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HomeMy WebLinkAboutMINUTES - 04151997 - P1 SD2 D2 P/ IN THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, STATE OF CALIFORNIA In the Matter of Proclaiming May 1997 ) as DROWNING PREVENTION MONTH) RESOLUTION NO. 971 179 in Contra Costa County ) WHEREAS, the summer months are approaching andpeople will soon be spending warn, sunny days outside in their yards and swimming pools; and WHEREAS, tragically, summertime is also associated with increasing numbers of drowning incidents; and WHEREAS, children under five years of age are especially vulnerable to drowning deaths and injuries associated with near drowning submersions; and WHEREAS, the Drowning Prevention Foundation, in cooperation with the Contra Costa Health Services Department, will conduct a drowning prevention educational outreach campaign in the spring and summer of 1997 through Labor Day; and WHEREAS, the purpose of this effort is to inform the public that drownings can be prevented when people are aware of the problems and know how to eliminate them; and WHEREAS, raising community awareness about swimming pool safety is critical for the protection of our children from preventable drowning. NOW, THEREFORE, BE IT RESOLVED that the Board of Supervisors proclaims May 1997 as DROWNING PREVENTION MONTH in Contra Costa County and calls upon the, citizens of the County to take the necessary precautions to ensure a safe and happy summer. PASSED AND ADOPTED ON April 15, 1997, by a unanimous vote of the Board members present. /} IM—k4u k� Mark DeSaulnier, aiL�i r Ji Rog Gayle B. Uilkema Donna Gerb r Joe Canciamilla I hereby cert that the foregoing is a true and orrect copy of an order entered on the Minutes of said Board of Supervisors on the aforesaid date. Witness my hand and the Seal of the Board of Supervisors affixed this 15th day of April, 1997 PHIL BATCHELOR, Clerk of the Board of Supervisors and County Administrator. By Deputy Clerk Introduced by Supervisor Mark DeSaulnier, District IV sD.2 "� 6E Contra ' Costa To: BOARD OF SUPERVISORS a , P County FROM: Mark DeSaulnier ' DATE: April 15, 1997 SUBJECT: Contra Costa County Youth Hall of Fame SPECIFIC REQUEST(S) OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: Propose a Contra Costa County Youth Hall of Fame and refer the proposal to the Family and Human Services Committee and the Countywide Youth Commission for recommendations to implement it. BACKGROUND: Youth are often portrayed in a negative way. In reality, the vast majority of Contra Costa's young people are hard working, good citizens. A Youth Hall of Fame would give the County a means to recognize youth for their positive contributions to our communities. Nominations could be sought, and selections could be made by a collaborative of youth and adults. An annual event could be held to induct the young people into the Hall of Fame. A plaque(s) could be placed in the Board of Supervisors' chambers, which could act as the physical location for the Hall. FINANCIAL IMPACT: Monetary and/or in-kind donations could be sought from the business community to sponsor the Hall of Fame. The Countywide Youth Commission could provide the volunteer base to organize and implement the event. CONTINUED ON ATTACHMENT:_YES SIGNATURE: _RECOMMENDATION OF COUNTY ADMINISTRATOR —RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ON April 15, 1997 APPROVEDAS RECOMMENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS(ABSENT - - - ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED April 15, 1997 PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR contact: Valerie Matlock, Dist. 4 «: /J BY .4 4,L L)A 14 4 ,DEPUTY TO: BOARD OF SUPERVISORS FROM: William Walker, M.D., Health Services Director Contra Costa DATE: March 25, 1997 County SUBJECT: Update on Tobacco-Free-Youth SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: ACCEPT report from Tobacco Prevention Coalition regarding update on Board request to make tobacco-free youth a public priority and to develop policy recommendations for reducing impact of tobacco on young people. BACKGROUND: Last May, the Board of Supervisors declared the reduction of youth use of tobacco and proliferation of tobacco advertising in Contra Costa County as priority public health issue. At the same time, the Tobacco Prevention Coalition was designated as the Board's representative with the responsibility for developing policy recommendations, including a model tobacco free youth ordinance, to reduce the impact of tobacco on young persons in our county. The Coalition, along with the Tobacco Prevention Project staff, representatives from various community-based organizations, schools, health care organizations, and young persons from throughout the county researched the issues, studied the success of options tried in other communities, and examined the opinion of tobacco prevention experts in the development of recommendations for Contra Costa County. The outcome of this effort is the attached paper Tobacco Free Youth:Assessing Policy Options Which Reduce Demand for and Supply of Tobacco to Young People in Contra Costa County. The Tobacco Free Youth paper is divided into sections including policy options to be used for the development of ordinances, voluntary options that communities can undertake on their own, and suggestions for strengthening currently existing laws that address the supply and demand for tobacco products. In the next few months, these options will be developed into a model tobacco free youth ordinance. The Tobacco Prevention Project and the Tobacco Prevention Coalition will be developing model ordinance language to support the reduction of the impact of tobacco on Contra Costa's youth. They will follow the Board's request to work with the City/County Relations Committee and other appropriate entities in the development of model language. The areas to be addressed are as follows: Advertising/Placement: ■ Ban tobacco advertising placement withing 1/2 mile of places where youth congregate, such as schools and parks; ■ Eliminate tobacco ads on publicly owned land, such as transit shelters, fairgrounds, sidewalks, lands that are municipally owned, etc. Advertising/Content: ■ Limit outdoor tobacco ads to black and white text only ("tombstonne") ads; CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE _OTHER SIGNATURE(S): ACTION OF BOARD ON April 15 , 1997 APPROVED AS RECOMMENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT — — — ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. Contact Person: Regina Penna 313-6819 CC: Health Services Director ATTESTED April 15, 1997 Tobacco Prevention(via HSD) PHIL BATCHELOR,CLERK OF THE BOARD OF County Administrator SUPERVISOIRS AND C UNTY ADMINISTRATOR BY ,.N' 'C'A 1 ,DEPUTY Board of Supervisors page 2 Update on Tobacco Free-Youth March 25, 1997 Advertising/Promotions: ■ Ban all tobacco industry sponsored events or events that promote tobacco; ■ Eliminate point-of-purchase displays for tobacco; ■ Ban distribution of promotional items for tobacco products; Retail Outlets: ■ Require all tobacco retailers to be licensed; ■ Require conditional use permits for the sale of tobacco products; ■ Ban self-service tobacco displays. During the development of the paper,the Coalition garnered input from various segments of the public in two community forums and also by mailing drafts of the paper. Their ideas are included in the recommendations. The options outlined in the paper will next be brought to local communities in the coming months in order for them to determine what are local priorities and to design local action plans for adoption. At the same time, a youth mobilization project will be occurring throughout the county. Young people will be working within their own communities to plan and execute local action to highlight, educate and mobilize their constituents to take action to support tobacco free youth TOBACCO-FREE YOUTH: Assessing Policy Options Which Reduce Demand for and Supply of Tobacco to Young People in Contra Costa County "The way has been made straight for physicians and public health professionals,for parents and teachers,for law officers and politicians -all citizens-to take at least a small first step toward saving the children, supporting the family, preserving the community, and upholding the law." Donald W. Garner, JD, Journal of the American Medical Association 1996 April 1997 Developed by the Contra Costa County Tobacco Prevention Coalition 597 Center Avenue, Suite 325 Martinez, CA 94553 510-313-6214 This material was made possible with funds received from the Tobacco Tax Health Protection Act of 1988-Proposition 99,through the California Department of Health Services under contract#29-3% EXECUTIVE SUMMARY Tobacco-related disease is the number one cause of preventable death in this country. Recent indicators show that while tobacco use is steadily declining among adults, youth rates of tobacco use are rising dramatically on local, statewide, national, and international levels. The two primary factors which contribute to child and adolescent tobacco use are tobacco marketing and the ease of youth access to tobacco products. The most successful approaches to reducing youth tobacco use are comprehensive and multi- pronged. These approaches reduce demand for tobacco by reducing or eliminating the presence of tobacco advertising and promotions, and inoculating communities against the impact of tobacco industry marketing. They also reduce the supply of tobacco available to youth by working with merchants and enforcement agencies to reduce tobacco sales to youth, and altering community attitudes about youth tobacco use and sales. This report provides a description of a wide range of policy options which address both supply and demand. As requested last year by the Contra Costa County Board of Supervisors and the Conference of Mayors, the policy options described here will shortly be incorporated into a model tobacco-free youth ordinance which can be considered for adoption in whole or in part by the County and the cities in the county. (The policy options are identifiable by the ow icon) Significant efforts have been made on national, statewide, and local fronts to counter tobacco use, especially among adolescents: ♦ The Food and Drug Administration (FDA), a federal agency, has developed strong and fairly comprehensive regulations which will greatly restrict tobacco advertising, promotions, and sponsorship, as well as implement tougher restrictions regarding the sale of tobacco to minors. ♦ In California, successful programs funded by Proposition 99, the voter-mandated Tobacco Tax Initiative, have reduced statewide adult smoking rates from 26% in 1988 to 16.7% in 1995. Prop 99 priorities now focus on reducing adolescent tobacco use. ♦ In Contra Costa County, there have been vigorous efforts to prevent tobacco use and exposure to secondhand smoke. Prior to the statewide bans on smoking in the workplace and youth-accessible vending machines, the County and most cities passed clean indoor air ordinances that protected residents from secondhand smoke and reduced youth access to tobacco from vending machines. In 1996, an effort to protect youth from tobacco advertising resulted in a voluntary agreement with the billboard industry that prohibits tobacco billboards from within 1600 feet of public schools in the unincorporated areas of the County. Following that agreement, the Board of Supervisors and the Conference of Mayors declared that creating a generation of tobacco-free youth" was a regional public health priority and asked the County's Tobacco Prevention Coalition to develop a comprehensive strategy, including a model ordinance, for reducing the impact of advertising on youth and reducing youth access to tobacco. The Coalition and the Tobacco Prevention Project developed this document, Tobacco-Free Youth, in response to that request. The report outlines policy options for reducing the demand for tobacco among youth. These include: • restrictions on tobacco advertising, such as storefront and billboard restrictions; • limitation of tobacco promotional and sponsorship activities; • strengthening existing laws In addition, the