Big City Tobacco Control
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Commissioner Choucair presenting at the National Cancer Institute State and Community Tobacco Control Research Initiative, September 2014 Meeting.
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Big City Tobacco Control
- 1. Big City Tobacco Control Bechara Choucair, M.D. Chicago Department of Public Health September 19, 2014 @choucair #HealthyChicago
- 2. Tobacco control is one of the top priorities of Healthy Chicago โ and for good reason. โEnsuring that our children donโt start smoking is a key priority for the City of Chicago.โ โMayor Rahm Emanuel HEALTHY CHICAGO Supporting Document Available: http://bit.ly/1lFMoHL
- 3. Taxes are Upโฆ And Youth Smoking is Downโฆ 3 $8.00 $7.00 $6.00 $5.00 $4.00 $3.00 $2.00 $1.00 $0.00 30 25 20 15 10 5 0 Tobaco Tax in Efect Percent Youth Smoking Youth Smoking Rates and Total Tobacco Tax, Chicago % Youth Smoking Total Effective Tax Linear (% Youth Smoking) Effective January 1, 2014, Chicago has the highest-priced cigarettes in the country. All taxes combined equal $7.17 a pack.
- 4. CALLING ON THE FDA TO ACTโฆ To immediately disrupt tax evasion, the Mayor has called on the FDA to implement a national โTrack and Traceโ System. Track and Trace is required by the Tobacco Control Act of 2009 โ a bill he co-sponsored. The Mayor has made bold calls to action on menthol, too.
- 5. FINDING LOCAL SOLUTIONS TO TAX EVASIONโฆ Residents provide tips about illegal sales including unstamped cigarettes, sales to minors, or sale of โloosies.โ $100 cash rewards 60 days into the program and we know it is working!!
- 6. BOLD ACTION ON MENTHOL... We all know it takes a long time to get things done in Washington, D.C. Less than 48 hours after the FDAโs menthol report was released, Mayor Rahm Emanuel insisted the City must take swift action.
- 7. A Special Town Hall Meeting: Reducing Menthol Use Among Chicagoโs Youth Thursday, September 19th 6:30 โ 8:00PM Austin Town Hall Park Field House 5610 W. Lake Street In Collaboration with Representative LaShawn Ford Refreshments generously provided by American Heart Association Chicago Southside Cancer Disparities Initiative Coalition for Asian Substance Abuse Prevention For more information please contact Juleigh Nowinski Konchak at 312-747-9656.
- 8. FLAVORED TOBACCO PRODUCTS SIMPLY DO NOT BELONG NEAR SCHOOLS... Chicago has banned the sale of flavored tobacco within 500feet of schools. Convenience stores near schools contain more cigarette advertising than stores farther from schools. This is especially true of schools located in minority communities.
- 9. CHARTING A NEW PATH OTHER CITIES AND TOWNS CAN FOLLOWโฆ No other jurisdiction at any level of government โ Federal, state, or local โ has ever included menthol in the laws that regulate flavored tobacco. Local governments have always led the way on tobacco control. Supporting Document Available:http://bit.ly/1fUmK9f
- 10. REGULATION OF THE SALE OF E-CIGARETTESโฆ Behind the counter, out of reach of children. Licensing requirements, youth sting operations and penalties for selling to minors. New restrictions on flavors apply to e-cigarettes!
- 13. Smoke-Free Parksโฆ 580 parks 90 gardens 90 museum campuses 9 lakefront harbors 9 ice skating rinks More than 24 miles of lakefront property, including 17 historic lagoons
- 14. Chicago, in just one short yearโฆ New tax = Highest priced cigarettes Only law regulates menthol cigarettes as a flavored tobacco product First of the 20 largest U.S. city to propose legislation to include e-cigarettes in their clean indoor air law Comprehensive regulations on sale of e-cigarettes, too, including flavored e-cigarettes Smokefree parks
- 15. Are you thinking of research questions? With Chicagoโs newest tax, did we hit a point of diminishing returns? Or, are we still enjoying substantial health and economic benefits of tax increases? What was the impact? Did limiting the sale of flavored products near schools help prevent youth experimentation with tobacco?
- 16. Are you thinking of research questions? Did limiting the sale of flavored tobacco cause other benefits, such as reductions in tobacco displays and advertising that are popular with kids? Is the African American community continuing to support restrictions on menthol? Do restrictions on menthol help reduce health disparities?
- 17. Are you thinking of research questions? How were retailers impacted? Did the sky fall? Are sales restrictions effective in keeping e-cigarettes out of the hands of kids? What is happening in cities where no such policies exist? What is the impact of smokefree parks on litter? What about tobacco use? Are people obeying the law?
