New Center Publication
Albany County Moves Closer to Ending Pharmacy Sales of Tobacco
CVS Ends Tobacco Sales Early
CDC Survey Results Raise Concerns of Rapidly Rising Youth E-Cigarette Use
FDA Cracks Down on Online Tobacco Retailers
Did you know…?
We at the Public Health and Tobacco Policy Center (Center) want to welcome new contractors to the tobacco control program! While returning contractors are familiar with the Center and its role within the program, we want to briefly introduce ourselves, describe how we may assist you and the communities with which you work, and let you know of some upcoming changes.
The Center provides legal expertise to support tobacco control and other public health policies. Within the context of New York’s tobacco control program, the Center serves as a resource and partner for tobacco control contractors and local communities to achieve policy change. Our support services include:
- Responding to specific law and policy questions from state program staff and contractors;
- Assisting local communities to craft policies to address specific needs;
- Developing model tobacco control policies to illustrate effective interventions for New York communities;
- Disseminating news about tobacco control laws and policies; and
- Surveying contractors to determine what support services have been most helpful in an effort to improve our technical assistance.
We share this news and information through various written resources, social media, webinars and conferences. Our written resources and news updates, including technical reports, educational guides, fact sheets, newsletters and litigation summaries may be found on our website at www.tobaccopolicycenter.org. Additionally, news updates and publications are often posted through Facebook (www.facebook.com/CPHTP) and Twitter (@CPHTP), so be sure to follow us!
All contractors should note that the Center will be available to assist you through December 31, 2014. Thereafter, our website and linked resources will be available, but will not be updated, pending the award of a new policy support center contract for the next grant period (to begin March 1, 2015). Please feel free to continue using the website and other written materials, but be sure to inform your community partners and leaders that we will be unable to provide technical assistance during that time.
We look forward to working with all of you during the coming months! Please do not hesitate to contact us with any questions.
The Center has published a new report to its website titled A Citizen’s Guide to New York Tobacco Controls.
A Citizen’s Guide to New York Tobacco Controls is a single tobacco control resource for New York citizens. The Guide presents current federal and state legal constraints on tobacco products in New York, along with the entity responsible for enforcing each control. The controls are organized by issue, focusing on those most relevant and accessible to a typical tobacco control advocate or consumer.
You can review the new publication here.
On August 11, 2014, the Albany County Legislature adopted by a vote of 21-17 a local law that would prohibit pharmacy sales of tobacco products. Specifically, the law would prohibit tobacco sales by health care institutions, pharmacies and retailers that contain pharmacies as of March 1, 2015.
Many pharmacies are delving into health care delivery, acquiring or developing health clinics within their stores. As these retailers evolve into health care providers, the sale of lethal tobacco products becomes hypocritical, and sends a dangerous mixed message about the risks of tobacco use. Moreover, the presence of these products, and their associated marketing materials, contribute to community normalization of tobacco – a factor in use rates.
Recently, CVS Health (formerly CVS Caremark, Corp.) came to the same conclusion and voluntarily eliminated tobacco products from its shelves. In announcing this move, the company stated that based on its study of the effect of pharmacy tobacco sales bans implemented in San Francisco and Boston (resulting in a 5.5-13% reduction in unique purchasers of tobacco products in those cities), CVS officials believe that significant reductions in tobacco use could be achieved by reducing the number of tobacco retail outlets—including pharmacies.
The Albany County effort is crucial because voluntary moves like that made by CVS are, according to some, unlikely to be replicated by other big pharmacy chains. While the County Executive vetoed the proposal on September 10, 2014, the legislature has 45 days to override that veto (an override requires the approval of 3/5 of the 39 member legislature—or 24 votes). Regardless of the final outcome, approval of this law by the legislature should be celebrated. The bill’s passage was made possible by the tireless community education efforts of contractors in the Capital Region and the strong leadership of Tim Nichols, the legislation’s sponsor.
The second-largest pharmacy chain in the country has pulled tobacco products from its shelves and committed to increasing its cessation services. The company fulfilled its promise, made earlier this year, to stop tobacco sales October 1st a month ahead of schedule. Dr. Troyen Brennan, chief medical officer at CVS Health (the new name of the company formerly known as CVS Caremark, Corp.) was quoted saying, “The sale of tobacco in a retail pharmacy conflicts with the purpose of health care services delivered there….Even more important, there is evidence developing that indicates that removing tobacco products from retailers with pharmacies will lead to substantially lower rates of smoking with implications for reducing tobacco-related deaths.”
Brennan was referring to evidence arising from a recent CVS Health study that concluded that the enactment of policies to eliminate the sale of tobacco products at retailers with pharmacies in San Francisco and Boston was associated with up to a 13.3 percent reduction in purchasers of tobacco products. While the study is limited by the small sample size and other factors, company officials say that the implications of significantly reducing smoking rates by reducing cigarette sales in pharmacies cannot be overlooked.
