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HomeMy WebLinkAboutCOUNCIL - AGENDA ITEM - 01/07/2020 - YOUTH ACCESS TO NICOTINE IN LARIMER COUNTYDATE: STAFF: January 7, 2020 Beth Sowder, Director of Social Sustainability Jeff Mihelich, Deputy City Manager WORK SESSION ITEM City Council SUBJECT FOR DISCUSSION Youth Access to Nicotine in Larimer County. EXECUTIVE SUMMARY The purpose of this item is for Larimer County Health and Environment to share information and potential strategies for responding to youth access to nicotine in Larimer County. Public Health Director Tom Gonzales, Health Promotion Services Director Andrea Clement-Johnson and Tobacco Prevention Health Educator Christa Timmerman will present. GENERAL DIRECTION SOUGHT AND SPECIFIC QUESTIONS TO BE ANSWERED 1. Do Councilmembers have feedback on the strategies proposed for reducing youth access to nicotine in Larimer County? 2. Do Councilmembers have any questions about next steps or requests for more information? BACKGROUND / DISCUSSION History, Current Policy, Previous Council Actions Smoke-free Policy Fort Collins has long been considered a leader in smoke-free policies and clean air, being one of the first municipalities in Colorado to develop a local indoor smoking ordinance in 2002. The smoking ordinance was updated in 2015 to include no smoking on City property, at City-approved events, parks and trails, and within a large area of downtown. In addition, Fort Collins added vape devices to its definition of smoking, well before the state and many other communities. Retail Sales policy The current policy for retail sales places few limitations on the retailer or retail store other than requiring identification to prove the person making a purchase is 18 years or older. Fort Collins also has an additional restriction of not selling products in vending machines where minors may have access; though this restriction may protect youth, vending machines as described are likely outdated. History of current Council addressing issue Over the last few years, youth e-cigarette or vaping rates have increased substantially, with 34% of Larimer County high school students reporting current vaping. This led to current Councilmembers bringing tobacco retail licensing up at a Council meeting during “other business” in a past meeting. No action was proposed or taken at that time. Over the last few years, Councilmembers have brought up the idea of tobacco retail licensing several times. The first time it was brought up, no action was proposed or taken. Most recently, Councilmembers again brought retail licensing to a Council meeting at a December 2019 meeting. The City Manager was asked to explore the matter further at that time. January 7, 2020 Page 2 In addition, several Councilmembers have visited with Larimer County Department of Health and Environment (LCDHE) staff, receiving updates on how evidence-based practices for tobacco retail licensing and raising the age of sales to 21 are occurring throughout the state. More recently, the Larimer County Board of County Commissioners held a work session on November 6, 2019, where it was very supportive of additional conversations with municipalities around options for responding to youth access to nicotine in Larimer County. Municipal partners, including Fort Collins, participated in a municipal stakeholder meeting on December 5, 2019, to discuss policy options and the importance of consistency across the County. Costs or Benefits There would be an annual cost to the tobacco retailer for the ability to sell tobacco and nicotine. There would be a cost for administering and enforcing the license, but this should be covered by the costs of the annual license fee. A retail license is a beneficial tool to reduce youth access, ensure compliance with tobacco-related laws, and lessen the public health impacts of tobacco and nicotine use. It allows for local enforcement, rather than depending on state compliance checks, which do not consistently happen at every retailer on an annual basis. With a local retail license, municipalities or counties can monitor who is selling the products, conduct more regular compliance checks, and promote license provisions for selling tobacco and nicotine products to consumers. Alternatives or Options A tobacco retail license, with strong enforcement, is recommended by the American Medical Association. There are currently 28 municipalities in Colorado that have passed a license requirement. Additional components can also be included in a license, such as prohibiting sales within a certain distance of schools and/or youth spaces and prohibiting flavors. On December 20, 2019, the President signed legislation to amend the Federal Food, Drug, and