report describes major strategies which may reduce the supply of tobacco available to youth. These are: • regulation of tobacco retailers, such as licensing and conditional use permit restrictions; • restriction of tobacco self-service displays & vending machines; • strengthening existing laws Implementing any combination of these strategies through a model tobacco-free youth ordinance could support and complement the FDA regulations. Surveys show widespread national, state and local support for many of these policy options. Tobacco-Free Youth examines that support and describes legal issues related to the policy options. The report emphasizes the need to select strategies that do not deliver messages to youth that tobacco use is an "adult" behavior. It also underscores the need to insure any tobacco-free youth strategy be youth-driven to create significant changes in norms and behavior related to tobacco use. While policy makers are considering a model tobacco-free youth ordinance, teams of teenagers and young adults will be working to involve young people in the dialogue. They will launch local projects that can begin reducing the impact of tobacco on their communities and neighborhoods. These youth participants will be trained in tobacco prevention basics, leadership development, community organizing, facilitating groups, public speaking and participating in decision-making and policy development processes. This report also includes a description of voluntary efforts which local communities are encouraged to move forward with immediately to reduce the impact of tobacco on the youth of the county. The Tobacco Prevention Coalition and the Tobacco Prevention Project encourage all members of the Contra Costa community to participate in this important public health effort to create a generation of tobacco-free youth. Questions and requests for presentations to describe the policy options should be directed to Regina Penna at the Tobacco Prevention Project at 313-6819. TABLE OF CONTENTS Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Dimensions of Youth Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Factors that Promote Youth Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Marketing & Creation of Youth Demand for Tobacco Products . . . . . . . . . 2 Forms of Tobacco Marketing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Youth Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 The Youth & Tobacco Policy Landscape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Key Issues Regarding Federal, State & Local Tobacco Policy . . . . . . . . . . . . . . 5 Federal Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Freedom of Speech . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Pre-emption of Local Ordinances . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Food and Drug Administration Regulations . . . . . . . . . . . . . . . . . . . . . 8 Local Support for FDA Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . 9 The Synar Amendment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 State Attorneys General Working Group . . . . . . . . . . . . . . . . . . . . . . 10 State Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Proposition 99 and California Policy . . . . . . . . . . . . . . . . . . . . . . . . . 11 Stop Tobacco Access to Kids Enforcement Act (STAKE) . . . . . . . . . . . 11 Contra Costa County Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Clean Indoor Air Ordinances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Vending Machine Ban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Advertising Bans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Board of Supervisors/Conference of Mayors . . . . . . . . . . . . . . . . . . . . 13 Storefront Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Public Opinion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Policy Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Demand and Supply Policy Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Demand Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Restrictions on Tobacco Advertising . . . . . . . . . . . . . . . . . . . . 15 A Partial Ban on Outdoor Advertising . . . . . . . . . . . . . . . . . . . 16 Eliminate Tobacco Advertising in Public Places . . . . . . . . . . . . . 16 Ban Pictures and Color Advertising . . . . . . . . . . . . . . . . . . . . . 17 Ban Use of Cartoon Characters to Sell Tobacco . . . . . . . . . . . . . 17 Strengthen Existing Signage Laws . . . . . . . . . . . . . . . . . . . . . . 18 Restrict Tobacco Promotional and Sponsorship Activities . . . . . . . 19 Ban Tobacco Industry Sponsorship . . . . . . . . . . . . . . . . . . . . . 19 Restrict Point-of-purchase (POP) Advertising . . . . . . . . . . . . . . 20 in Ban Self-Service Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Ban Distribution of Promotional Items Bearing Tobacco Brands, Names or Imagery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Ban Tobacco Gear on Public School Grounds . . . . . . . . . . . . . . 20 Supply Reduction Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Licensing Retailers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Conditional Use Permits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Ban Self-Service Displays of Tobacco Products . . . . . . . . . . . . . 23 Vending Machine Bans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Increase Penalties for Retailers Who Repeatedly Sell to Minors . . . 24 Voluntary Efforts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 A Word to Local Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Reducing the Demand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Counteradvertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Counterpromotions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Media Advocacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Public Service Announcements . . . . . . . . . . . . . . . . . . . . . . . . 26 Boycotts and Demonstrations . . . . . . . . . . . . . . . . . . . . . . . . . 27 Voluntary Approaches Involving the Tobacco Industry . . . . . . . . 27 Other Voluntary Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Restricting the Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Civil Lawsuits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Encourage Enforcement of PC 308 and STAKE Act . . . . . . . . . . 28 Merchant Outreach and Education Programs . . . . . . . . . . . . . . . 28 NextSteps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Choosing Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Community Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Community Input . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Youth Mobilization Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Board of Supervisors and Conference of Mayors . . . . . . . . . . . . . . . . . . . . . . 30 Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 BACKGROUND Dimensions of Tobacco Use Among Youth Tobacco-related disease is the number one cause of preventable death in this country. It is well on its way to becoming the leading cause of death world-wide. In the United States alone, over 434,000 people die each year from their use of tobacco products or their exposure to environmental tobacco smoke. Contra Costa County spends $188 million dollars each year in tobacco-related health care expenditures. Each day over 3,000 youth nationally begin using tobacco and one in three of those who become addicted will eventually die from their tobacco use. The majority of adult smokers began smoking and are addicted to nicotine by the time they are 14 years old. Ninety percent began smoking before the age of 19 (US DHS, 1991; NIDA, 1991). Tobacco use is on the upswing among adolescents. Between 1993 and 1995, smoking rates among California teens aged 12 -17 increased 30.8%. Studies show that few teens are smoking at ages 12 and 13 (2.8%) while 11.7% of 14 and 15 years old, and 22% of 16 and 17 year olds smoke (CA Department of Health Services, 1996). A 1993 study shows that nearly 40% of Contra Costa youth are susceptible to using tobacco in the future. It should be noted that the process of initiating smoking extends somewhat beyond adolescent years and young people continue to be at risk for becoming smokers until they are about 21 years old (Pierce, 1994). This trend is in marked contrast to the decline in adult smoking over the past three decades. California adolescent smoking rates parallel a national upturn in youth smoking. National school prevalence studies show that nearly 1 in 3 adolescents have smoked a cigarette in the prior month and 1 in 5 smoke daily (Consumer Reports). Factors that Promote Youth Tobacco Use Many factors contribute to child and adolescent tobacco use. Tobacco marketing is highly influential. Ninety-two articles submitted to the Contra Costa County Board of Supervisors in 1995 by the Tobacco Prevention Project describe a link between tobacco marketing and adolescent use of tobacco. Community norms, familial and peer smoking behavior and attitudes, and commercial and social access to tobacco products can also encourage or discourage tobacco uptake by youth. Research studies show that even when other influences are considered, youth exposed to tobacco marketing are 40% more likely to use tobacco. As exposure to tobacco advertising and involvement in tobacco promotions increases, so does the likelihood that young people will use tobacco (Schooler, 1996; Altman, 1994). A 1993 study found that tobacco advertising in Contra Costa County last reached "near saturation" level, with 4 out of 5 youth exposed to tobacco advertising immediately prior to being surveyed (Pierce, 1993). Attributes of adolescent development are also important when examining approaches which Tobacco Prevention Coalition l Contra Costa County,California,April 1997 impact youth tobacco use. A primary developmental task of adolescence is the establishment of autonomy. Teenage rebellion, identification with peers, and youth desire to be initiated into adulthood are developmental themes that have been exploited by the tobacco industry. When examining potential strategies for reducing the impact of tobacco on youth, it is important to be cautious of"forbidden fruit" approaches which define tobacco use as an adult- only activity inappropriate for youth. Marketing & Creation of Youth Demand for Tobacco Products In order for the tobacco industry to maintain their market, they must attract at least 2 million new smokers each year to replace those smokers who die or quit (Myer & Hollar, 1989). Those who produce and market tobacco are well aware that if people do not begin to smoke or chew tobacco while they are in their teenage years, it is highly likely that they will never use tobacco. Given this, it comes as no surprise that internal documents of the tobacco industry reveal that they have been targeting their marketing and advertising efforts toward "pre-smokers" (children) and tobacco "starters & learners" (teen smokers) for decades. Confidential marketing memos written by R.J. Reynolds (with titles such as "new Brands of Cigarettes for the Youth Market") discuss strategies for exploiting adolescent peer pressure and for marketing their cigarettes to youth as the "in" brand. Other tobacco industry documents encourage marketers to present tobacco use to "starters" and "young smokers" as "one of the few initiations into the adult works; ...as part of the illicit pleasure category of products and activities." These efforts have clearly been very successful, as the tobacco industry makes more than $1.26 billion dollars in illegal sales of tobacco products to children annually (DiFranza, 1990). In fact, Camel's share of the illegal underage tobacco market increased from 0.5% to 32.8% in the first three years following the introduction of the Joe Camel cartoon character. "Old Joe" is as familiar to children aged 3 to 6 as is Mickey Mouse. Eighty six percent of teen smokers buy the most heavily advertised brands of cigarettes - Camel, Marlboro, and Newport (DiFranza, 1990). The tobacco industry spent more than $6 billion nationally in 1993 to advertise and promote its products (Altman, 