Raising the Sale Age for Tobacco Products in the North Country Lead • Empower • Innovate Raising the Sale Age for Tobacco Products in the North Country Presenter Name Title Presenter Name Title 2017

Tobacco Use and Health Impact

This is the North Country’s world. “Two Worlds” There has been a substantial decrease in smoking in the US with just 15% of adult Americans still smoking, but… Americans with less income, less education or who live in a rural area now smoke more and die more from cigarettes than other Americans. This is the North Country’s world.

Adult Smokers in the North Country

Young Adult Smokers in the North Country

ENDS – Electronic Nicotine Delivery Systems Vaping among high school students in New York State doubled between 2014 and 2016 and far exceeds the rate of cigarette smoking. Studies show that youth who vape are more likely to smoke cigarettes than those who don't vape.

Family Members, Friends, Co-Workers The incidence rates (per 100,000 population) in the North Country exceed the New York State rates for the following smoking-related health conditions: Condition North Country Rate New York State Rate Lung & Bronchus Cancer Incidence 84.8 61.6 Lip, Oral Cavity & Pharynx Cancer Incidence 12.2 10.5 Chronic Lower Respiratory Disease Incidence 107.8 99.1 Cardiovascular Disease Premature Deaths 48.7 29.8 Premature Births 2.0 1.7

Premature Death Tobacco remains the leading cause of preventable disease and premature death in the U.S. More than half a million Americans die each year due to smoking, including as many as 28,000 New Yorkers. ©2015 Trinity Health - Livonia, MI

Causes of Death in the U.S.

Young People and Tobacco

Moving From Experimental Smoking to Regular Use 95% of current adult smokers began before the age of 21. The ages of 18 to 21 are a critical period when many smokers move from experimental smoking to regular, daily use. ©2015 Trinity Health - Livonia, MI

Surgeon General’s Warning Individuals who begin smoking at a young age have a greater risk of becoming addicted, progressing to daily use, transitioning to heavier use in adulthood, and having difficulties quitting.

Nicotine’s Impact on Young People Nicotine is addictive, and adolescents and young adults are more susceptible to its effects because they are still going through critical periods of growth and development.

Early Nicotine Use Changes the Brain Compared to non-smokers, adolescent smokers experience… 3 times more alcohol use 8 times more marijuana use 22 times more cocaine use Higher dropout rates Higher rates of unplanned pregnancy

Why Raise the Sale Age?

Tobacco Supply to Younger Kids 18–20 year olds purchase only 2% of cigarettes sold, but are 90% of the supply of addictive tobacco to younger kids.

Older Kids Are A Source of Cigarettes More than two-thirds of 10th grade students and nearly half of 8th grade students say it’s easy to get cigarettes. Older youth smokers (18-19 years) are a major supplier of cigarettes for younger kids who rely on friends and classmates to buy them. More 18-19 year olds in high school means younger kids have daily contact with students who can legally purchase tobacco. Helps keep tobacco out of schools.

Saves money (health care savings) Scientific Evidence 21 There is increasing scientific evidence that raising the sale age for tobacco… Saves lives and… Saves money (health care savings) 18 ©2015 Trinity Health - Livonia, MI

Institute of Medicine Report

12% Drop in Premature Births Over Time… Immediate impacts… 12% Drop in Premature Births 16% Drop in SIDS

Potential North Country Impact Raising the sale age to 21 throughout the North Country will improve the region’s health, save lives and reduce health care costs. For example, raising the sale age would: Reduce the number of potential new smokers (approximately 13,000) among young people currently between the ages of 0 to 17 by as many as 1,575 individuals.

Potential North Country Impact Reduce the number of premature deaths due to smoking-related conditions; more than 2,000 North Country residents died prematurely due to cancer, heart disease, and chronic lower respiratory disease between 2012 to 2014. Reduce the $6 million in Medicaid costs currently incurred each year by North Country counties to treat tobacco-related illnesses and diseases.