Cosmetic Act, and raise the federal minimum age of sale of tobacco products from 18 to 21 years. It is now illegal for a retailer to sell any tobacco product, including cigarettes, cigars and e-cigarettes, to anyone under age 21. It is recommended that the Council replicate the language that is being used at the federal level, as needed. Consideration Leading to Staff Conclusions Youth e-cigarette use (vaping) has increased dramatically across the US (rising by 78% between 2017-2018). Colorado has the highest youth e-cigarette use rate in the nation at twice the average and Larimer County youth use at a higher rate than the state average. Fort Collins has one of the lowest smoking rates in the state, which is down to 9% according to the 2016 Health District of Northern Larimer County Community Health survey. On that same survey, 62% of respondents that reside in Fort Collins favored requiring retailers to obtain a license to sell tobacco products, whereas only 11% percent opposed such a measure. In addition, 27% of Fort Collins respondents had “no opinion” of requiring tobacco retail licensing. LCDHE conducted a survey of tobacco retailers in 2016. Of the 111 known retailers in Fort Collins at that time (the most recent numbers show 135 retailers), 73 responded. Of those, 65% either supported (38%) or were neutral (27%) to requiring tobacco retail licensing. Of the respondents that supported tobacco retail licensing (n=28), 64% also agree with having local control of retail licensing and enforcement efforts. Between 2016 and 2018, 7.5% of Fort Collins retailers who sell nicotine/tobacco products failed compliance checks and sold products to minors. While seemingly a low rate, it is important to note that currently, retailers are usually not checked more than once per year and some are not checked at all. According to the 2017 Healthy Kids Colorado Survey (HKCS), 58% of underage Larimer County high school students reported buying their own cigarettes at a gas station, convenience store, grocery store, or drug store. Retailers will be required to make a change in tobacco/nicotine retail sales based on the minimum legal sale age being changed from 18 to 21, so this is a good time to further align this change with the requirements of a local January 7, 2020 Page 3 license. In September 2019, the Larimer County Board of Health passed a resolution recommending communities in Larimer County strongly consider establishing a local tobacco retail licensing model and recommending raising the minimum legal sales age to 21.Community coalitions in Fort Collins, including the Communities that Care community board, Partnership for Healthy Youth, and Youth Action for Health, a group of dedicated high school students, have identified youth vaping as a top health priority. Actions taken by these groups include a letter sent to Council in October 2019 from Partnership for Healthy Youth, expressing concern about youth vaping rates and recommending establishing a tobacco retail license to limit youth access to nicotine products. In 2019, there was an outbreak of vaping-associated respiratory illnesses, primarily among young people. Though the Centers for Disease Control and Prevention (CDC) has reached some conclusions about an association with vitamin E acetate found in some THC products, CDC recommended the safest option is not to vape at all. Nationally, there have been more than 2,500 hospitalizations and 54 deaths. In Colorado, there have been 12 cases reported, with one in Larimer County. Next steps Next steps could include the following: • Participation in future conversations with county and municipal partners around reducing youth access to tobacco and nicotine, ensuring compliance with tobacco-related laws, and lessening the public health impacts of tobacco and nicotine use in communities • Potential development of a draft policy for a Council vote If licensing were to pass, next steps could include: • Determination of enforcement components • Determination of licensing fees and implementation processes • Development of appropriate information for retailers describing the policy and provisions; Outreach to retailers about policy changes, providing adequate timing for implementation; Development of an assessment plan Measuring success The Tobacco Retail Access Colorado (TRAC) system is a web-based mapping application for viewing locations of tobacco retailers, recent compliance check/inspections, and sales to minors violations for known tobacco retailers across the State of Colorado. A decrease in sales to minors would be a measurable way to determine success. With a robust local process, additional local-level coordination to better monitor who is selling products and set standards