1996); well over $1.5 million of these advertising dollars are spent daily in California (CA DHS, 1996). While the industry holds that this advertising is strictly to maintain brand loyalty or encourage brand switching, studies demonstrate evidence that this advertising is designed to encourage youth to start and continue to use tobacco, increase current smokers' cigarette consumption, and provoke relapse among those who have quit. Only 10% of smokers switch brands each year. Cigarettes are more heavily marketed than any consumer product other than automobiles (Altman, 1996) and are the most heavily advertised product on billboards and other outdoor media (Centers for Disease Control, 1990). Teens report seeing cigarette advertising most frequently in retail outlets, on billboards, and in magazines (Schooler, 1996). Tobacco Prevention Coalition 2 Contra Costa County,California,April 1997 This deluge of advertising messages and dollars impacts individuals and communities both directly and indirectly. The direct effects encourage consumers and future consumers to use tobacco. The indirect effects of tobacco advertising are more subtle and create a social and political environment in which tobacco products are acceptable and "normalized" (ANR- ASSIST, 1994). It also decreases the likelihood that media outlets which accept tobacco advertising revenue will run stories critical of the tobacco industry or educate readers on the danger of tobacco use (Stanford Center for Research in Disease Prevention, 1993). Merchants are given significant economic incentives, called "slotting fees", for the placement of tobacco and promotional items in easily visible and accessible locations. These self-service displays for tobacco prompt impulse buys of tobacco by youth and facilitate theft of tobacco by minors. The lucrative fees paid to merchants more than offset any economic impacts of tobacco shoplifting. Youth are heavily influenced by tobacco advertising and promotions. Research studies show that teenage smoking behavior is related to previous and present advertising exposure and that this effect is three times stronger than among adults. (Pollay, 1996). Even when accounting for the influences of family and peer smoking, it is clear that the more advertising youth report having seen, the more likely they are to experiment with tobacco use (Schooler, 1996). Youth are two times more likely to be influenced by advertising and promotions of cigarettes than they are by peer pressure, family members, demographic characteristics or school performance (Pierce, 1994, Schooler, 1996). Forms of Tobacco Marketing Tobacco marketing, aimed at creating demand for tobacco products, takes on two primary forms: advertising and promotions. Advertising includes all paid media advertisements such as billboard advertising, storefront advertising, and print advertising in magazines and newspapers. Although tobacco advertising is banned on television and radio, the tobacco industry buys strategic placement of billboard and stadium advertising at televised events to circumvent this ban. Much of this advertising targets particular populations the tobacco industry perceives as vulnerable to manipulative advertising. This target marketing has largely been aimed at select populations including youth, low-income individuals, women, and people of color. Promotions are efforts to influence consumers through the sponsorship of artistic, cultural or sporting events, retail value-added store promotions, catalog specialty item distribution (t- shirts, lighters, hats, bags, and other log "gear"), coupons, and free or discounted sampling of tobacco. The tobacco industry has also historically paid for product placement in film and television to promote its products. They claim to have ceased this practice, however, prominent positioning of brand-name cigarette packaging and key characters' tobacco use are still frequently seen in film (Stanford Center for Research in Disease Prevention, 1993; Altman 1996; ANR, ASSIST 1994). Tobacco Prevention Coalition 3 Contra Costa County,California,April 1997 Youth Access Youth access deals with the way in which young people are supplied with tobacco products. Youth have relatively easy access to tobacco products even though nearly all states ban selling or distributing it to minors. In fact, more than 947 million packs of cigarettes and 26 million containers of chewing tobacco are illegally sold each year to minors (DiFranza, 1988). The Stop Tobacco Access to Minors Program (STAMP), a Prop 99 funded project, identified several primary sources for tobacco for youth. The mostly frequently used youth tobacco source is from over-the-counter sales from retail merchants such as convenience stores, grocery stores, gas stations, drug stores, and liquor stores. The second leading source of tobacco for youth is through social access channels, with the tobacco coming from parents, siblings, and friends. Third on the list is vending machine sales, followed by youth shoplifting of tobacco. According to retailers, tobacco products are among the most frequently stolen items. A 1992 survey of ninth graders found that 44% of those who smoked daily reported having engaged in shoplifting to obtain cigarettes. (North Bay Resources Center, 1992). A review of thirteen studies of in-store tobacco sales to minors found that youth were able to buy tobacco products 67% of the time (Surgeon General's report 1994). A University of Michigan study found that 75% of 8th graders and 89% of 10th graders stated that cigarettes are easy to get (Campaign for Tobacco-Free Kids, 1996). Recent data released by the California Department of Health Services shows that in random compliance checks, merchants sold tobacco to minors 30% of the time statewide; in Contra Costa, compliance with laws banning sale to minors was somewhat better - 23% of merchants sold to minors (Unpublished information, CDHS Food and Drug Division). Lax enforcement of existing tobacco sales to minor laws and inconsistent community messages about youth tobacco use contribute to an environment where minor tobacco access laws are not taken seriously by many retailers or law enforcement officers. A 1990 study by the U.S. Department of Health and Human Services' Office of the Inspector General found little evidence that youth access laws are being enforced. They noted that where enforcement was active, strong local leadership was a primary factor in this achievement. A survey conducted in 1996 by the American Lung Association of Contra Costa/Solano of police departments in Contra Costa county and an earlier one conducted by the Tobacco Prevention Project in 1995 indicated that few local police jurisdictions enforce laws banning the sale of tobacco to minors. Tobacco Prevention Coalition 4 Contra Costa County,California,April 1997 THE YOUTH & TOBACCO POLICY LANDSCAPE "It is no longer the lawyers who control the debate over tobacco advertising regulation. The legal authority states and municipalities need to at least ban tobacco ads from the most invasive media is now clearly marked and city councils can finally get on with the business of passing ordinances instead of being frozen by fear of expensive lawsuits." - Donald J. Gamer, JD, JAMA, 1996 Key Issues Regarding Federal, State and Local Tobacco Policy A number of factors, including constitutional restraints and federal laws and regulations must be considered when developing local policies related to youth and tobacco. Local tobacco- free youth advocates must understand these legal constraints, the tactics the tobacco industry has used to defeat earlier local initiatives and the more recent developments that have made local action more feasible. At the same time, it is important to remember that state and federal activities are often slower than local efforts, which can be more effective in changing community norms and behavior. Federal Policies Key areas of federal policy are defined and discussed here: freedom of speech issues, pre- emption and the Federal Cigarette Labeling and Advertising (FCLAA), and the new Food and Drug Administration (FDA) regulations. Pre-emption of local control by weaker federal or state legislation has been successful in undermining passage of strong local ordinances and usurped local ability to frame policy, citing health considerations. There are, however, encouraging signs that indicate a more favorable climate for passage of stronger restrictions. Tthe new FDA regulations would strengthen local efforts across the country and give youth advocates great cause of optimism. Freedom of Speech It is important for communities to realize that tobacco advertising enjoys far fewer constitutional protections than other forms of commercial speech. Supreme Court Justice Blackmun, a vigorous defender of commercial free speech, said, "'child pornography and cigarette advertising' will never be fully protected by the First Amendment." In reporting the court's view, law professor Donald W. Gamer says that the power of the people to protect themselves and their children from predatory cigarette advertising has never been stronger. (Gamer, 1996) Until 20 years ago, there was thought to be no protection for commercial speech, but beginning in 1975 and continuing until today, court cases began to hint there might be some. In 1980, in Central Hudson Gas and Electric vs. the Public Service Commission of New York, the court said commercial free speech was entitled to less protection than individual free speech. It described four conditions that must be met if commercial speech such as Tobacco Prevention Coalition 5 Contra Costa County,California,April 1997 product advertising was to be regulated: 1. To be protected at all, the advertising must concern a legal activity and not be fraudulent or deceptive. 2. The Government interest in regulating or banning the advertising must be substantial. 3. The regulation must advance the government's interest. 4. The regulation cannot be any more extensive than necessary to serve the stated interest. In 1994, the City of Baltimore enacted a billboard restriction to reduce consumption of cigarettes by minors. There were exceptions to the restrictions, including billboards near interstates, at stadiums, on buses and cabs. Public hearings were held. The tobacco industry challenged the ordinance. It was upheld in District Court and in the 4th Circuit Court. The U.S. Supreme Court issued a decision (Rhode Island v Liquor Mart) that seemed as though it would overturn the Baltimore ordinance. In that case, Rhode Island had banned price advertising of liquor to promote temperance. The Court overturned the ordinance, saying other alternatives were more likely to serve the government interest. As a result of this case, the Court ordered the 4th Circuit to review the Baltimore ordinance. On review, the 4th Circuit upheld the Baltimore ordinance. The case now returns to the Supreme Court. Pre-emption of Local Ordinances Pre-emption is a strategy used by the tobacco industry to undermine local jurisdictions' ability to regulate the sale and promotion of tobacco in their community. They have consistently attempted to pass relatively weak laws at the federal and state level that pre-empt stronger local laws designed to reduce youth access to tobacco and restrict the marketing of tobacco products. There are a number of reasons why experts suggest that the passage of local ordinances is preferable to state and federal legislation. The tobacco industry has far more influence at the state and federal level than at the local level. Tobacco companies spent more than $2.1 million during the last California primary campaign cycle on campaign contributions to key state legislators, making them the second largest group of political contributors. They have greater difficulties derailing local ordinances and buying "friends" among the tens of thousands of local jurisdictions all over this nation. (Monardi, Institute for Health Policy Studies, 1996) Former tobacco industry lobbyist, Victor Crawford, has testified extensively about the strategies that the tobacco industry has used to defeat local control of tobacco prevention. "We could never win at the local level...So the Tobacco Institute and tobacco companies' first priority has been to pre-empt (local control), and put it all on the federal level...