated that strong retailer enforcement reduced sales to minors, which reduced the overall cigarette supply for minors. (Preventive Medicine, 2007)

25. Helping Kids Make Healthy Choices About Tobacco What is the problem with youth smoking? How does the tobacco industry & advertising contribute? New Products How is policy part of the solution?

26. Policy Option:Remove tax penalty on localities for licensing or taxing cigarettes Cities and towns will lose share (27%) of state cigarette tax if they impose “fees, licenses or taxes” on cigarettes. Increase locality authority to monitor and enforce restrictions on sales to minors through local licensing. Grants localities the authority to raise additional revenue if they choose. Reduce youth smoking in communities that increase the price of cigarettes.

27. Policy Option:Enact a statewide retailer license for selling tobacco products Colorado is one of 7 states without any retailer license provisions. Retailer licensing can be an effective tool for enforcing laws preventing tobacco sales to minors. Stricter enforcement of illegal sales to minors laws may reduce overall tobacco supply to minors. Other provisions can be included within comprehensive retailer license law.

28. Policy Option:Prohibit sale of single tobacco/nicotine products Prohibit sale of single tobacco/nicotine products FDA law bans sale of single cigarettes; does NOT ban sales of single cigars, other products Healthy Kids Colorado Survey indicates that cigar use INCREASED among teens between 2001 and 2008, even while cigarette smoking has gone down. Prohibitions on single products most likely to discourage more price-sensitive consumers, such as teens.

29. Policy Option:Restrict price manipulation strategies; Establish minimum price Every 10% increase in REAL price of cigarettes, reduces number of kids who smoke 6-7%. Single most effective policy intervention to decrease smoking rates is to increase cost of cigarettes Tobacco industry uses a variety of tools – coupons, etc. to counteract cigarette taxes and other efforts to increase the price of tobacco 25 states have enacted minimum price laws

30. Policy Option:Restrict Flavored nicotine products FDA bans flavored cigarettes, but doesn’t address other flavored products popular with teens, like smokeless, cigars and newer products. New products look like candy, easily concealed FDA ban on flavored cigarettes does not include menthol

31. Policy Option:Prohibit tobacco sales near youth-oriented facilities One study found that stores where teens shop have higher amount of tobacco advertising Teens are more susceptible to advertising than adults Most tobacco industry marketing occurs at point of sale – advertising and price discounts

32. Policy Option:Update Tobacco-free schools law Prohibits use of tobacco by students, faculty and staff on school property and at school functions Law was originally enacted in 1994 Rocky Mountain Center conducting a stakeholder process with schools to get feedback on possible amendments to the tobacco-free schools law.

33. Policy Option:Enact selected provisions of FDA law into state law Grants state authority to enforce provisions, such as: ban on flavored cigarettes Prohibition of self-service displays or vending machines where youth may be present State cannot regulate product or manufacturing standards, registration, premarket review