Tobacco Free Mass Monthly Update — January 2019 Edition

Well, January was quite a month!  The Governor’s budget came out, new legislation has been filed, and we’re off to a roaring start!

Status of Tobacco Legislation

  • The governor cut the Massachusetts Tobacco Cessation and Prevention Program (MTCP) by over $100,000 in his version of the state budget. Last fiscal year, TFM advocates won a $500,000 increase for the program, funding the program at $4,218,872 for FY 2019.  The governor proposed $4,117,730 for FY 2020.  He also added an e-cigarette tax to the budget.  He proposed taxing them at 40% of wholesale, while we’d like to see them taxed at 75% of wholesale.  Still, this is a great step because it opens the conversation.
  • Banning the sale of all flavored tobacco products.  Senator John Keenan and Representative Danielle Gregoire filed An Act regulating flavored tobacco products (Senate Docket 905 and House Docket 418, respectively).This priority bill would ban the sale of flavored tobacco products in Massachusetts. The ban would include flavored Juul and other e-cigarettes and vape products.  Menthol and other mint flavors are included in the definition of flavor.  In Massachusetts, many communities have already restricted the sale of flavored products to adult-only establishments (see Local Action section, below), and Somerville, Needham, and Ashland have included mint/menthol in their restrictions.
  • Raising the cigarette tax and instituting an excise tax on e-cigarettes and vape products.  Senator Harriette Chandler and Representative Marjorie Decker filed An Act protecting youth from nicotine addiction (Senate Docket 1231 and House Docket 3416, respectively).  This bill would add an excise tax of 75% of wholesale to e-cigarettes, increasing their prices and making them harder for young people to afford. It would also increase the tax on cigarettes by $1.00, bringing it to a more reasonable $4.51, and increase the tax on cigars from 40% of wholesale to 80% of wholesale. Increasing the price of cigars and cigarettes is one of the most effective ways to help smokers quit and prevent kids from starting. History and evidence show that this will reduce the smoking rate, saving some of the more than $4 billion in health care costs annually attributed to tobacco use in Massachusetts.
  • Close the loopholes in the MassHealth tobacco cessation benefit. Senator Jason Lewis and Representative Christine Barber have filed An Act to provide Medicaid coverage for tobacco cessation (Senate Docket 818 and House Docket 543, respectively).  This bill seeks to expand access to the program by allowing trained and approved dentists and behavioral health practitioners to provide cessation counseling to patients on MassHealth as recommended by the CDC.  The MassHealth smoking cessation benefit was a huge success when it was introduced in Fiscal Year 2007, but certain providers, including dentists and behavioral health providers, were not included.  Closing the loophole would enable certified professionals in these fields to counsel, and bill for, tobacco cessation for their MassHealth patients.
  • Although it’s not one of Tobacco Free Mass’ stated priority issues, Representative Lori Erhich’s tobacco bill, An Act relative to tobacco premium ratings (HD 103), would prohibit insurers from charging higher premiums for tobacco users.  Current law provides for the Commissioner of the Division of Insurance to decide each year whether to allow tobacco as a rating factor.  Tobacco Free Mass firmly  believes that tobacco users should not be punished for an addiction started by, and made worse by, the tactics of Big Tobacco!  Quite the opposite—we  should ensure they have access to the evidence-based tools needed to help them quit.

We’re watching vigilantly for any efforts to preempt local authority on tobacco issues, including any efforts to undermine the statewide smoke-free workplace law.  We’re ready to support any legislation that will help smokers quit, prevent young people from becoming addicted to tobacco and nicotine, and that will prevent exposure to secondhand smoke.  Our priorities are the issues we’ll be concentrating our efforts on because we think they can make the most impact, we have the right support, and we think they have a good chance of passing.

We’ll send out information about the House Ways and Means budget when we have it, and we’ll keep you up-to-date in the months ahead!

Interesting Articles

  • An editorial in the New England Journal of Medicine calls for a ban on flavors in all e-cigarette products.  Interesting!  The article is attached.
  • CNN had a nice piece on why vaping is so dangerous for kids. NBC profiled a young person whose Juul addiction sent him to rehab.  An article in JAMA reports that, nationally, high school students’ use of e-cigarettes increased 78% (11.7% to 20.8%) between 2017 and 2018 alone. Frequent use of e-cigarettes (more than 20 days in the past month) among high school students also increased between 2017 and 2018 from 20% to 27.7%.  More than two-thirds of these individuals reported using flavored e-cigarettes.  Another JAMA study’s findings support the notion that e-cigarette use is associated with increased risk for cigarette initiation and use, particularly among young people who would otherwise be at low risk for smoking.
  • A California study published in Pediatrics found that teenagers living in cities or towns that more strictly policed retail sales of tobacco products were a third less likely to try cigarettes or e-cigarettes as those living in areas with more lax regulation, and they were half as likely to become regular users of tobacco, including e-cigarettes. Massachusetts’ cities and towns have been leaders in requiring local tobacco sales licenses, and the Massachusetts Tobacco Cessation and Prevention Program provides support for enforcing the policies.  A statewide tax on e-cigarettes and vape products (see above) would require stores that sell those products to have a state license as well.  All of these tobacco policies work together—none can do the job alone.  Happily, we’re on the right track, and we’re moving forward!
  • The New England Journal of Medicine published an article on an English study touting e-cigarettes as more helpful for quitting than FDA-approved medications. An editorial in the same journal pushed back against the study.  It’s not clear how transferable the study’s findings would be here in the US, as England has caps on nicotine levels for e-cigarettes, so products sold here often contain a higher level of nicotine. The two articles are attached.
  • A new Cancer Moonshot program aims to help cancer patients quit smoking.  Quitting after a cancer diagnosis is associated with longer survival and a reduced risk of new cancers, but many cancer centers are not prepared to help patients with smoking cessation.  The Cancer Center Cessation Initiative (C3I) is designed to use implementation science to jump-start smoking cessation treatment at NCI-designated cancer centers, and we’re excited to say that TFM member Dana-Farber Cancer Institute is part of this new program.  The New England Journal of Medicine article is attached to this email.

