Mysterious lung illnesses, menthol targeting, Juul shakeups, a ban on all vape sales, and now…

The legislation to ban the sale of ALL flavored tobacco products is moving forward—fast!  It has advanced from the Joint Committee on Public Health to the Ways and Means Committees in the House and Senate.  The next big step is a floor vote, so THIS IS IT!  Please, please make sure your organization has weighed in and that you spread the word so we have a loud voice right now!  We expect the bill to go to a vote in the next week or two, so this is the moment!

• You can:
  • Send an action alert to your mailing lists (and act on it yourself!)
  • Write a letter from your organization to Senate President Spilka and House Speaker Robert DeLeo
  • Write a letter to the editor
  • Ask your local board of health to pass a resolution on vaping and flavored tobacco products
  • Ask your school committee to pass a resolution on vaping and flavored tobacco products

…and it’s easy!! Templates for all of these alerts, letters and resolutions can be found at: https://tobaccofreema.org/take-action/

Man, a lot has been happening.

• In early September, the CDC announced the occurrence of lung disease caused by vaping—a disease that has killed at least two dozen people and has sickened over a thousand across the United States.  Massachusetts is not immune; the Department of Public Health announced the Commonwealth’s first death from a vaping-related lung disease earlier this week. The CDC cautioned against the use of e-cigarettes and other vape products until the cause of the disease was understood.
• In response to the CDC’s announcement, a few governors began to restrict the sale of certain vaping products.  On September 24, Governor Baker declared a ban on the sale of all vaping products for four months—in person and online.  This set off a flurry of lawsuits, protests, commendations, and questions about why governments had not acted earlier – especially when FDA staff appears to have to have pushed for a ban on flavored e-cigarettes years ago. Despite the lawsuits, the temporary ban is allowed to stand for now.  For comprehensive information about the Governor’s temporary sales ban and its implementation, visit Mass.gov. 
• As the furor over the lung injuries rages, the addictiveness of e-cigarettes remains a priority concern.  We are learning more about how vaping nicotine affects the teenage brain.  That strong addictiveness has led doctors to speak out about the difficulties of treating nicotine addiction in young people. DPH’s Commissioner testified before Congress about how flavors—including menthol—are used to target kids.  A study found a significant increase in the odds of marijuana use in young people who used e-cigarettes.  And for a new perspective, a conservative columnist argues that it’s not a free market when the consumers are addicted.
• In the middle of the lung disease kerfuffle, Juul got real.  It fired its CEO and replaced him with an Altria executive, finally ending its pretense of being anything but a part of Big Tobacco.  Altria, of course, is Phillip Morris, and owns 30% of Juul’s stock.  Juul has been using Big Tobacco’s strategy of hurling wads of cash at government entities to influence policy.  But there are doubts about Juul’s success so far in the State House—those full-page ads in the Globe didn’t seem to convince anyone.
• Juul, Juul, Juul!  UGH!  Can’t we talk about anything else? Sure we can—let’s talk about Juul-alikes, flavored nicotine pods that are off-brand but compatible with Juul devices.  Flavors, again.  Back in early August, the FDA told four companies to stop selling flavored e-liquids, leaving only a gazillon companies still selling the stuff.    
• In an attempt to stop the rising youth vaping rates, the Trump administration proposed banning flavored vaping products.  It’s a good idea, of course, but it’s unlikely to happen anytime soon… or be very strong.  And the legislation we’re fighting for here in Massachusetts would ban the sale of ALL flavored tobacco products—including vape products, menthol cigarettes, and those cheap little flavored cigars – and it could happen very soon!
• Hey!  Remember combustible cigarettes? People are still smoking them, and many kids are still exposed to that secondhand smoke.  The disparity is stark: in the United States, the percentage of youth exposed to secondhand smoke was higher among non-Hispanic black (61.8%) youth compared with non-Hispanic white (34.3%), non-Hispanic Asian (18.3%), and Hispanic (24.9%) youth. We still have work to do.
• In good news, the FDA finally issued new graphic warnings for cigarette packs… after a lawsuit forced them to.  The images on the packs use simple, evocative pictures to show how smoking impacts the body.  Oh—don’t click on that link if you’re reading this while eating your lunch! TFM is proud to claim most of the plaintiffs in the lawsuit as members—including our past Chair, Lynda Young! 
• In other good news, MassHealth has eliminated copays for cessation medications!  The nicotine patch, nicotine gum, Chantix, Wellbutrin, and other FDA-approved medications have been covered by MassHealth, as have counseling services to help people stop smoking.  The elimination of the copay takes down a barrier to people accessing that medication.  And there’s other good news in smoking cessation: there’s evidence that pediatricians can help their patients’ parents quit smoking through interventions during patient visits.  In addition, SAMHSA has come out with a new guide for implementing tobacco cessation for people with severe mental illness.
• It’s not easy for young people to break a nicotine addiction, but there are tools to help teens quit.  The Massachusetts Tobacco Cessation and Prevention Program has also compiled an excellent toolkit to help schools address vaping—though it would be suitable for use by any youth-serving organization.
• And, just to keep us on our toes, Phillip Morris is rolling out sales of its IQOS heated cigarette in test markets here in the United States.  There’s a menthol version, so make your voice heard NOW in support of the flavored tobacco ban!

