Truths of Chicago's Tobacco Policy

Notes de l'éditeur

1. No tweeting! Molly Murphy’s polling data suggests people do not believe any level of government is excellent. But, I have to brag on Chicago and tell you why we are. Mayor Larry MacDonald – Bayfield, WI. Just 460 miles off. Will come full circle and bring my bragging back to lessons learned.
2. I want to start my presentation by talking about “Healthy Chicago.” During his first 100 days in office, Mayor Rahm Emanuel released “Healthy Chicago,” the City’s first-ever comprehensive public health agenda. Tobacco control is one of the top priorities of Healthy Chicago — and for good reason. Tobacco still remains the #1 cause of disease and death. And, let me tell you right off the bat, under the leadership of Mayor Emanuel, the City of Chicago has been using a wide variety of innovative strategies to reduce smoking among adults and to keep tobacco out of the hands of children. And, the past year has truly been extraordinary!
3. The theme for this presentation is “TRUTH TELLING.” So, I’ll start with a TRUTH that we all know already… 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. It’s 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 — but, not in Chicago.  Under Mayor Emanuel’s leadership we continue to see steep declines in youth smoking.  Again, today, only one in 10 CPS students smoke. This is a record low — a full five points below the national average and the lowest youth smoking rate ever recorded in Chicago. 
4. The second TRUTH is that tax evasion is real. And, the TRUTH is, there is a solution available at the Federal level to immediately disrupt tax evasion. It called a “Track and Trace” System. It is the same kind of system that tracks FedEx Packages. Or, our luggage when we fly. Tobacco products could be traced through the supply chain to let us know when products are being diverted into the Black Market. This system is something that is statutorily mandated in the Tobacco Control Act if 2009, a piece of legislation that Mayor Emanuel co-sponsored when he was in Congress and saw signed into law when he served at Chief of Staff at the White House. And, since then, the Mayor has publicly called on the FDA to act on the “Track and Trace” system. Unfortunately, another TRUTH is we all know it takes a long time to get things done in Washington. The TRUTH is, when change is slow to happen on the Federal level, we can and should act on the local level. That is why… In June, the Chicago Department of Public Health (CDPH) and BACP launched the “Check the Stamps” campaign – offering $100 rewards to residents whose tips of illegal sales result in a conviction against the person or persons selling cigarettes illegally.  Within just the first 60 days of this program being launched, $500 Million in fines written related to the sale of untaxed cigarettes, loosies, and other illegal transactions involving tobacco.
5. Another TRUTH we all know very well is that smoke-free laws create environments that encourage adults to quit and prevent kids from ever picking up the habit in the first place. This is why Mayor Emanuel supported a new, 100% smoke-free policy (including e-cigarettes) that was unanimously adopted in September by the Chicago Parks District – which is the oldest and largest park district in the U.S.
6. You probably realize by now, that Mayor Emanuel doesn’t have any friends in Big Tobacco. And, it is not hard to see why the tobacco control community is a big fan of Mayor Emanuel. But, another TRUTH is that not every jurisdiction has brilliant Mayor to champion a bold tobacco control agenda. Having a legislative champion is essential. But, if you cannot find a good legislative champion, that does not mean the work should stop. If you cannot get your City Council to adopt Chicago’s sweeping tobacco control reforms of 2014, other very meaningful policy changes are still possible at the institutional level. Research demonstrates that institutional policies -- and especially smoke-free housing policies when coupled with cessation support -- can have a very big impact on health. And, I am proud to tell you that Chicago Department of Public Health is working with organizations across the City to enact institutional policies, too. Numerous universities in Chicago have gone tobacco free. Chicago Housing Authority has continued is its smokefree work — designating the Dearborn Homes and Sullivan Station smoke-free — 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. Chicago Housing Authority is also expanding their existing cessation efforts, too. In the private sector, more than 3,500 multi-unit residences in Chicago have gone 100% smokefree.