Impact of Change to Minimum Drinking Age

Raising the Sale Age is Popular Across the board, the majority of adults in every demographic group (i.e., age, race, gender, education level, U.S. Census region, and income) as well as smoking-status category supported increasing the minimum age. ©2015 Trinity Health - Livonia, MI

Get a license to possess or carry a handgun (in NYS) You Must Be 21 To Buy alcohol Gamble in a casino Get a license to possess or carry a handgun (in NYS) Rent a car (must be age 25) Rent a hotel room in some hotels

Approx. 60% of NYers Reside in Counties with Sale Age of 21 NYC (all five boroughs) (2014) Suffolk (2014 ) Orange (2016) Albany (2016) Schenectady (2016) Cortland (2016) Cattaraugus (2016) Chautauqua (2016) Sullivan (2017) Tompkins (2017)

Local Law to Raise the Sale Age for All Tobacco Products

Model Local Law A local law to raise the sale age would prohibit the sale of tobacco products, not the possession of tobacco products.

Model Local Law A strong local law that raises the sale age for tobacco to 21 would include the following: A comprehensive list of all tobacco and smoking-related products that would be prohibited for sale. A requirement that the purchaser demonstrate with a photographic ID that he/she is at least 21 years of age.

Model Local Law A requirement that a business post, in a conspicuous place, a sign that contains information about the sale age. Authority for the county to inspect businesses for compliance with the law.

Model Local Law The option to impose a civil penalty upon a person who violates the law. An enforcement protocol that could include random inspections of places that sell tobacco products or the authority to receive and pursue complaints about violations of the law.

Questions and Answers

Questions and Answers Q. Who supports raising the sale age in the North Country? A. A Task Force of more than 35 organizations in the region are working together to reduce tobacco use in the North Country. The Task Force has collected Statements of Support from many other health care, behavioral health, faith- based and community-based service organizations from throughout the region.

Questions and Answers Q. Shouldn’t the sale age for tobacco be a statewide law? A. There is state legislation that has been introduced, but not voted on by the state legislature. The more counties that pass local laws, the more likely a state law will ultimately be implemented. By adopting local laws in our counties, the North Country can take a leadership role in making 21 the legal sale age throughout NYS.

Questions and Answers Q. Shouldn’t people over 18 have the right to make their own decisions about tobacco use? A. Is tobacco use a right or an addiction? Nicotine is addictive and adolescents are more susceptible to its effects because their brains are still developing. Our society has always recognized that young people are vulnerable to impulsive and risky behaviors and have granted young people gradually increasing access to potentially dangerous activities.

Questions and Answers Q. If people under 21 can serve in the military, shouldn’t they also be able to choose to use tobacco? A. The Department of the Defense (DoD) wants to dramatically reduce tobacco use among recruits and service members. DoD recognizes that tobacco undercuts military readiness, impairs healing of wounded warriors, and costs an estimated $1.6 billion each year in medical costs and lost work time.

Questions and Answers Q. What will be the impact on businesses that sell tobacco? A. Raising the sale age to 21 would result in an immediate 2% loss in revenue. Retailers would adjust to the changing market conditions just as they did when the alcohol sale age was increased. Needham, MA, which raised the age in 2006, experienced a 47% reduction in youth smoking without a single retailer going out of business.

Questions and Answers Q. What will be the impact on county budgets? A. A study showed a minimal decrease in sales tax (0.48% at most). This loss would be more than offset by healthier county residents and a significant reduction in a county’s Medicaid expenditures related to treating health conditions caused by tobacco use (approximately 10% of all Medicaid expenditures in NYS).

Learn more about the initiative on the website HealthyADK at Show Your Support There are a number of ways to show your support for raising the sale age to 21 throughout the North Country including: Join the North Country Tobacco Use Reduction Task Force. Sign a petition to voice your support for raising the sale age. Have your organization sign a Statement of Support. Learn more about the initiative on the website HealthyADK at http://www.healthyadk.org/

Presenter Name email address www.ahihealth.org | 518.480.0111