Status of Priority Legislation

• ***URGENT!*** Banning the sale of all flavored tobacco products.  The Joint Committee on Public Health reported out favorably legislation filed by Senator John Keenan and Representative Danielle Gregoire: An Act regulating flavored tobacco products (new numbers: Senate Bill 2357 and House Bill 4089, respectively).This is a TFM priority bill and would ban the sale of ALL 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. The bill is now in the House and Senate’s respective Ways and Means Committees; the next big step is a floor vote, which we expect to happen in mid-October.  We are working hard to get phone calls in to legislators expressing support for the legislation—and specifically stating the need to include combustible tobacco and menthol in the ban.  Many organizations have already sent letters to the Senate President and House Speaker—make sure yours gets there next week, at the latest!  Please forward me a copy of your letter and we’ll hand-deliver it to ensure it gets noticed.  Please do everything your organization is able to do to help push this legislation forward—and do it by October 18 for maximum impact.

• 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 Bill 1606 and House Bill 2436, 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.  The Joint Committee on Revenue held a hearing on June 18, and many TFM member organizations sent in written testimony—thank you!  We’ll let you know when we have an update on next steps.

• 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 Bill 704 and House Bill 1129, 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. Referred to the Joint Committee on Health Care Financing, which held a hearing back in May.  Thanks to all the TFM members who submitted written testimony or spoke on behalf of the legislation!  We’ll let you know when the bill moves.

• Increase the budget for the state’s tobacco control program.  The legislature increased the budget for the Massachusetts Tobacco Cessation and Prevention Program (MTCP) by $400,000 to a total budget of $4,618,872 for FY 2020.  This amounts to a $900,000 increase to the program over the last two years.  We’re heading in the right direction!  MTCP is critical to the fight against tobacco in Massachusetts. It implements and enforces laws, funds local boards of health and community organizations to do enforcement and education, runs the state’s quitline, produces materials educating about tobacco and nicotine, and provides surveillance and evaluation for tobacco issues, including the rise in e-cigarette use among young people. Strong funding for MTCP will allow the tobacco program to educate parents and other adults about e-cigarettes, Juul and other emerging products; provide more enforcement of local tobacco laws protecting youth; and work more effectively to help all smokers quit.

Preemption and other tobacco industry strategies remain a very real threat.  As we gain momentum, that threat intensifies.  We’re watching vigilantly for any efforts to preempt local authority on tobacco issues, to criminalize youth possession of tobacco products, and any efforts to undermine the statewide smoke-free workplace law.  We’re also remaining vigilant to ensure that the bill that passes includes mint, menthol, and wintergreen flavors and also includes combustibles and other tobacco products.