- 19. Academic partners matterโฆ Deciphering the evidence base. Identifying promising policy options and quality improvement efforts. Science-based study of the development, implementation, and impact of public health policy. Making the case for replication of innovative policy projects proven to be successful.
- 20. 20 Bechara Choucair, M.D. Chicago Department of Public Health @choucair #HealthyChicago
Editor's Notes
- Good morning! It is such an honor to be here. I was looking at the list of attendees. There appear to be tobacco control policy experts here from every corner of the country. This such an impressive crowd. To all of those who traveled to be here, on behalf of the City of Chicago and Mayor Rahm Emanuel, welcome to Chicago โ weโre glad youโre here! And, you know, it really is appropriate the location for this national tobacco control research conference is in Chicago! Under the leadership of Mayor Rahm Emanuel, Chicago has become THE national leader in innovating new tobacco control policies. During his first 100 days in office, Mayor Rahm Emanuel released โHealthy Chicago,โ the Cityโs first-ever comprehensive public health agenda. Tobacco control is one of the top priorities of Healthy Chicago. And, as you will see in a minute, Mayor Emanuel is taking his commitment to innovating new tobacco control policy very seriously.
- We all know increasing the price of tobacco is the SINGLE MOST EFFECTIVE WAY to reduce youth consumption. We can attribute the steep declines in youth smoking to taxes. And, I am proud to tell you that Chicago has the single highest price cigarettes in the country. No other jurisdiction in the U.S. has higher priced cigarettes. In fact, in Chicago, some premium brands sell for up to $14 a pack! This is because, at the end of last year, in his budget, Mayor Emanuel proposed a significant increase in the tobacco excise tax. Ultimately, the City Council passed a 50 cent tax increase on a pack of cigarettes. And, effective January 1 of this year, each pack is taxed at a whopping $7.17 per pack. Itโs also worth noting that youth prevalence rates have hit a record low in Chicago. In 2000, about a quarter of all highschool students smoked. Today, that number is just 1 in 10. In 2011, (when Mayor Emanuel took office) youth smoking rates in many parts of the U.S. began to plateau โ but, not in Chicago.ย Under Mayor Emanuelโs leadership we continue to see steep declines in youth smoking. ย Again, today, only one in 10 CPS students smoke. This is a record low โ a full five points below the national average and the lowest youth smoking rate ever recorded in Chicago.ย ย
- Of course, whenever I am in a room with tobacco control researchers talking about taxes, I know they will want to talk about tax evasion, too. The City of Chicago takes tax evasion very seriously because of in the impact is has on kids. That is why โฆ we have called on the FDA to implement a national track and trace system. A national โTrack and Traceโ system is required, by law, under the Tobacco Control Act of 2009. It is worth noting that Mayor Emanuel co-sponsored the Tobacco Control Act when he served in Congress. And, he saw it signed into law when he served as Chief of Staff at the White House. As shown there on the screen, the Mayor has also called on the FDA to act on Mentholโฆ Which I will talk about more in just a bit.
- But, first, I want to talk about our innovative, local efforts to thwart tax evasion. We know it could be years before a national โTrack and Traceโ system will be in place to crack down on tax evasion. That is whyโฆ In June, the Chicago Department of Public Health (CDPH) and BACP launched the โCheck the Stampsโ campaign โ offering $100 rewards to residents whose tips of illegal salesย result in a conviction against the person or persons selling cigarettes illegally.ย We have a big announcement coming soon on this program. I cannot share too many details, just yet. But, let me assure you, just 60 days after launching this program, there are very strong signs it is working. Stay tuned for more exciting news!
- Last summer (July 23, 2013), the FDA released a scientific report related to menthol-flavored cigarettes. The FDAโs report confirmed what the public health community has known for years โ that menthol flavored cigarettes are more addictive and harder to quit. They are a starter product for youth. Kids aged 12-17 smoke menthols more than any other group. In addition, significant racial, gender and socioeconomic disparities were found in in the use of menthol cigarettes. We all know it takes time to get things done in Washington. But, here in Chicago, we donโt wait for the Feds to lead. Which is whyโฆ Less than 48 hours after the FDAโs report on menthol was released, Mayor Emanuel took swift action โ urging the Board of Health to host a series of townhall meetings to educate the public about the unique health harms of menthol-flavored cigarettes and to seek the publicโs feedbak in crafting local policy options to curb their use. See โPreliminary Scientific Evaluation of the Possible Public Health Effects of Menthol versus Non-menthol Cigarettes.โ
- The Board of Health held townhall meetings all across the City following a Mayoral request. One of the town halls was bilingual. Hundreds of Chicago residents participated. And, a few national experts even flew in to give testimony. One of the things we are most proud of is that we engaged dozens of non-traditional partners in this process โ not just organizations like Cancer, Heart, and Lung. Groups like the Illinois African American Coalition for Prevention, Hip Hop Detox, Y2Kwanzaa, the Urban League, Howard Brown Health Center, the Chicago LGBT Health Advisory Council, Asian Health Coalition, and the Chicago Hispanic Health Coalition are just a few of the organizations that came to the table in a leadership role.