(or) at least the state level." (Skolnick, 1995). A spokesman of The Tobacco Institute has said that they "can't sue every place every time or even send people to challenge every proposal anymore." (ANR, SJ Mercury News, 5/8/94). Focusing on local ordinances has other benefits besides confounding the tobacco industry's Tobacco Prevention Coalition 6 Contra Costa County,California,April 1997 pre-emption strategies. They are easier to enact, have a higher rate of compliance, and are easier to enforce. Their most significant benefit may be their ability to raise community awareness and support for youth tobacco marketing and sales restrictions. The educational opportunities that are inherent in campaigns to pass local ordinances create an opportunity to change social attitudes about youth and tobacco use (ANR, 1996). The major piece of the tobacco industry's pre-emption strategy to undermine advertising restrictions is 15 U.S.0 1334.69, the Federal Cigarette Labeling and Advertising Act (FCLAA). FCLAA bans radio and television tobacco advertising and says that `no requirement or prohibition based on smoking or health shall be imposed by state law with respect to advertising or promotion." This act resulted in the requirement that cigarette packaging be affixed with a warning label that informs consumers that tobacco use is dangerous to their health. Court interpretations indicate FCLAA pre-empts the ability of communities to design ordinances with findings that suggest the purpose of the policy is to address health concerns related to tobacco use. Nonetheless, tobacco is an illegal product to sell to (and thereby market to) minors in California. When working for passage of local tobacco-free youth ordinances, advocates should not incur FCLAA challenges if the intention of their ordinances is related to the tobacco sales issues (such as enforcement of Penal Code 308 & the STAKE Act) rather than to health concerns. The City of Baltimore enacted a ban restricting tobacco and alcohol advertising from residential areas. It has been upheld by the appellate courts because it is narrowly framed and addresses the conditions stipulated in earlier court cases. The Baltimore ban regulates location of billboard advertising but does not regulate content of the advertisements, and therefore was not challenged on First Amendment protection of speech grounds (Gardner, 1996). Other communities engaged in similar policy efforts, such as Cincinnati, have had courts find their ordinances pre-empted by the FCLAA either because they mentioned health impacts of tobacco use in the findings section of the policy and in public hearings on the matter or because they did not describe the restrictions narrowly enough to avoid First Amendment challenges. It is not clear how far pre-emption restrictions go. While some experts say that it is clear that any state or local law requiring a health warning on tobacco is pre-empted, there are exceptions. Smoking bans, tobacco taxes, and other restrictions related to tobacco sale and permits are not pre-empted. On the other hand, the 1992 Cippolone v. Liggett product liability case seems to indicate that the scope of FCLAA's pre-emption is quite narrow. The Supreme Court said the pre-emption did not apply to warranty, fraud, misrepresentations, conspiracy or other bad faith issues. The Tobacco Products Liability Project in Massachusetts is available to review draft ordinance language in order to help local communities avoid being taken to court by the tobacco industry. Tobacco Prevention Coalition 7 Contra Costa County,California,April 1997 Food and Drug Administration (FDA) Regulations The U.S. Food & Drug Administration (FDA) has announced it will regulate nicotine as a medical device beginning in February 1997. The FDA has developed a series of rules which will reduce youth access to tobacco products and severely restrict tobacco advertising and promotional activities targeting children and adolescents. These regulations are being hailed as "the single most powerful tool currently available to protect our youth from the health dangers of tobacco and the insidious recruitment and marketing tactics of the tobacco companies" (Kropp, 1996). Unfortunately, there are currently three lawsuits already against the federal government by tobacco interests which attempt to block various provisions of the regulations. It is not clear how these lawsuits will impact the implementation of the other components of the regulations. The FDA regulations will: • establish 18 years old as the federal minimum age for purchase of tobacco products; • prohibit cigarette vending machines, self-service displays, sampling, mail-order sales, sale of single cigarettes and packs less than 20; • require retailers to verify age of purchasers by photo identification when a sale is made to anyone appearing under 26 years old; • ban outdoor advertising within 1,000 feet of schools and playgrounds; • restrict remaining outdoor advertising to black & white text only, including billboards, transit, and point-of-sale ads; • restrict ads to a text-only format in publications with large teen readership; • prohibit distribution of promotional items (baseball caps, bags, etc.) with tobacco brands, names, or imagery; • restrict sponsorship of entertainment and sporting events to corporate name only; and • require tobacco manufacturers to fund a national public education campaign to prevent teenage tobacco use. California already has elements of the FDA regulations in place, including a statewide ban on vending machines in all settings with the exception of free-standing bars; prohibition of the sale of tobacco to minors; a ban on free sampling of cigarettes; and prohibition of the sale of single cigarettes. The FDA is viewing the regulations as a floor for regulation of tobacco issues, not as a restrictive ceiling. States and local communities with ordinances and laws that are stronger than the FDA regulations, after obtaining a waiver, will be permitted to retain their stronger requirements. The regulations will be phased-in in stages, primarily over the six month period between February - August 28, 1997, with the exception of event sponsorship restrictions which will not go into effect until early 1998. The first component of the FDA regulations to be phased in for February 1997 will be the minimum age of purchase and identification check requirements of the proposal. These sections of the regulations have not been challenged by the industry in court. California state Tobacco Prevention Coalition 8 Contra Costa County,California,April 1997 The Synar Amendment To encourage states to reduce youth accesses to tobacco, the federal government enacted the Synar Amendment in 1993. It requires that states reduce the level of youth access to tobacco or face significant loss of federal funding for alcohol and drug programs. Each state was required to pass legislation describing how reduction of youth access would be accomplished. California enacted the Stop Tobacco Access to Kids Enforcement (STAKE) Act in 1994. State Attorneys General Working Group A recent report issued by a working group of State Attorneys General encourages retailers and state legislators to pass certain reforms (N.Y. State Attorney General's Office, 1994). This report encourages state legislators to: • be wary of solutions advanced by the tobacco industry; • protect local ordinances and avoid pre-emption; • create or require a licensing system for tobacco sales and have that licensing system self-support a compliance program through the use of a graduated fines. • suspend licences for repeat offenses; • include positive incentives for responsible retailing; • require periodic compliance checks; and • pass laws which limit youth access to tobacco by restricting vending machine sales and banning sampling; The Attorneys General report also has a series of recommendations for retailers that include: • monitoring employee compliance with laws that prohibit the sale of tobacco to minors through the use of internal "secret shoppers"; • rewards for employees who comply with the law, and swift disciplinary action for those who do not; • utilizing technology such as programming of electronic price scanners with tobacco "locks" that prompt employees to check identification of tobacco purchasers; • developing effective training on avoiding illegal tobacco sales to minors, and giving this training equal emphasis with that given to training on avoiding illegal alcohol sales; • holding store managers accountable for their store's compliance with the law; • keeping tobacco behind the counter or in a locked case; • removing self-service displays; • posting signs that reinforce the law; • removing vending machines from retail establishments; • requiring proof of age for anyone appearing 25 or under; • removing advertisements, in-store displays, and promotional items that encourage youth to buy tobacco; and • suggesting that retailers who prefer not to take proactive steps to prevent illegal sales of tobacco should consider simply eliminating tobacco from their stores. Tobacco Prevention Coalition 10 Contra Costa County,California,April 1997 State Policy Proposition 99 and California Policy The fact that California has already implemented such laws as a statewide ban on cigarette vending machine sales where youth have access can be attributed, at least in part to changing community norms and attitudes resulting from enactment of Proposition 99, the Tobacco Tax Initiative, passed by the California voters in 1988. The campaign, which operates in every county, has worked to "denormalize" tobacco by countering the efforts of the tobacco industry to promote tobacco use; protect communities from secondhand smoke; and reduce the availability of tobacco products to children and teens (CA DHS, 1996). Through local program interventions and a statewide media campaign, the program has reduced adult smoking statewide from 26.7% to 16.7% and prompted more than 1.3 million smokers to quit. Nearly all indoor workplaces and 63% of households have clean indoor air policies. The percentage of retailers willing to sell tobacco to minors has decreased from 52% to 37%. Most importantly, community norms, and individual attitudes, knowledge and behaviors regarding tobacco use have shifted dramatically. Additionally, the California Legislature passed a bill in 1991 which mandated that all schools receiving Proposition 99-funded tobacco use prevention and education (TUPE) funds become completely smoke-free. Strong legislation and codes have been enacted to ensure that minors' access to tobacco is limited. California State Penal Code Section 308 prohibits the sale of tobacco products to minors and the purchase of those products by youth. Senate Bill 1849 recently amended PC 308 to make tobacco possession by a minor punishable by a fine of$75 or 30 hours of community service. It is important to note that SB 1849 highlights the controversy regarding whom should be punished when minors buy tobacco products. The bill was opposed by Americans for Nonsmokers' Rights, American Lung Association, and the American Cancer Society. These groups and other youth advocates feel strongly that penalizing teens reinforces the "forbidden fruit" image, making tobacco even more attractive to youth; directs energy away from merchant responsibility, and reduces liability for the tobacco industry by focusing on individual behavior over the environmental cues that seduce youth into tobacco addiction. Penalizing youth for succumbing to the cues will not remove the cues. The STAKE Act To comply with the federal Synar Amendment (discussed above), the Stop Tobacco Access to Kids Enforcement Act (STAKE) was enacted by the California Legislature in 1994. It mandates random compliance checks of tobacco retailers to ensure that they are not selling tobacco to minors; requires that signs be posted declaring the illegality of sales to minors and providing a toll-free number to report non-compliant merchants; and imposes fines on Tobacco