From Kool to Juul: TFM Policy Forum

At this year’s Policy Forum, Tobacco Free Mass brought together national experts to examine the way the tobacco industry has used flavors, especially menthol, to target people of color and young people. We looked at the history and the impact of flavored tobacco and the tobacco industry’s use of the specific chemical qualities of menthol to make its products more addictive. What we learned has informed our conversations at the State House and has solidified our view of flavored tobacco as a social justice issue.

We’d like to thank our speakers, national experts with decades of experience, for a thought-provoking and motivational forum:

• Dr. Valerie Yerger, ND, Associate Professor in Health Policy University of California, San Francisco and founding member of the African American Tobacco Control Leadership Council
• Dr. Phil Gardiner, DrPH, Senior Program Officer, Tobacco Related Disease Research Program, University of California Office of the President and Co-Chair African American Tobacco Control Leadership Council
• Simon McNabb, Senior Policy Advisor, Office on Smoking and Health, Centers for Disease Control and Prevention
• The Policy Forum was moderated by Tobacco Free Mass’ Chair, Dr. Lauren Smith, a pediatrician and Co-CEO of FSG. 

Thank you to all of you who attended – it was amazing seeing so many people from so many different disciplines show such passion for this issue!

Slides of the presentations are available on Tobacco Free Mass’ website.

Upcoming Tobacco Free Mass Meetings

The next full coalition and Advocacy Committee meetings are coming up later this week!  Remember that we’ve switched to alternating months for Executive and Advocacy committee meetings, so the meetings are less frequent.

• October 24 – Advocacy Committee meeting from 10:00 AM to 11:30 AM at The Strategy Group’s offices at 40 Court Street, 11^th Floor, Boston
• December 5 – Full Coalition meeting from 10:00 AM to 12:00 PM – Massachusetts Medical Society, Waltham
• December 5 – Advocacy Committee meeting from 12:15 PM to 1:15 PM (following full coalition meeting) – Massachusetts Medical Society, Waltham

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

Upcoming Events and Opportunities

• October 24 – Flavored Tobacco Product Restrictions in Massachusetts: Impact on Availability and Youth Use. Webinar from 2:00 – 3:30 PM.  In response to the proliferation of alcohol, candy and fruit flavored tobacco products in stores, cities and towns across the nation have taken policy action to remove flavored tobacco products from youth-accessible retailers. This webinar will cover the ongoing evaluation of flavored tobacco product restrictions passed in several municipalities across the state of Massachusetts. Evaluators from Massachusetts will discuss the impact of such policies on statewide availability of flavored tobacco products, retailer compliance, and the state’s enforcement infrastructure. Results from the policy’s short-term impact on youth tobacco use in two communities and a detailed overview of flavored tobacco product availability before and after policy implementation in Boston, Massachusetts will also be discussed. Provided by the Massachusetts Tobacco Cessation and Prevention Program.  Free. No registration required. Use this link to connect to the webinar.
• October 24 – Maximizing the Political Determinants of Health: The 16^th Annual Public Health Leadership Forum. 1:00-5:00 PM at the Massachusetts Medical Society.  Nope, not a typo—same date as the webinar above.Policy leaders and the medical community now widely acknowledge that the physical, economic, environmental, and social conditions in which people live have a significant impact on health outcomes. Yet initiatives to abate the health effects and disparities caused by social determinants have been slow-moving. This program will examine the impact political decision-making and policies have on patients and on medical practice, as well as the physician’s role in supporting evidence-based policies based on efforts to improve health outcomes.  Keynote presentation by Monica Bharel, MD, MPH, Commissioner of the Massachusetts Department of Public Health.  Free, but registration required. See flyer (attached) for details.

The rest of this month promises to be unpredictable and entertaining—I’ll let you know as soon as anything happens with the flavor legislation or anything else!