- One of the things we heard over and over during town hall meetings was that flavored tobacco products do not belong near youth-centered environments. National experts testified that adolescents are routinely exposed to the widespread advertising for cigarettes located in stores near schools. And, tobacco retail outlets near schools have been found to contain more cigarette advertising than outlets farther from schools โ this is especially true of schools located in minority communities. Now, we all know that nearly all adult smokers started as adolescents โ usually using a flavored tobacco product. We also know that youth aged 12 to 17 use menthol more than any other age group. That is whyโฆ In Chicago, we are piloting a brand new policy. Effective November 7 of this yearโฆ Flavored tobacco products, including menthol-flavored cigarettes, cannot be sold within 500 feet of a Chicago school.
- Of course, we realize the policy solution Chicago chose to pursue might not be politically viable in other communities. And, we realize not everyone has the staffing or resources to engage in extensive townhall meetings and to compile a list of potential policy options. That is why we developed the report that you can see there on the left hand side of the screen. This report summarizes testimony that was given by Chicago residents during our townhall meetings and it outlines more than 25 policy options, as well as important pitfalls to avoid. It is our hope that other cities and towns will use the information contained in this report to help educate the public about the dangers of menthol-flavored cigarettes and to build support for a variety of new, innovative policy changes at the local level. It is important to point out that local governments have ALWAYS led the way on tobacco control. Local government lead the way on taxes and clean indoor air. Local governments lead the way on youth access restrictions. And, its appropriate for cities and towns to lead on menthol-flavored cigarettes and other emerging tobacco control problems, such a e-cigarettes.
- Speaking of e-cigarettesโฆ Chicago has the single-most comprehensive e-cigarette laws ANYWHERE in the country. Earlier this year, the Chicago City Council overwhelmingly passed an ordinance to regulate e-Cigarettes. The vote was 45 to 4. In Chicago, e-cigarettes have to be locked up or behind the counter โ out of the reach of children. ย Stores have to have a tobacco license to sell e-cigarettes. The sale of e-cigarettes is becoming part of our youth sting operations. Retailers that sell cigarettes to kids can be fined and have their license revoked. If sales to minors occur repeatedly, we donโt just revoke their tobacco license, we can revoke ALL of the business licenses. Literally, we can shut them down. And, something I am very excited about, our new law that restricts the sale of flavored tobacco products near schools โ it applies to e-cigarettes. We are the ONLY jurisdiction in the country with this kind of law. Of course, we hope that will change soon because we would like to see other cities and towns enact these policies, too.
- In Chicago, we also acted swiftly to regulate the use of e-Cigarettes in public places. We were the FIRST of the 20 largest cities in the U.S. to introduce this kind of legislation. (NYC and L.A. introduced shortly thereafter. NYC passed it first. L.A. implemented it first.) We limited the use of e-cigarettes in public places for three reasons: We are concerned e-cigarettes are re-normalizing smoking and have the potential to reverse decades of tobacco control progress. We heard compelling testimony from waiters and bouncers that e-cigarettes create confusion in bars and restaurants and were causing problems with enforcement of the smokefree law. Chicagoโs e-cigarette ordinance makes enforcement of the existing smokefree law easier. And, finally, we are convinced the aerosol from e-cigarettes is not just water vapor. Laboratory test have provide more than enough evidence to be concerned. We believe everyone has the right to breathe clean indoor air. And, in Chicago until these products are proven safe, we will not allow that right to be eroded.
- City government is not doing this work alone. Across the city, organizations are enacting institutional policies, too. Right here at the University of Illinois at Chicago, a smokefree policy has been passed. It is a policy that will impact 27,000 students, as well a faculty, staff, and hospital patients and visitors. Chicago Housing Authority has continued is its smokefree work โ designating the Dearborn Homes and Sullivan Station smoke-free โ bringing the total number of smoke-free CHA developments to 6 with a total of 610 smoke-free public housing units. And, demand for smokefree housing is so large there is a waiting list. In the private sector, more than 3,500 multi-unit residences in Chicago have gone 100% smokefree.