Prevention Coalition t 1 Contra Costa County,California,April 1997 violators. STAKE is enforced at the statewide level by inspectors from the Department of Health Services Food and Drug Branch. A recent survey finds there has been a 20% decrease in illegal sales of tobacco to minors from 1995 figures. (CA DHS, 1996 - Annual Statewide Youth Purchase Survey) Contra Costa County Initiatives The County Board of Supervisors and the Health Services Department have long recognized that a multi-faceted, broad-based approach to improving the status of health must encompass not only clinical services and individual education, but also policy and legislative action in partnership with community groups. Clean Indoor Air Ordinances In 1985, the Contra Costa County Smoking Education Coalition (SEC), including the County Health Services Department and voluntary health organizations (the American Cancer Society, American Heart Association, and the American Lung Association of Contra Costa/Solan Counties), launched a clean indoor air ordinance campaign. The ordinance prohibited smoking in enclosed public places, created smoke-free areas in the workplace, and mandated 40% non-smoking seating in restaurants with an occupied capacity of 50 or more patrons. By 1986, all 18 cities and the unincorporated areas had adopted the SEC's model ordinance. The multi jurisdictional ordinance was the first of its kind in the nation. In 1989, the Health Services Department established the Tobacco Prevention Project (TPP) with its Proposition 99 funds to facilitate and support a variety of community-based program services, policy initiatives, and media advocacy. As community norms changed and the federal government's found secondhand smoke to be a class A carcinogen with no safe level of exposure, the TPP, SEC and other groups began to advocate for stronger regulations to ban all smoking in workplaces and public places. In 1991, the TPP helped a county-wide group of city mayors and members of the County Board of Supervisors develop a model ordinance mandating a 100% smoking ban in the workplace and in restaurants, bantling tobacco vending machine sales, and prohibiting tobacco sample giveaways. Unlike its predecessor, which was adopted quickly with minimal resistance from business owners and the general public, the 1991 ordinance encountered considerable opposition largely initiated and organized by the tobacco industry. Nevertheless, by 1995, when California's Law for a Smokefree Workplace was enacted, 14 of the cities and the county had implemented 100% workplace smoking bans. (Ellis, 1996) Vending Machine Ban By 1996, when the California Legislature implemented a ban on cigarette sales in vending machines where youth have access, 13 of the county's cities and the county Board of Supervisors had already enacted similar or more restrictive local ordinances. Tobacco Prevention Coalition 12 Contra Costa County,California,April 1997 Advertising Bans In 1991, an initiative to ban billboards from within 2000 feet of schools and youth congregation areas was proposed before the Richmond City Council. When the ordinance was considerably weakened prior to passage, neighborhood advocates placed the original initiative before the voters. Measure J was narrowly defeated when the tobacco industry set up a well-funded campaign. Richmond did enact an ordinance reflecting the industry's voluntary code that bans billboard advertising within 500 feet of schools. Some experts feel that distance is close enough to read the advertisement but not the smaller, mandatory Surgeon General's warning. In 1995, the Board of Supervisors considered an ordinance to reduce youth exposure to tobacco advertising in unincorporated parts of the county by banning tobacco (and alcohol) advertising within 2000 feet of schools. Dozens of representatives of the tobacco, alcohol and billboard industries testified there was no link between advertising and youth use of tobacco. They threatened the County with a lawsuit if the ordinance passed. The Board of Supervisors agreed to negotiate a voluntary agreement with the billboard industry removing any tobacco billboards that were within 1600 feet of schools in the unincorporated areas of the county. The Board of Supervisors and the Conference of Mayors Disappointed with the voluntary agreement and realizing that achieving tobacco-free youth would require more than just billboard restrictions, community groups, including the American Cancer Society, the American Lung Association, Women and Girls Against Tobacco, the Center for Human Development, the PTA and others, asked the Board of Supervisors and the Contra Costa County Conference of Mayors to declare tobacco-free youth a public health priority and to develop policies that went beyond billboards. The Supervisors and the Mayors requested that the Tobacco Prevention Coalition, in coordination with the Health Services Department and with the assistance of the American Cancer Society and the Smoking Education Coalition, recommend a comprehensive strategy for reducing youth access to tobacco and restricting the impact of tobacco advertising on youth. They requested that a model ordinance be developed to move forward with the policy initiative. The Tobacco Prevention Coalition established the Youth Task Group to spearhead the effort. From the beginning, TPC was committed to insuring that the initiative be youth-driven. Based on research, TPC realized that unless youth were involved in shaping the policy and participating in community education, no significant change in community norms would occur. The Storefront Initiative Project In 1995, the California Department of Health Services launched a statewide project to determine the extent of storefront and in store advertising. Contra Costa's effort, the Storefront Initiative Project, recruited youth to conduct a community mapping campaign Tobacco Prevention Coalition 13 Contra Costa County,California,April 1997 which identified the amount and types of storefront and point-of-purchase advertising found in cities throughout Contra Costa County. The youth surveyed over 150 local stores and were overwhelmed by the amount of in-store advertising they found that clearly targeted youth. Storefront youth made a number of recommendations, including that: • teen groups be created to fight advertising from the tobacco industry; • a peer education campaign be carried out using youth-focused commercials, no-smoking posters, and animated shows; • youth forums be held to raise awareness; 0 merchant education programs be conducted; • boycotts of the tobacco industry be organized; and • celebrities and role models be encouraged to do no-smoking commercials. The youth requested both financial resources and community support to implement their recommendations. They wanted to investigate which stores sell tobacco to youth, educate other youth, and get more youth involved with anti-tobacco efforts by forming a youth group. An unexpected cut in funding by the California legislature prevented the project from continuing. Public Opinion Numerous public opinion polls show that people strongly favor policies that restrict the marketing and sales of tobacco products to youth. Nearly all California adults think preventing teens from smoking is very important (97%) and feel that local communities should strongly enforce laws which prohibit sales of tobacco to minors (96%) . Eighty percent feel that tobacco advertising encourages youth tobacco use and three out of four adults support licensing store owners who sell cigarettes (CADHS, 1995). Several national and statewide studies show broad-based support for some form of advertising restrictions with regard to the marketing of cigarettes and other tobacco products (Marcus, 1994; Forster, 1991; CA DHS, 1991; NCI, 1989). A 1995 report by the California Center for Health Improvement shows 88% of Californians support increased penalties to retailers who sell to minors, 75% support banning vending machine sales of tobacco, 73% support licensing tobacco retailers and 71% support broad tobacco advertising bans (CCHI, 1995). POLICY OPTIONS Demand and Supply Policy Considerations Approaches used to address the factors that contribute to teen tobacco use often fall into one of two categories: supply and demand. The demand approaches seek to reduce youth demand for tobacco by focusing on countering tobacco industry marketing. The supply approaches focus on reducing youth access to tobacco through interventions with local merchants and enforcement agencies (ANR, 1994). Tobacco Prevention Coalition 14 Contra Costa County,California,April 1997 Prevailing wisdom suggests that approaches to reaching the goal of tobacco-free youth will require that we integrate comprehensive demand-reduction efforts with effective and enforceable youth tobacco supply strategies. Experience has shown limited success with programs which focus on only access issues without addressing the many environmental factors that contribute to youth demand for tobacco products. Approaches that seek to change community attitudes and behaviors with regard to the marketing and sales of tobacco to minors, rather than addressing individual behavior, appear to be the most successful in terms of long term impact. Both demand-side and supply-side approaches have limitations though, and these must be considered before any synthesis can be achieved. The following is a description of policy options addressing a range of approaches. Some may be mutually exclusive. References to FDA regulations is provided, but not intended to eliminate those options. Demand Approaches Tobacco marketing is a very significant contributor to youth tobacco use and one of the most significant obstacles to tobacco prevention (US DHHS, 1989). This section will examine approaches which reduce the presence and impact of advertising and promotions of tobacco products in local communities. These restrictions often raise concerns about freedom of speech, but are attractive because they address the tobacco industry's role in youth tobacco use rather than penalizing youth for responding to tobacco marketing which targets them. Restrictions on Tobacco Advertising A 1993 study found that tobacco advertising in Contra Costa County has reached "near saturation" level, with 4 out of 5 youth exposed to tobacco advertising immediately prior to being surveyed (Pierce, 1993). Several policy options are being recommended to reduce the presence and impact of advertising, including: • a partial ban on outdoor advertising, including billboards within 1000 ft to 1 mile of sites where youth congregate (schools, community centers, churches, parks, etc.); • a ban on tobacco advertising in public places including sports arenas and transportation systems; • limitation of tobacco advertising both outdoors, on products and in magazines, to "tombstone" ads (black & white print ads without pictures or other images); • a ban on the use of cartoon characters to market tobacco products; and • strengthening local signage laws to limit the amount of a storefront window that could be covered with advertising (the current state law requires that no more than 33% be covered). In addition, a number of options are recommended to restrict tobacco promotional and sponsorship activities: Tobacco Prevention Coalition Is Contra Costa County,California,April 1997 • a comprehensive ban on all tobacco industry sponsorship of events; • elimination of point-of-purchase tobacco displays, advertising, and promotions; • a ban on all self-service tobacco displays with subsequent relocation of tobacco (to behind the counter or in locking cases), which would address both supply and demand issues (this is covered in the section on supply options); • a ban on distribution of promotional items bearing tobacco brands, names or imagery; and • a ban on the presence of tobacco gear on public school grounds. Following is a fuller description of the policy options recommended above. The order is not intended to infer priority. or A Partial Ban on Outdoor Advertising Although some have suggested a complete ban on tobacco advertising, court decisions seem to indicate such sweeping restrictions