Upcoming Tobacco Free Mass Meetings

The next full coalition and Advocacy Committee meetings are:

  • March 7 – Full Coalition meeting from 10:00 AM to 12:00 PM – Massachusetts Medical Society, Waltham
  • March 7 – Advocacy Committee meeting from 12:15 PM to 1:15 PM (following full coalition meeting) – Massachusetts Medical Society, Waltham
  • April 25 – Advocacy Committee meeting from 10:00 AM to 11:30 AM at The Strategy Group’s offices at 40 Court Street, 11th Floor, Boston

See the full calendar on our website, at tobaccofreema.org.

Upcoming Opportunities

  • Year of Cessation—2019: An Update from CDC’s Office on Smoking and Health, a free webinar, will be held on Thursday, February 7, 2019, at 1:00 pm and will last about an hour.  The Director of the Office on Smoking and Health, Corinne M. Graffunder, DrPH, MPH, will describe OSH’s work and priorities.  She’ll talk about the importance of cessation and will consider strategic opportunities for the coming year.  She’ll also identify existing resources, including data and cessation support, available from the CDC.

TFM Working Groups

  • TFM’s E-Cigarette Working Group has decided to focus on collecting personal stories and photos that can inform the community and legislators about the impact of e-cigarette use on real people and communities. This idea was enthusiastically received by the Advocacy Committee!  The group will discuss a draft of questions that could be used to elicit stories that paint a picture of e-cigarette use in Massachusetts.  The E-Cigarette Working Group will hold its next meeting during the last week of February. If you would like to participate in the meeting or be a member of TFM’s E-Cigarette Working Group but are not on the list, please email Annegret Klaua or Jonina Gorenstein, who are heading up the working group.
  • TFM’s Menthol Working Group has met several times over the last couple of months as municipalities have started moving on restricting menthol sales. Members of the group are involved in these local hearings and are able to give information about the kinds of arguments being used by the other side.  The group is currently thinking about who is missing from the menthol conversation in Massachusetts and how to invite those people and groups into the discussion.  If you have thoughts on who the group should be reaching out to, are interested in joining the group, or would like to come to the next meeting, please contact Chris Banthin, who’s heading up the TFM Menthol Working Group.

Local Tobacco Policies

Cities and towns across Massachusetts have been passing tobacco policies that fight the tobacco industry’s influence in communities and pave the way for statewide policy. The statewide youth prevention law that goes into effect on December 31 was brought about in large part because of the high number of local regulations banning tobacco sales in pharmacies, prohibiting use of e-cigarettes in smoke-free locations, and raising the minimum legal sales age of tobacco from 18 to 21. Thank you to everyone who worked on those local regulations! Here’s what’s next…

Municipalities have been looking at ways to counteract the tobacco/vape industry’s efforts to make their products appealing to young people.  Here are some examples of regulations that do so:

  • Raising the minimum age of sale from 18 to 21.  ARE WE SERIOUSLY STILL TALKING ABOUT THIS?!? Didn’t we just pass a statewide law to do this?  Yes, but the law grandfathers in young people under 21 who are currently able to purchase tobacco. Cities and towns without an existing Age 21 regulation spent the last few months of 2018 in a mad rush to pass regulations that would close the loophole. As of this writing, 235 cities and towns have passed this regulation, covering 92.6% of the state’s population.  An unintended benefit of this rash of hearings is that many are bundling other good tobacco policies in.  Excellent! 
  • Restricting the sale of flavored tobacco to adult-only establishments. This is one of the key statewide priorities discussed at the planning session earlier this month.  This policy prohibits the sale of all flavored tobacco products and flavored e-cigarettes, except for in qualified retail tobacco stores and “smoking bars.”  142 cities and towns have passed this policy, covering nearly two-thirds of the state’s population, at 62%.  Three of these policies now include menthol as a flavor, and other municipalities are beginning to consider it.  Anyone interested in the menthol issue should contact Chris Banthin and join the Menthol Working Group.
  • A full 123 municipalities limit, or cap, the number of tobacco sales permits they will issue, covering 39% of the state’s population.  Of these, five cities and towns also have a cap on the number of tobacco retailers they will allow.  This is stated in language such as: “This municipality limits tobacco sales permits to X number and of that X number, only Y number can be issued to Retail Tobacco Stores.”  When specific tobacco products, such as flavors, are restricted to adult-only tobacco retailers, the “Retail Tobacco Stores” are the stores the regulations refer to.
  • Prohibiting a new tobacco retailer opening within 500 feet of an existing tobacco retailer.  This policy cuts down on density issues—having a high concentration of tobacco retailers in one area.  Vape stores are considered tobacco retailers. 12 cities and towns have already passed this new regulation, covering 4% of the state’s population.
  • Prohibiting new tobacco retailers from opening within 500 feet of a public or private elementary or secondary school. This policy addresses the issue of kids’ exposure to tobacco products and marketing, while also addressing issues of density.  119 municipalities have passed this regulation, covering a third (34%)  of the state’s population.

Information about local policies can be found on the Massachusetts Tobacco Cessation and Prevention Program’s website, MakeSmokingHistory.org

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Take a moment today to get outside and enjoy the gorgeous weather!  Perhaps the groundhog was right… though his 40% success rate is troubling.