7. Here is another TRUTH… e-cigarettes are not just renormalizing smoking, they are flat-out glamorizing it again! Marketing to youth has been repeatedly demonstrated, including a Congressional report issued by Illinois’ Senator Dick Durbin. Which is why, Chicago has passed the single most comprehensive eCig regulations in the U.S. Behind counters. Out of reach of kids. Tobacco license. Youth sting operations. Fines. Knowingly selling to kids, license revoked. All licenses! Cotton candy and the 270+ kid-friendly flavors we have documented cannot be sold near schools. Only jurisdiction in the country with this kind of law.
8. Here is another TRUTH… e-cigarettes are not just renormalizing smoking, they are flat-out glamorizing it again! Marketing to youth has been repeatedly demonstrated, including a Congressional report issued by Illinois’ Senator Dick Durbin. Which is why, Chicago has passed the single most comprehensive eCig regulations in the U.S. Behind counters. Out of reach of kids. Tobacco license. Youth sting operations. Fines. Knowingly selling to kids, license revoked. All licenses! Cotton candy and the 270+ kid-friendly flavors we have documented cannot be sold near schools. Only jurisdiction in the country with this kind of law.
9. This is why, under Mayor Emanuel’s leadership, Chicago was the first of the nation’s 20 largest cities to propose limiting the use of eCigs in indoor areas. New York City introduced similar legislation immediately after. They were the first of the 20 largest Cities to pass. Los Angeles and San Francisco also introduced and passed similar legislation. The e-Cigarette laws for Chicago, NYC, L.A., and San Francisco all went into effect in April 2014 — providing new protections to more than 17 million residents and hundreds of millions of visitors – IN JUST ONE MONTH. Which brings me to another TRUTH… There is power in collaboration and coalition building. That Chicago, NYC, L.A., and S.F. all did this together was not an accident. It was part of a coordinated effort by the Emanuel administration, dedicated staff in each of these cities, the Campaign for Tobacco Free Kids, NACCHO, and others. What happened in April 2014 happened because of relationships and coalition building. It is a defining moment that turned the tide in what is still a very contentious debate about the proper way to regulate e-Cigarettes.
10. Here is another TRUTH… it is not just the act of re-normalizing smoking and creating enforcement problems that warrant the inclusion of eCigarettes in clean indoor air laws. Contrary to what vaping enthusiast will tell you, the TRUTH is the aerosol emitted from an e-Cigarette is not water vapor. Currently, there are no restrictions in the ingredients the products contain, or the toxic chemical they can emit. Laboratory tests show e-Cigarettes emit many chemicals and ultra-fine particles, which is more than enough evidence to warrant the protection of clean indoor air. Another TRUTH is that work around e-Cigarettes requires going back to the same talking points we used to pass smoke-free laws. This single most effective talking point is that “EVERYONE HAS THE RIGHT TO BREATH CLEAN INDOOR AIR.”
11. There is a place for peer-reviewed literature! In fact, my colleagues and I just published an article on Twitter Bombing and our experiences in Chicago. If you want copy, let me know. I can send you a link.
12. Last summer (July 23, 2013), the FDA released a scientific report related to menthol-flavored cigarettes. The FDA’s report confirmed what the public health community has known for years – 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. Again, Washington has been slow to act. But, in Chicago, we don’t wait for the Feds to lead. Which is why… Less than 48 hours after the FDA’s report on menthol was released, Mayor Emanuel took swift action – urging the Board of Health to host a series of town hall meetings to educate the public about the unique health harms of menthol-flavored cigarettes and to seek the public’s feedback in crafting local policy options to curb their use. The Chicago Board of Health has authored a report that summarizes a number of recommended strategies.