might violate freedom of speech protections. Restrictions on outdoor advertising near youth congregation areas are not as comprehensive as a total ban. Although youth may be likely to continue to be exposed to tobacco advertising as they travel to school and youth congregation sites, this type of narrower ban has greater chance of surviving a freedom of speech challenge because the restrictions are consistent with protecting a legitimate government interest. If the interest is to reduce the illegal sales of tobacco to minors, then the restriction is not pre-empted by the FCLAA. Implementing such a ban would deliver a strong message that tobacco advertising targeting young people will no longer be tolerated in Contra Costa County. The Food and Drug Administration's new regulations include a ban on tobacco billboard advertising within 1,000 feet of schools and parks. The tobacco industry has imposed a voluntary ban on tobacco advertising within 500 feet of schools. Experts point out that at 500 feet, all images and text, with the exception of the Surgeon General's health warning, can be clearly read at that distance, as previously noted. or Eliminate Tobacco Advertising in Public Places Local governments can have a significant impact on advertising in their communities and set an example by banning tobacco advertising (and sales) on all publicly or municipally owned property. This could include prohibiting tobacco product advertising and sales on all city, county, and special district-owned property, including: • fairgrounds; • entertainment and sports facilities; • buses, bus shelters, subways, trains, rail stations, airports, port authority facilities, and other transit depots; • public sidewalks; and • publicly owned vacant and developed properties. Tobacco Prevention Coalition 16 Contra Costa County,California,April 1997 These actions would remove advertising from public sites where youth congregate, and would provide a consistent tobacco-free youth message for young people in transit to school, home, and community activities. As state and local government have a responsibility to uphold the laws governing tobacco sales to minors and promote the safety and well-being of children, appropriately framed bans are unlikely to be successfully challenged by tobacco industry. In some systems, bus shelters may be privately owned, but on city-owned sidewalks or public property, bans on tobacco ads could eliminate all bus shelter tobacco ads. Transit systems can also refuse to contract with bus shelter developers that accept tobacco advertising. Arguments against such bans have focused on loss of revenue. However, in cities where such bans have been implemented, other advertisers have quickly replaced tobacco advertisers. No public transit systems with tobacco advertising bans in place have reported any net loss of revenue (ANR-ASSIST, 1994). In Contra Costa County, AC Transit, County Connection and BART have already banned tobacco ads on trains and buses and in stations. BART has prohibited both advertising and sales of tobacco at regional BART stations. The Port of Oakland has banned tobacco advertising in the Oakland Airport and all property under its jurisdiction. (ANR, 1996) FDA regulations would restrict transit advertising to black and white text only. E' Ban Pictures and Color Advertising "Tombstone" advertising restrictions, as required in the FDA regulations, limit tobacco advertising on billboards and in magazines, to black and white print ads without use of pictures or other images. The intent of these restrictions is to eliminate the use of appealing images - including cartoon characters - that are appealing to youth, convey misleading images and are the primary means of glamorizing and normalizing tobacco use. This type of advertising restriction, when implemented nationally, will likely cause a significant reduction in the amount of high-impact tobacco advertising in communities. Tobacco advertising executives are rumored to have stated that they would cease to advertise if this restriction were to be implemented nationally (ANR, 1996). The FDA regulations would limit outdoor billboard, transit and point-of purchase ads to black and white text only. Publications with large teen readership (over 25%) would be restricted to text-only ads. While Contra Costa County could not restrict advertising in publications, it could impose restrictions on outdoor billboard, transit and point-of-purchase advertising. rW Ban Use of Cartoon Characters to Sell Tobacco A more limited approach to restricting tobacco advertising would be a mandated or voluntary ban on the use of cartoon characters on tobacco billboards and other display advertising. Since it is well-documented that campaigns that use cartoon characters, like Joe Camel and the Kool Penguin, successfully target children and youth, such a restriction would seem to be Tobacco Prevention Coalition 17 Contra Costa County,California,April 1997 amply justified. The proposed FDA regulations would completely eliminate use of these cartoon figures in local and national advertising, point-of-purchase displays and in promotional activities. It is not clear what limits local jurisdictions have in their ability to selectively ban advertising and promotional activities. Americans for Nonsmokers Rights feels that this approach may raise more serious constitutional issues than a total ban on tobacco advertising. (ANR- ASSIST 1994). It should be noted that during community input discussions, youth felt that all advertising, not just those which included cartoon characters, targeted young people. Assemblyman Don Perata has introduced a joint resolution urging RJ Reynolds shareholders to drop the use of Joe Camel. If the Board of Supervisors and the Conference of Mayors determined not to include a ban on cartoon characters in a tobacco-free youth ordinance, they could pass similar resolutions, which would be merely advisory. rdr Strengthen Existing Signage Laws California law (AB 2742) restricts the amount of advertising that a store can have covering its windows to no more than 33% of total storefront window area. This was developed as a means of ensuring public safety and allowing police officers the ability to see inside of a store in the event of a robbery or other dangerous or illegal activity. Convenience stores have the greatest percentage of mortality associated with workplace violence and communities can frame their arguments for enforcement of these laws focusing on concern for the welfare of store clerks, customers, and public safety officers. The Alcoholic Beverage Commission (ABC) is the agency responsible for the enforcement of AB 2742. This type of initiative requires strong cooperation from local and state enforcement agencies, as well as community members to be effective. Since the state law is not pre-emptive, the tobacco-free youth ordinance could include more restrictive language to be enforced by local authorities. In Richmond, San Jose and Mountain View, California, ordinances have been passed to strengthen the state law and reduce storefront sign coverage to 25% as a means of reducing visual blight and clutter. Local campaigns to increase citizen complaints and enforce sign control ordinances have brought about a reduction in retail tobacco advertising in these communities (ANR). Local ordinance should be clear as to what local agency is responsible for enforcement. This type of restriction would not limit in-store advertising. While surveys done in 1995 of stores in Contra Costa County indicate a proliferation of tobacco ads in stores at eye level with elementary-aged youth, it appears that in-store advertising might not be able to be restricted through ordinance provisions without violating FCLAA preemption. FDA regulations would not address signage on windows or in-store advertising. Tobacco Prevention Coalition 18 Contra Costa County,California,April 1997 cr Restrict Tobacco Promotional and Sponsorship Activities While tobacco advertising is a major factor in influencing the use of tobacco by youth, tobacco promotional activities also play a significant role. These promotional efforts take two primary forms: sponsorship by the industry of events such as rodeos, sports events and other activities, many of which attract and involve young people; and, distribution of a range of clothing and other "gear" that bear tobacco brand names, images and logos, many of which are designed to appeal to youth. It is estimated that 30% of 12-17 year olds, both smokers and nonsmokers, own at least one tobacco promotional item. Tobacco company expenditures for promotional items quadrupled between 1991 and 1993, from $184 million to $756 million. In 1994, the Federal Trade Commission reports the industry spend $850 million. These items carry no health warnings. There are several recommended approaches for eliminating or reducing the presence and impact of tobacco industry promotional activities in communities. These include: • a comprehensive ban on all tobacco industry sponsorship of events; • elimination of point-of-purchase tobacco displays, advertising, and promotions; • a ban on all self-service tobacco displays with subsequent relocation of tobacco (to behind the counter or in locking cases), which would address both supply and demand issues (this is covered in the section on supply options); • a ban on distribution of promotional items bearing tobacco brands, names or imagery; and • a ban on the presence of tobacco gear on public school grounds. sw Ban Tobacco Industry Sponsorship The tobacco industry spent $157.3 million in 1994 (FTC report, 1996) to sponsor events that place brand names and logos in front on its target audience, including youth. Sponsorship is also an effective way for the industry to circumvent a long-standing ban against tobacco advertising on television. When events it sponsors are broadcast, including major league baseball games, football games, golf and tennis tournaments, their name and images are seen many times by millions of people, many of them young people. It is clearly within the purview of government to ban tobacco industry sponsorship of community events and tobacco promotion at those events. Providing organizations with assistance in identifying alternative sponsorship for events may facilitate willingness to refuse tobacco contributions. Recently, anti-tobacco advocates were successful in lobbying the Del Mar Fair Board (in North San Diego County) to ban all tobacco promotions and sponsorship from county fairgrounds. The FDA regulations would restrict sponsorship of entertainment and sporting events to the display of corporate names only. Tobacco Prevention Coalition 19 Contra Costa County,California,April 1997 rW Restrict Point-of-purchase (POP)Advertising Point-of-purchase advertising is both a supply and demand issue and is the most prevalent form of tobacco promotion. Eighty-seven percent of retail stores carry some form of promotional items that advertise tobacco products. A number of approaches have been outlined including prohibitions on all in-store advertising and promotion of tobacco products, including banners, signs on shopping baskets and carts, in/out decals, separator bars, clocks, and logo merchandise. Some municipalities have considered eliminating all in-store advertising and promotions and allowing only "tombstone" ads, which consist of black on white lettering devoid of pictures and images. Preston, Minnesota proposed a ban on all point-of-purchase displays with the exception of "tombstone" style lists of the tobacco brands available for purchase and their prices. These could not be disguised as promotions for particular brands of tobacco. A District court overturned the ordinance on the grounds that it was preempted by FCLAA. The city chose not to appeal. The FDA regulations would ban point-of-purchase advertising. 