for best levels for compliance checks that will curb youth sales and youth use over time. ATTACHMENTS 1. Resolution of the Larimer County Department of Health and Environment Board of Health (PDF) 2. Possible Local Solutions (PDF) 3. Retail Tobacco Policy Domains (PDF) 4. PowerPoint Presentation (PPTX) ATTACHMENT 1 Current Laws Are Not Enough - Possible Local Solutions Funding for this event/project/program was provided (in part) by Amendment 35 Tobacco Education, Prevention and Cessation Grant Program funding. The views expressed do not necessarily reflect the official policies of, nor does the mention of imply endorsement by, the Colorado Department of Public Health and Environment. Looking for our data resources? Visit larimer.org/tobaccoresources Local Support Number of known tobacco retailers located in Larimer County Strong local tobacco retail licensing T21 can make a significant impact on decreasing tobacco initiation especially among 15 to 17 year olds. Regulatory Framework Regular compliance checks may result in large reductions in the use of cigarettes and may also result in lower e-cigarette use. An independent study conducted in Colorado indicates that retail licensing leads to lower tobacco violation rates. Framework can include items such as prohibiting sales within a certain distance of schools and youth spaces and prohibiting flavors. Create a regulatory framework for retail tobacco store licenses to reduce the number of illegal sales to minors. In Colorado, 19 municipalities have adopted T21 while nationally 18 states and 500 cities and counties have raised the minimum legal sale age. Increasing the minimum legal sale age for tobacco Between 2016 and 2018, 8.3% of Larimer County retailers who sell nicotine/tobacco products failed compliance checks and sold 8.3% products to minors. 289 62% 62% of Fort Collins residents surveyed in the 2016 Community Health Survey completed by the Health District of Northern Larimer County favored a license to sell tobacco products. ATTACHMENT 2 Nicotine Use Among Youth is an Epidemic Why It’s Important Adolescent and young adult brains are still developing and they are more vulnerable to nicotine addiction. Symptoms of nicotine dependence can occur within only days or weeks of experimentation with nicotine use. Youth who use use e-cigarettes are more likely to use cigarettes and other tobacco products, even if they’ve never smoked before. Larimer County Department of Health & Environment, 1525 Blue Spruce Drive, Fort Collins, 80524 of minors bought their own cigarettes at a gas station, convenience store, grocery store or drug store of minors bought their own electronic vapor products at a gas station, convenience store, grocery store or drug store Point-of-Sale Report to the Nation: The Policy Environment 12 RETAIL POLICY DOMAINS & SCORES The study’s advisory board of state and local tobacco control staff, researchers, and legal experts, developed the original policy domains and options for the initial (2012) interviews. Through feedback from interviewees and further consultation with advisors, later interview rounds the original six domains and 25 policies were supplemented with eight new policy options, including one new policy domain for ENDS, and a total of 33 policies. Table 1. Retail Tobacco Policy Domains Policy domain Policy options Licensing & Density • establish or increase licensing fees • limit or cap total number of licenses in a specific area • prohibit tobacco sales in youth locales • restrict retailers from operating within a certain distance of other retailers • restrict retailers in certain zones (e.g., residential zones) • prohibit tobacco sales in certain types of retailers (e.g., pharmacies) • limit number of hours or days for sales Advertising • limit the times (of day) when advertising is permitted • limit placement of ads at certain store locations (e.g., near youth locales) • limit placement of ads inside stores (e.g., near cash registers) • limit placement of outdoor ads • ban certain manners of advertising (e.g., outdoor sandwich board-style ads) • establish content-neutral advertising restrictions (e.g., 15% of window space) Non-tax Price Increases • establish cigarette minimum price laws • ban price discounting (e.g., specials, multipack options) • ban redemption of coupons • ban distribution of coupons • require disclosure of manufacturer incentives for retailers (i.e., sunshine law) • establish mitigation fees (e.g., for litter clean up, to cover cessation services) Product Placement • ban product displays (i.e., require products to be stored out of view) • ban self-service displays for OTPs • restrict the number of products that can be displayed (e.g., one sample of each) • limit