13. The contents of the Board of Health’s report was developed following a series of townhall meetings all across the City. 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 – not just organizations like Cancer, Heart, and Lung. Again, the TRUTH here is that partnerships matter. Coalition building is essential. “Educate before you legislate” is another TRUTH we lived by in Chicago. If any community is thinking about floating a menthol policy before engaging in some deliberate effort to educate key policy makers and the public about the unique public health harms caused by menthol, I would advise against it. Eighty percent (80%) of African Americans who smoke use a mentholated product. So, it was inconceivable to us to even begin discussions about this issue without make a cognizant effort to reach out to leadership within the Black community. We had the same concerns about the LGBT, Latino and Asian communities, too. Which is why the Chicago Department of Public Health made a deliberate effort to invite minority health groups to take a leadership role in the Board of Health’s townhall meetings. It worked. 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.
14. 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 — this is especially true of schools located in minority communities. Now, we all know that nearly all adult smokers started as adolescents – usually using a flavored tobacco product. That is why, in Chicago, we are piloting a new policy. Just last month, flavored tobacco products, including menthol-flavored cigarettes, are being pulled from the shelves of stores within 500 feet of a Chicago school. This ordinance restricts not only menthol-flavored cigarettes, but also flavored cigarillos or little cigars, snuff, and chew. In addition, this ordinance, coupled with our new e-cigarette ordinance, will also restrict where flavored e-cigarettes and vape pens can be sold. Of course, this might not be a policy solution that you think will be politically viable in your community. Again, I encourage you to read the Chicago Board of Health’s report to explore other recommended strategies.
15. Another TRUTH is that Big Tobacco has no business fighting tobacco control polices using a social justice message — but, they do!!! We should never concede on arguments about social justice. In Chicago, retailers and the tobacco industry, mobilized members of the African American community to attend our town hall meetings. In fact, we believe they even paid some members of minority communities to attend and do their bidding. One of Big Tobacco’s favorite talking points is that regulating menthol is socially unjust because we were unfairly targeting the product that is used most the African American community. You should never allow the tobacco industry to run unopposed with social justice arguments. They are disingenuous. The TRUTH is, the industry targets the Black community and other minority populations for a reason. Using culturally relevant messages, they cultivate high levels of brand loyalty in minority communities. And, it is no accident the customers they are most aggressively targeting are the demographic groups that are among the LEAST likely to have health care insurance, least likely to have access to pharmacotherapy, the least likely to receive a medical intervention, and also the least likely make a quit attempt. This equates to highly-brand loyal, life-long customers for Big Tobacco. That is socially unjust. Let me say this just one more time… if you are having this debate in your community, you should never concede on social justice arguments. The tobacco control community has much more solid arguments regarding what is a socially just and unjust. Another piece of advice that I would give, if you are thinking about regulating menthol, I would encourage you to frame this issue to be about flavored tobacco in general — and, then add in arguments about why a socially just, flavored tobacco law must include menthol. This is the framing we used in Chicago. I outlined a number of these arguments in a letter submitted to the FDA. If you’d like to see his letter, a copy is available online.
16. We all know Big Tobacco and tobacco retailers have historically engaged in intimidation through litigation tactics. That has not changed. The TRUTH is, they will sue — even if it means using baseless lawsuits as a bullying tactic. You need a solid team who can fully analyzes the legal risks before crafting new, innovative policies. In Chicago, we are facing two separate lawsuits related to the regulation of menthol-flavored cigarettes.
17. I am a Doctor, not a lawyer. So, I won’t try to explain the details about these two cases to you. What I can tell you is they threw everything from Preemption claims to Constitutional challenges at us. And, I am very happy to report that despite several attempts to block this Ordinance in court, Chicago’s menthol ordinance just went into effect. We are still fighting these cases in court. But, preliminary rulings have been very positive.
18. Here are a few highlights from the other case we are fighting. The TRUTH is the City of Chicago is taking its commitment to creating a tobacco-free generation very seriously. And, Mayor Emanuel has vowed he will continue to fight these battles in court.
19. And, finally… one last TRUTH, we would like connect with you on social media and stay in touch.