1W Ban Self-Service Displays In addition to serving to encourage demand, self-service and countertop displays for tobacco products also encourage shoplifting and impulse purchases of tobacco and provide significantly increased youth access to tobacco. Some cities have passed ordinances that restrict tobacco placement to areas behind the sales counter or in a locking case. (See Supply Reduction Options) ir Ban on Distribution of Promotional Items Bearing Tobacco Brands, Names or Imagery A comprehensive ban on promotions is seen as the most direct approach to reducing their presence. Anti-tobacco advocates have concerns that broad bans would likely to be challenged by the tobacco industry on First Amendment grounds. The FDA regulations would prohibit distribution of promotion items (such as baseball caps, bags etc.) with tobacco brands, names or imagery. cW Ban Tobacco Gear on Public School Grounds This policy initiative, requiring action by local school boards, is recommended by the California Association of School Boards. It is aimed at removing environmental cues that encourage young people to smoke and "normalize" tobacco. Some school districts in Contra Costa already have such bans; there have been reports of limited or no enforcement of the bans. Tobacco Prevention Coalition 20 Contra Costa County,California,April 1997 Supply Reduction Options Although advertising and promotion lies at the heart of what encourages youth to want to use tobacco, it is clear that access to tobacco products also contributes to the problem. The assumption that underlies the implementation of youth access policies is that reducing access will lead to a reduction in teen tobacco use. While the ease of access to tobacco products by minors has not been debated, determining how best to address the issue has been confusing. Contradictory findings abound. Several research studies and anecdotal reports find that reducing youth access in certain settings has an impact on rates of teen tobacco use. One area in which youth access ordinances have had a significant impact is in Woodbridge, Illinois, where researchers found that cigarette experimentation and regular use declined by 50% following enactment and vigorous enforcement of a strong youth access ordinance. While it should be noted that Woodbridge is a small suburban community with only ten tobacco retailers and strong law enforcement commitment to reducing youth tobacco access, youth access enforcement has helped to reduce youth tobacco use in other communities. Other research has found little association between reduction in commercial tobacco sales to youth and actual teen tobacco use. A two-year study found that raising merchant compliance to nearly 80% in three similar communities did reduce sales to minors but had no impact on teen smoking rates. They caution that they have only two years of data, and that outcomes may be more long term when it comes to changing social norms (Rigotti, 1996). It has been speculated that as the commercial supply of tobacco available to youth shrinks, teens are simply turning to social sources to obtain tobacco (CADHS, 1996). Some advocates and researchers hold that until societal attitudes around teen tobacco use change, we are "plugging our fingers in the dike." The debate on where to place responsibility and sanctions for youth tobacco sales has been equally fervent. Educational efforts and sanctions have been implemented at the merchant and sales clerk levels, and some jurisdictions penalize youth who purchase tobacco. Some advocates feel it is the tobacco industry that must be held accountable for their mercenary-like approach to recruiting young people into tobacco addiction and that a focus on youth sanctions moves the blame to the individual level, and lessens the liability of the tobacco industry (ANR, 1996). Others feel that youth sanctions, along with merchant education, youth purchase surveys, PC 308 & STAKE Act compliance checks (along with citations and fines for violators) are part of an effective means of reducing the tobacco supply to youth. Evidence suggests that such approaches may be more effective in suburban communities than urban areas (ASSIST, 1994). There is consensus that strong and enforced youth access laws do provide a consistent message to communities that youth tobacco use is unacceptable and is as important as teen use of alcohol and other drugs (NAAFI, 1996). The tobacco industry has mimicked the efforts of merchant education strategists and Tobacco Prevention Coalition 21 Contra Costa County,California,April 1997 developed programs such as WE CARD which is mainly the posting of informational signs. This program is promoted by the Washington, D.C.-based "Coalition for Responsible Retailing" and led by Executive Director Read DeButts, a top lobbyist for the R.J. Reynolds Tobacco Company. The coalition includes among its chief members the Tobacco Institute, the Smokeless Tobacco Council, and the National Association of Convenience Stores. American for Nonsmokers' Rights suggests that when the tobacco industry adopts a strategy typically used by tobacco-free youth advocates, it may signify that they have determined that this approach will have little impact on youth tobacco sales. In fact, these industry-sponsored programs may not only be ineffective, but may actually contribute to creating increased demand for tobacco by youth. Experts say that while these programs create the impression that their sponsors are committed reducing youth access to tobacco, they are in fact utilizing a strategy which makes tobacco more appealing to youth by identifying smoking as an "adult privilege." Such "Trojan horse" programs are uniformly devoid of any messages of the dangers of tobacco use and are dangerous in that they may mollify policymakers and manipulate the general public into believing that by supporting these programs they have addressed youth access to tobacco. A recent study of the "It's the Law" program showed that it has no impact on children and teens' ability to buy tobacco (DiFranza, 1996). There are a number of local policy options that may impact youth access to tobacco These include: • licensing tobacco retailers; • requiring conditional use for new tobacco retailers; • banning self-service displays; • banning vending machines; • increasing penalties for merchants who repeatedly sell to minors; • civil lawsuits; • effective local enforcement of PC 308 and STAKE Act;and • merchant outreach and education programs. Following is a fuller description of the policy options recommended above: cr Licensing Retailers Some people argue that licensing alcohol retailers and not licensing tobacco retailers sends the wrong message to young people, implying that tobacco use is acceptable while alcohol use is not. Just as with alcohol retailers, tobacco retailers can be regulated either through licensure or issuance of conditional use permits. Licensing ordinances require merchants to purchase a license in order to sell tobacco products. This license can be suspended or revoked if the merchant sells tobacco to minors. Tobacco sales are a large revenue producer for many merchants and account for 71% of sales and 62% of profits at convenience stores. The loss of the right to sell tobacco to adults has far greater financial implications for a retailer than would a $200 fine for non-compliance under current youth access laws. Tobacco Prevention Coalition 22 Contra Costa County,California,April 1997 Several states and some local communities currently license tobacco retailers and use underage inspectors to spot-check compliance. Americans for Nonsmokers' Rights recommends that license fees should be designated to support these enforcement efforts and a graduated schedule of fines and penalties be established with licensure suspension or revocation as a last resort. Retailers should bear the cost of contesting sanctions, if they are allowed to appeal, in order to reduce frivolous contests. There is a possibility that the tobacco industry may challenge licensure in California as it may be pre-empted by state law. FDA regulations will not address this strategy. OW Conditional Use Permits Another strategy to regulate tobacco retailers is to use local zoning processes to require conditional use permits for new merchants. This relatively new approach to tobacco control allows for a community feedback and review process. Residents can assert that they either do not want, or are already saturated with, tobacco retail outlets, and that they don't want any more in their area. Tobacco retailers who are approved through the conditional use permit process would be required to follow conditions set for their operation, which could include strict adherence to laws relating to the sale of tobacco to minors. Merchants who violate these conditions could have their local business licenses suspended or revoked. FDA regulations would not address this strategy. Wr Ban Self-Service Displays of Tobacco Products Self-service displays allow customers to obtain tobacco without the assistance of a store employee. Youth Tobacco Purchase Survey found that 49% of youth buy their own cigarettes and found that it is easier for youth to purchase tobacco from self-service displays than with the assistance of a clerk. (TCS, 1996) The alternative to self-service displays are behind-the counter or locked displays. Youth may be less likely to try to buy tobacco when they have to ask a clerk for the tobacco product. Clerks are also less likely to sell tobacco products to youth if they are specifically asked for the tobacco product. In addition, behind-the-counter displays make cigarettes and chewing tobacco more difficult to shoplift. Many teen smokers report obtaining tobacco through shoplifting from self-service displays. Retailers receive substantial "slotting fees" to place tobacco in self-service displays. These fees subsidize tobacco losses through shoplifting (ANR, 1996). Increasingly more local communities, including several in the Bay Area, have passed ordinances that require that tobacco products be kept behind the sales counter and prohibit the use of all free-standing and /other self-service tobacco displays. Tobacco Prevention Coalition 23 Contra Costa County,California,April 1997 The FDA regulations would ban self-service displays. cr Vending Machine Bans Statewide and local surveys conducted in the past indicated that youth are successful 100% of the time they attempt to purchase cigarettes from vending machines. Realizing that, nearly every city in Contra Costa County and the Board of Supervisors for the unincorporated areas, passed ordinances banning vending machine sales where youth have access. A state law was implemented in January 1996 banned vending machine tobacco sales everywhere except in businesses with on-sale liquor licenses. FDA regulations would ban vending machine sales where youth have access. rW Increase Penalties to Retailers Who Repeatedly Sell to Minors Under the STAKE Act and Penal Code 308, retailers receive a civil penalty of$200 for a first offense of tobacco sales to a minor. Fines can increase to as much as $6,000 for repeated sales over a five year period. Recent efforts in the California legislature have centered around increasing penalties for youth who possess, buy or attempt to buy tobacco products and reducing penalties for merchants who sell to minors. It is within the jurisdiction of local municipal bodies to implement stiffer penalties for merchants who sell to minors. It is also within the jurisdiction of the County district attorney to use the California Business and Professions Code to penalize merchants who repeatedly sell to minors. It is recommended that these penalties be civil and on a graduated schedule. The local courts should have responsibility for assessing fines, similar to traffic enforcement. Reporting of violations by localities and the state should be coordinated and convictions should be counted toward licensing suspensions, if applicable (USDHS, 1990). VOLUNTARY EFFORTS A Word to Local Communities While a tobacco-free youth ordinance is being developed by local policy makers, local residents can move forward immediately to achieve the goal of tobacco-free youth. This section contains a description of projects local communities can undertake (See Next Steps section for other ideas): • Identify outdoor advertising in your community that you would like removed. • Conduct policy forums to educate your community about the problem and solutions. • Organize