Emerging Issue: More than just a passing trend, e-cigarettes are emerging as the next mode of nicotine addiction. E-cigarette use tripled from 2011 to 2013 and recent data clearly describes higher utilization of e-cigarettes than regular cigarettes among teens. Although they are marketed as a safer alternative to traditional cigarettes, e-cigarettes have serious health consequences.
 
In addition to the addictive effects of nicotine, the liquid nicotine cartridges used with e-cigarettes come in kid-friendly flavors and can be poisonous to young children. In 2014, there were 4,000 calls to poison control centers involving exposures to e-cigarettes and nicotine liquids.
 
When considering tobacco cessation, the action team recommends that the discussions include cigarettes, cigars, pipes, chew, and snuff, but also e-cigarettes and other forms of alternative nicotine delivery systems and similar products, except those that are FDA approved smoking cessation devices.

Action, Advocacy, and Assessment


 

Prevent youth tobacco use

 
A fundamental tenet of public health is prevention. Preventing tobacco use among youth creates wide-ranging and lifelong health benefits. More than 95% of adult smokers started smoking before the age of 21 and more than two-thirds started smoking before the age of 18. There are proven and promising strategies to achieve our primary goal of reducing youth tobacco use by 20% by 2020.
 
  • Increasing the cost of tobacco products has enormous public health benefits, particularly for youth who are more price-sensitive. Research demonstrates that every 10% increase in cigarette price reduces youth smoking by about 7%. Missouri ($.17) and Kansas ($.79) have statewide tobacco taxes that lag well below the national average of $1.54 per pack.
  • Increasing the age of sale for tobacco products from 18 to 21 will offer a significant public health win by preventing the initiation of tobacco use among youth. Smokers between the ages of 18-21 are some of the major ‘suppliers’ of cigarettes to teens below the age of 18. Nicotine is incredibly addictive and youth are even more susceptible to this addiction because their brains are still developing. Many localities have already adopted local laws preventing the sale of certain tobacco products to anyone under the age of 21, including New York City, Evanston, IL, and Columbia, MO. The Tobacco Use Cessation and Prevention action team believes the Kansas City area has been a leader in preventing tobacco use through smoke-free laws and has an opportunity to continue this leadership through age of sale policies.

Create tobacco-free environments through policy change

 
Tobacco-free public places prevent tobacco use by encouraging new cultural norms. These changes are already taking place, with smoke-free restaurants becoming the standard, rather than the exception. We can further encourage this culture of wellness by continuing to implement tobacco-free policies. While more than 95% of the KC-area population is fortunate to live in an area with tobacco-free laws for worksites, restaurants and bars, there are some lingering communities and public places where individuals may still encounter public smoking. We recommend that the Healthy KC initiative work to maintain this level of tobacco-free environments, but also strive for the aspirational, but very difficult, goal of 100% clean air policies region-wide.
 
Presently, very few local tobacco-free ordinances prohibit the use of e-cigarettes and other nicotine delivery systems. As noted above, there are serious concerns among researchers about the long-term health effects of e-cigarettes. Therefore, it is the recommendation of this action team that the Healthy KC initiative advocate for alternative nicotine delivery systems, to be regulated the same as cigarettes in local clean air ordinances; except nicotine delivery systems that are FDA approved smoking cessation aids.
 
 

Determine the feasibility of amending state laws that prevent stricter regulation of tobacco products by local governmental entities

 
Some cities in other states, including New York City and Philadelphia, have chosen to increase tobacco tax rates beyond the state level. Though there are tools that can be used at the local level to decrease tobacco use in our area, Missouri law was amended in 1993 to remove local authority over these issues. Revoking these preemption statutes and other barriers to local tobacco control would create opportunity for local elected officials to advance the health of area residents. This would also allow the opportunity for municipalities to create an effective system to ensure enforcement of the legal age requirement keeping tobacco out of the hands of our youth. Currently, there is no way to establish a fully independent system due to the preemption statutes that prohibit local funding mechanisms for enforcement. Although removing preemption statutes would be a tough and long-term political fight, it is worthy of consideration and this group recommends exploring how such changes to the law could be implemented.
 
 

Educating the community

 
To accomplish the recommendations, the Tobacco action team recommends collaboration with the organizations represented in this report and other organizations and coalitions with an established presence on tobacco control efforts including: Clean Air KC, Tobacco Free Kansas, Tobacco Free Missouri, Tri-County Prevention, the Metropolitan Healthy Communities Coalition, and the KCMO Health Commission’s Tobacco Use Reduction Committee and youth tobacco prevention programs. We believe many of these groups emerged with smoke-free air as their rallying cry and are looking to develop some consensus about their next priority. The recommendation in these reports could be future priorities. The Healthy KC effort has the potential to unite these groups behind a cohesive strategy for the KC-area tobacco control community.
  • Existing tobacco education efforts should use standard messaging to emphasize the lifelong impacts of early tobacco use initiation and enhance use of cessation treatments.
  • Healthy KC should engage those area health professionals who can speak to the harms of youth tobacco initiation, particularly pediatricians, primary care doctors, certified tobacco treatment specialists, and neurologists.
  • A social media campaign should be developed to disseminate our goals and encourage participation and implementation.