The removal of tobacco products from its shelves coincides with the rollout of the company’s “Let’s Quit Together” campaign promoting its smoking cessation services. The CVS website now provides an interactive nicotine dependence assessment for smokers and offers tips and information for both smokers and those who want to help loved ones quit.
Concerns over youth e-cigarette use continue to grow with the release of new Centers for Disease Control and Prevention (CDC) data. CDC survey results reveal that more than a quarter of a million youth who had never smoked a conventional cigarette used an e-cigarette in 2013. This is a significant increase from 2011 when 79,000 youth reported using e-cigarettes. Importantly, not only did more non-smoking youth report using e-cigarettes, those youth were also twice as likely to have intentions of trying conventional cigarettes (43.9% who had tried e-cigarettes compared to 21.5% who had not used e-cigarettes).
E-cigarette use among youth is particularly concerning for several reasons. Nicotine is especially harmful to youth as it is highly addictive and can harm adolescent brain development. The CDC reports that approximately three out of every four teen smokers become adult smokers. Because almost all adult regular smokers begin as teenagers, public health professionals worry that youth will transition from e-cigarettes to conventional cigarettes.
Consistent with prior studies, the CDC’s survey results confirm that youth exposure to tobacco product marketing is a determining factor in youth intention to smoke. Youth that reported exposure to tobacco marketing had higher rates of intention to smoke than those youth who did not report the same exposure.
The complete CDC survey results have been published in the journal Nicotine and Tobacco Research.
The Center for Tobacco Products (CTP) of the Food and Drug Administration (FDA) recently issued warning letters to four online tobacco retailers making sales in violation of the Family Smoking Prevention and Tobacco Control Act (FSPTCA) and the Comprehensive Smokeless Tobacco Health Education Act of 1986 (CSTHEA). The alleged violations include underage sales of tobacco products, unauthorized sale of products purporting to be “modified risk” products, and the sale of prohibited flavored tobacco products.
Sales to minors
The FSPTCA prohibits the sale of tobacco products to any person under the age of 18. All four retailers were cited for selling tobacco products to minors through their websites. While it is unclear how the violations were detected, the FDA monitors compliance by investigating whether minors are able to successfully complete an online purchase (among other methods).
Sale of modified risk products
The FSPTCA prohibits the sale of any “modified risk tobacco product”—a product marketed with language that explicitly or implicitly communicates that a tobacco product presents a lower risk of harm, contains less of or is free from a harmful substance—without prior FDA approval. The CTP warned two retailers that they used prohibited tobacco product descriptors such as “light” and “mild” to describe tobacco products for sale through their websites and warned another retailer that made health claims about certain products on their site such as “[t]here is no known scientific literature linking entorrhinal cancer (cancer of the nasal cavity) to the use of nasal snuff. It is by far the safest form of tobacco use.”.
Sale of flavored cigarettes
The FSPTCA prohibits the sale of cigarettes or component parts (including tobacco, filter, or paper) with a “characterizing flavor” other than tobacco or menthol flavors. The CTP warned two retailers about their sale of flavored cigarettes in violation of the provisions of the FSPTCA.
Health warnings in advertising
The CTP warned one retailer that it was selling smokeless tobacco products without including the required health warning label statements in their smokeless tobacco product advertisements. The CSTHEA (as amended by the FSPTCA) requires that smokeless tobacco product advertisements be labeled with one of the following health warning label statements:
WARNING: This product can cause mouth cancer.
WARNING: This product can cause gum disease and tooth loss.
WARNING: This product is not a safe alternative to cigarettes.
WARNING: Smokeless tobacco is addictive.
For more information the CTP warning letters can be visited on the FDA website here:
Local boards of health in New York play an important role in the enforcement of public health laws and local tobacco control interventions. New York State authorizes the establishment of local boards of health at the county, city, town or village level. The state charges local boards of health with adopting public health regulations, so long as the regulations help the board of health carry out the specific powers delegated to them under state law. In other words, boards of health can “fill in the details” of state statutory grants of authority; in the context of tobacco control, local boards of health may adopt regulations that further their enforcement efforts related to Clean Indoor Air Act and the Adolescent Tobacco Use Prevention Act (ATUPA) and may adopt regulations that further their enforcement efforts. For example, the Dutchess County Board of Health adopted regulations establishing a registration requirement for tobacco retailers to more effectively carry out ATUPA enforcement activities.
Local boards of health are technically a branch of the state government, even though they are located within communities. This means that while most counties in New York have established a county board of health, over 20 counties rely on district offices of the New York State Department of Health to enforce many of New York’s public health laws.
Contact information for local Boards of Health can be accessed via the New York State Association of County Health Officials website: http://www.nysacho.org/i4a/member_directory/feSearchForm.cfm?directory_id=2&pageid=3289&showTitle=1.
Contact information for the State District offices can be found here: https://www.health.ny.gov/environmental/water/drinking/distphn.htm.