Once a national leader in anti-tobacco efforts, California is slipping in some key measures, including its low cigarette tax, according to an annual ranking of cancer-fighting policies in all 50 states, released Thursdayby the American Cancer Society.
The study emphasized tobacco use, but looked at other anti-cancer measures, such as bans on tanning beds, cancer research spending, healthier eating and cancer screenings for breast, cervical and colorectal cancers.
By some measures, the study found that California is doing better or on par with other states, citing the state’s success with expanding health care access under Medi-Cal, preventive screenings to low-income women for breast and cervical cancers, banning teens under 18 from indoor tanning beds, and “significant investments” in cancer-related research.
But in other efforts, California came up short.
“For most of the rest, we’re either doing fair or poor,” said Jim Knox, vice president of government relations with the American Cancer Society’s advocacy arm in California. “Most people in California probably assume we have model legislation and lead the country, but the reality is we’re in the back of the pack.”
Surprisingly, California did not lead the country in smoke-free workplaces, despite passing one of the country’s first bans covering restaurants and bars in 1995. Other states have extended those workplace protections statewide to all public spaces, including hotels and gambling facilities, which aren’t covered in California’s law. “Although we have the first law, it’s among the loopier laws in existence,” said Knox. “It’s long overdue for us to go back and clean up those holes and make it the model law that other states have created.”
The study comes as California lawmakers are debating several contentious tobacco-related bills in special session. In California, the survey’s state-by-state comparisons are more than welcome in some quarters. “The good news here is (that) there are legislative remedies to all of these shortcomings and they’re all pending this summer,” Knox said.
Here’s a look at four areas where the American Cancer Society says California fell behind:
At 87 cents, California has one of the lowest tax on cigarettes in the country, where the average is $1.59 per pack. The report said all states but three – California, Missouri and North Dakota – have raised their excise tax in the last 15 years, but recent efforts have stalled.
In California, legislation by state Sen. Richard Pan, D-Sacramento, to raise the state’s tax to $2 a pack was pulled in June. The additional revenue, about $1.5 billion a year, would have been partly used to fund cancer research, smoking prevention programs and anti-tobacco advertising.
“It’s clearly the biggest fight,” said Knox, noting that California has not significantly raised its cigarette tax since 1997, despite repeated attempts. “The tobacco industry never walks away from this type of fight. We’ve tried many times, and we’ll keep working on it until we get it passed.”
According to the American Cancer Society, for every 10 percent hike in the per-pack cost of cigarettes, there’s a 6.5 percent drop in youth smoking rates and a 4 percent decline in overall cigarette use.
Currently, e-cigarettes are banned for those under age 18 but do not fall under the same tax and advertising restrictions as regular tobacco products, such as cigars and cigarettes. State Sen. Mark Leno, D-San Francisco, is reviving legislation, SB 2X-5, that would regulate e-cigarettes similarly to regular tobacco products, plus require childproof packaging. An earlier bill, SB 140, died in an Assembly committee on July 8, after e-cigarette proponents and owners of vaping shops said their product was not nicotine-based and the proposed legislation would kill jobs.
Much of the alarm comes from surveys showing that e-cigarettes, which come in candy, fruit and alcohol flavors, are particularly popular among teenagers. In January, the state Department of Public Health issued an advisory about the alarming toxicity of e-cigarettes and warning Californians “to avoid the use of e-cigarettes and keep them away from children of all ages.”
California young adults, ages 18 to 29, are three times more likely to use e-cigarettes than those 30 and older, the state said. And nationally, there’s been a surge in teens using e-cigarettes, compared with regular smokes. In 2014, nationwide, “more than twice as many eighth- and 10th-graders (reported) using e-cigarettes more than traditional cigarettes,” the state said.
Raising the smoking age
Currently most states set 18 as the minimum age to purchase cigarettes, but Hawaii and more than 80 municipalities, including New York City, have raised that threshold to 21.
In California, a bill by Sen. Ed Hernandez, D-Azusa, to raise the legal age to 21 passed the Senate but stalled in the Assembly in July. The senator has reintroduced the measure in the current special session.
A recent U.S. surgeon general’s report said 5.6 million youths are expected to die prematurely from tobacco-related disease if current smoking rates remain the same.
According to a recent federal Institute of Medicine study, raising the smoking age “will likely prevent or delay initiation of tobacco use by adolescents and young adults,” particularly those ages 15 to 17 years. It said that raising the U.S. smoking age to 21 would result in about 223,000 fewer premature deaths and 50,000 fewer deaths from lung cancer for those born between 2000 and 2019.
Only seven states fund their tobacco-prevention efforts near levels recommended by the federal Centers for Disease Control and Prevention, based on federal and state allocations. According to the CDC, California should be spending $347.9 million annually; instead, the state allocates about $58.9 million to tobacco-prevention programs, roughly 16.9 percent of what it should. It ranks in the bottom half of all 50 states.
“The current low funding threatens the viability of state tobacco control programs that promote the health of residents, reduce tobacco use and provide services to help people quit,” the study said.
Despite nationwide strides in reducing smoking-related deaths, there’s a continued threat of backsliding, say some experts.
“There’s always the risk that these trends could reverse if we don’t sustain the effort,” said Richard Bonnie, a University of Virginia law professor, who has chaired several Institute of Medicine research committees on tobacco use, including a recent study on raising the minimum smoking age. “We’ve had the success only because we’ve had the sustained effort.”