- And, just last week, Chicago Parks District โ which is the nationโs oldest and largest park district โ voted UNANIMOUSLY to go smokefree. This policy change has received national attention. Mostly positive. And, it even captured the front page of the RedEye. The geographic scope of this policy is stunning. More than 580 parks in the city will be smokefree, including 24 miles of lakefront property.
- All of the new policies I just outlined for you passed between now and last November โ that is remarkable progress in less than 11 months. It has been a truly remarkable year for tobacco control policy in Chicago! So, right now, if you are thinking to yourselfโฆ โWow! No sitting policymaker in the U.S. has a stronger tobacco control record in the U.S. than Mayor Emanuel,โ I think youโre right.
- Or, because youโre researchersโฆ perhaps your thinking about all the research questions running through your mind? For example, maybe youโre wonderingโฆ With Chicagoโs newest tax, did we hit a point of diminishing returns? Or, is Chicago still enjoying substantial health and economic benefits related to tax increases? What was the impact? I know that Dr. Jamie Chriqui from UIC is here. I am sure that she or Dr. Chaloupka might have an interest in this. Did limiting the sale of flavored products near schools help prevent youth experimentation with tobacco?
- Or, maybe youโre wondering... Did limiting the sale of flavored tobacco cause other benefits, such as reductions in tobacco displays and advertising that are popular with kids? Is the African American community continuing to support restrictions on menthol? Do restrictions on menthol help reduce health disparities?
- Or, perhaps your wonderingโฆ How were retailers impacted? Did the sky fall? I know that Dr. Sandy Slater is here, too. She and Dianne Barker have been talking to my staff about this. And, I was excited to hear they are likely to be funded to study the menthol policy change here in Chicago. That is great news! If you are wondering if sales restrictions on e-cigarettes effective in keeping them out of the hands of kids, there is no better laboratory to study this question than in Chicago. What is happening in cities where no e-cigarette policies exist and how do they compare to Chicago? That is a question that needs to be answered โ and, fast. And, what is the impact of smokefree parks on litter? What about tobacco use? Are people obeying the new law?
- Partnerships play an important role in all of the Departmentโs work. We are actively engaged with hundreds of different organizations on a wide variety off health policy proposals. There are far too many to list in just one slide. So, I am putting upon the screen just a handful of some of our closest partners who work on tobacco control policy with us. Of course, there is one set of partners we cannot afford to missโฆ
- You. Our academic partners. You play an absolutely essential role to this work. Academic partners from UIC and UCSF were absolutely essential to helping my department decipher and digest all of the rapidly emerging literature on menthol-flavored cigarettes and e-cigarettes. These academic partners also helped us, based on peer reviewed literature, suggest a wide range of policy options for us to test that might work. And, some of them came to City Hall explained the evidence base to Aldermen and advocated for the policies. Now that that those policies are in place, we need science-based study of these policies and their impact on public health. And, of course, if the policies are proven successful, we need the help of academic partners to disseminate the findings so the policies can be replicated in other jurisdictions. There is an essential role for academic partners at every step of the policy development process. We need program evaluations, too. The tax evasion program I mentioned at the beginning of my remarks is a program that could easily be replicated all across the country. It will be ripe for an evaluation in just a few months! Regarding yesterdayโs breakout session on the STARS Collaborative Project, my staff tells me that researchers here at this conference will be attempting to validate a data collection instrument to determine if it can be used reliably by local practitioners. The data collection instrument will be used to capture point-of-sale information about tobacco advertising and displays. The development of this instrument will be essential to evaluating the effectiveness of Chicagoโs new flavored tobacco policy. We have an interest in this work and we want to be a good partner, too! Dr. Slaterโฆ My staff tell me you and Dianne Barker have been asking for a lot of information about implementation of the menthol ordinance. We are happy to provide it! And, Kendall and Donna will do everything they can to provide staff and volunteer support, including efforts to recruit adult and youth advocates to help with the data collection necessary to test the inter-rater reliability of this instrument when used by trained adults and youth advocates โ like the thousands of youth advocates across the country that already collect that data through programs like Operation Storefront. It would be amazing if those youth advocacy efforts could also be used as part of a validated data collection process. Yesterday, there was also a breakout session where researchers University of North Carolina at Chapel Hill, UIC, RTI International, and Washington University discussed simulations of the effect of minimum pricing regulations. Let me tell youโฆ Dr. Chriqui and others who are doing this work, we would be interested in staying in touch.
- And, with that, Iโll entertain a few questions if I have any time left. Or, we can simply move into our panel discussion.