times during which product displays are visible (e.g., after school hours) Health Warnings • require posting of graphic health warnings at POS • require posting of quitline information at POS E-cigarettes • establish MLSA for e-cigarettes • limit where e-cigarettes can be sold (e.g., near youth locales, at certain retailers) • ban self-service displays for e-cigarettes • establish tax on e-cigarettes • require licensing for e-cigarette retailers Miscellaneous • ban flavored OTPs (e.g., cigarillos, little cigars) • require minimum pack size for OTPs (e.g., no single or two-pack cigarillos) • raise the MLSA for tobacco products (e.g., from 18 to 21) • policies in green added in 2014; ban “use” of coupons (asked in 2012) was split into redemption or distribution ATTACHMENT 3 January, 2020 Tom Gonzales, MPH, REHS Andrea Clement-Johnson, MS Christa Timmerman, MPH LARIMER COUNTY: HEALTH & ENVIRONMENT Youth Access to Nicotine, Fort Collins City Council Youth Access to Nicotine Colorado House Bill 19-1033 Colorado House Bill 19-1033 accomplished four main things: • Allows Counties to set age for purchase of tobacco at 21 instead of 18 • Allows Counties to adopt regulatory schemes and issue licenses for sale of tobacco products • Allows Counties to set fees and issue licenses without sacrificing their share of state tobacco tax revenue • Allows counties to impose their own, countywide, tax on tobacco products. However, after local tax is enacted, county loses state tobacco tax revenue Raising the minimum legal sales age March 2019: House Bill 19-1033, promoting youth access to nicotine initiatives September 12, 2019: Board of Health Resolution, promoting raising minimum legal sales age to 21 & local retail licensing November 6, 2019: Board of County Commissioners work session, supporting conversations with municipalities around options for responding to youth access to nicotine in our county December 5, 2019: Tobacco/Nicotine Stakeholder Meeting with municipal partners Next steps: • Meet with remaining municipal partners • Attend municipal work sessions • Larimer County Attorney’s office develop possible regulatory frameworks for consideration • Meet with other stakeholders (e.g. enforcement partners, youth, vaping industry) • Share results and obtain direction from Board of County Commissioners Youth Access to Nicotine Recent Activities Youth and nicotine 1 • 90% of people who use tobacco or nicotine products begin before age 18 • Brain development continues until age 25; nicotine impacts attention and learning • Youth cigarette use has stayed neutral or declined; youth e-cigarette use (vaping) has increased dramatically (by 78% between 2017-2018) • Colorado has the highest youth e-cigarette use rate in the nation-twice the average • Larimer County youth use at a higher rate than the state average • Youth vaping use is second only to youth alcohol use • Youth who vape are at least 4 times more likely to smoke cigarettes Youth Access to Nicotine Youth & Nicotine Raising the minimum legal sales age With a nationwide T21 policy, we expect: • 25% drop in youth smoking initiation (notably in 15-17 age range) • 12% drop in overall smoking rates • 16,000 cases of preterm birth and low birth weights averted in the first five years A reduction in likelihood that older students can legally purchase for underage peers 12/20/19: Federal government raised the national minimum age of sales for tobacco products to 21; anticipate >9 months for full implementation Youth Access to Nicotine Raising Minimum Legal Sales Age (T21) Retail licensing A tobacco retail license is an effective tool to reduce youth access to tobacco and nicotine, ensure compliance with tobacco-related laws, and lessen the consequences of tobacco and nicotine use. A retail license is an effective tool to reduce youth access, ensure compliance with tobacco- related laws, and lessen the public health impacts of tobacco and nicotine use Federal compliance efforts have gaps: • Colorado: one of 13 states that does not require a license to sell products • Few consequences and penalties • Only half of known retailers inspected annually (289 known retailers in Larimer County; Fort Collins has 135 known retailers or 47% of total) With a local retail license, municipalities or counties can monitor who is selling, conduct more regular compliance checks, and promote license provisions for selling tobacco and nicotine products to consumers Youth Access to Nicotine Retail Licensing Retail licensing Do Councilmembers have feedback on the strategies proposed for reducing youth access to nicotine in Larimer County? Do Councilmembers have any questions about next steps or requests for more information? Youth Access to Nicotine Questions