grassroots merchant education, counteradvertising and awareness projects as described in the voluntary efforts section of this report. • Use the letters to the editor and other media opportunities to share information with Tobacco Prevention Coalition 24 Contra Costa County,California,April 1997 your neighbors. • Let your local school board know how you feel about banning tobacco gear and assuring smoke-free campuses. • Talk to law enforcement officials about conducting compliance checks and merchant education efforts. Contact the Tobacco Prevention Project (313-6808) for assistance in developing and implementing your plan and for small reimbursement grants to assist in local efforts. Reducing the Demand Counteradvertising Counteradvertising and counterpromotions are two strategies which help to counter tobacco marketing messages which glamorize tobacco use directed at youth. Experts suggest that effective counter advertisements focus on the tobacco industry; emphasize the social and political issues related to tobacco and highlight environmental change strategies. Such advertising has been effective in raising awareness of the health impacts of second-hand smoke and has attacked the tobacco industry directly. Counteradvertisements can be run through paid media buys or can be mandated. Billboard companies and others which carry tobacco advertising can be required to carry a certain number of anti-tobacco counteradvertisements for every tobacco ad. New York City required that one anti-tobacco ad be run for every four tobacco advertisements on city property. Their ordinance was successfully challenged by the tobacco interests on the grounds that such action is pre-empted by FCLAA. Any advertising produced for voluntary counteradvertising efforts should be developed by health advocates rather than by the tobacco industry or its allies. An effective counteradvertising campaign was carried out by youth organizers in South Central Los Angeles with the Community Coalition for Substance Abuse Prevention and Treatment. Youth conducted a survey of placement of tobacco advertising in a neighborhood identifying all tobacco billboards within 500 feet of where youth congregate. They then negotiated the removal of these billboards with the outdoor advertising company and arranged for them to be replaced with a counteradvertising message of the youth's design (Community Coalition for Substance Abuse Prevention and Treatment, 1996). Counterpromotions The tobacco industry spends a significant percentage of its marketing resources on promotional activities. The most effective public health strategy for countering these promotions is to eliminate them completely. Where this is not possible, it is important to engage in some form of counterpromotions, such as alternative sponsorship, countersponsorship, tobacco merchandise exchanges, or protests against specific promotional activities. The tobacco industry sponsors numerous artistic, cultural, and athletic events that provide a Tobacco Prevention Coalition 25 Contra Costa County,California,April 1997 means of sanitizing the image of the industry and serve as subversive advertising measures. Pro-health advocates can assist tobacco-sponsored events and teams find alternate sponsors. Doctors Ought to Care (DOC) arranged for alternative sponsorship to the formerly Philip Morris- sponsored U.S. Boomerang Team. Under tobacco industry sponsorship the team was required to wear Marlboro hats and shirts and promote Marlboro cigarettes in their media interviews. After extensive DOC protests and events which mock tobacco sponsorship of tennis and other sports, the former-Virginia Slims Tennis Tournament arranged to be sponsored by Bank of the West. The Australian Government raised the tobacco excise tax by 5% and has used some of these funds to buy out tobacco sponsorships and replace them with public health sponsorships of arts, athletic and community organizations and events (ANR- ASSIST, 1994). Proposition 99 has funded several pro-health countersponsorships of athletic events or programs, including the Tobacco-Free Challenge racing car and a ski racing program for children. Other forms of counterpromotions have included a T-shirt exchange organized by National Association of African-Americans for Positive Imagery (NAAAPI), and protests by youth at tobacco industry promotional events. Media Advocacy Media advocacy refers to strategic use of the media to counter tobacco promotions. The tobacco industry avoids circumstances that are likely to create unfavorable publicity, including examples of billboards near schools; proliferation of storefront advertisements bearing cartoon characters; advertising that blatantly targets communities of color;and distribution of tobacco gear to minors. Negative media attention drawn to industry-sponsored events through protests and creative measures gives pro-health advocates an opportunity to reframe the story, educate reporters, and highlight the impact tobacco marketing and use has on community health. Contra Costa County's tobacco-free youth initiative is an especially appropriate subject for media attention if advocates train young people to be spokespeople for their own cause. Guest editorials and letters to the editor are another means of providing unfavorable exposure for tobacco industry tactics (ANR-ASSIST, 1994). Public Service Announcements Public Service Announcements tend to have limited impact with some exceptions. They tend to be run very infrequently and rarely at peak listening hours. However, if they can be coordinated with a paid media campaign, extra placement or air time can sometimes be negotiated and ads can run as PSAs. It is recommended that PSAs be high quality and equivalent to tobacco industry efforts (ANR- ASSIST, 1994). Tobacco Prevention Coalition 26 Contra Costa County,California,April 1997 Boycotts and Demonstrations Communities have often resorted to economic boycotts of corporations, stores and other entities to gain support for change. Nationally, INFACT, for example, has called for a boycott of all products, including those that are not related to tobacco, made by the parent companies of the tobacco-producing corporations. Communities have also staged demonstrations calling attention to tobacco industry sponsorship of events, the proliferation of advertising and promotional activities that target youth. Voluntary Approaches Involving the Tobacco Industry Although many people favor voluntary approaches as the least invasive strategy, Americans for Nonsmokers Rights and other groups feel that approaches that require industry voluntary compliance have several major drawbacks. They are rarely likely to solve the problem permanently, because they must be monitored vigilantly and the responsibility for conducting those efforts fall with the community rather than a designated agency or official. Second, if the voluntary agreements are violated, as history indicates they often are, the community has no resource for penalties or corrective action. The phrase, "the fox guarding the henhouse," is often used to describe what is wrong with voluntary agreements. In a recent poll conducted by the Initiative on Tobacco Marketing to Children, 78% of advertising executives expressed doubts that voluntary tobacco advertising systems would work. (Wall Street Journal, 12/18/96) Some options include limiting advertising and promotion by voluntary action of billboard companies, newspapers, and merchants. Because point-of-purchase advertising and promotions are very lucrative for retailers, voluntary restrictions by these businesses may require strong encouragement from the community and promotion of non-tobacco promotion alternatives. Recently an ordinance which would have eliminated tobacco (and alcohol) billboards from a distance of 2000 feet from all youth congregation areas was under consideration by the Contra Costa County Board of Supervisors. The outdoor billboard companies offered a compromise voluntary agreement to remove tobacco advertisements from these billboards from a distance of 1600 feet of schools in the unincorporated areas of the county. Compliance has not been measured. Other Voluntary Options The Oakland Coliseum has voluntarily eliminated tobacco advertising from the arena as have a number of other sports arenas in the state and across the country. In other cities, outdoor advertisers have given free space to community groups for counter- tobacco advertising. In a recent survey of candidates for elected office in Contra Costa County, a transit board member offered free advertising space on buses for anti-tobacco ads. A merchant outreach program in the Castro District of San Francisco has successfully Tobacco Prevention Coalition 27 Contra Costa County,California,April 1997 encouraged local retailers to reduce the amount of tobacco advertising in the stores, and to eliminate advertising which appeals to youth or that targets the neighborhood lesbian and gay community (Alive with Pleasure Conference, 1996). Anti-tobacco poster contests can be conducted among children in the community and the winning entries can be displayed on billboards, on public transit or in other visible locations. Local businesses can be enlisted to cover production costs. Other voluntary efforts include persuading local media not to carry tobacco advertising (many newspapers in Contra Costa have policies banning tobacco advertising in their publications). In some parts of the country, community groups have pressured public pension funds to divest tobacco stocks from their portfolios or to introduce shareholder resolutions at annual meetings addressing tobacco industry policies. Restricting the Supply Civil lawsuits Lawsuits based on consumer protection statutes are a relatively new and consequently not a well tested approach to seeking compliance with the youth access legislation. Two individuals sued a Massachusetts convenience store chain for violating state minimum age laws for selling them tobacco when they were minors. These suits were settled out of court, with one part of the settlement requiring that they check identification of anyone not clearly of legal age before selling them tobacco products. Additionally, numerous states and counties, including Contra Costa, are currently proceeding with lawsuits against the tobacco industry to recoup the costs associated with tobacco-related disease. Encourage Enforcement of PC 308 and STAKE Act While local communities search for more effective approaches to reducing youth access to tobacco, there are already existing laws that can be enforced. Community members can encourage merchants to post STAKE Act signs. They can report non-compliant merchants to the state's toll-free number, 1-800-5-ASK 4 ID. They can enlist the assistance of local police departments in educating merchants about the provisions of PC 308, which prohibits the sale of tobacco to minors. It is important when considering these options, however, to maintain a clear focus on the root cause of the problem and to avoid penalizing youth, who are the victims of a $6 billion advertising campaign to encourage them to use tobacco products. Merchant Outreach and Education Programs Some research studies have shown that combining merchant education with increased enforcement of laws prohibiting the sale of tobacco to minors improves compliance. Merchant education programs provide an opportunity to build relationships and support for enforcement efforts among the business sector and the general public. (Feighery, 1991) Many merchants are unaware of the impact tobacco advertising, promotion and access Tobacco Prevention Coalition 28 Contra Costa County,California,April 1997 policies have on youth and tobacco. Most are unaware of the tobacco-free youth goal established by organizations and policy makers in the county. Some merchants, on the other hand, consider themselves to be active members of the community and should be given a chance to change their practices voluntarily and become part of the tobacco-free youth movement. Solid merchant education programs should not be stand-alone strategies, but be included as part of a comprehensive approach to addressing youth tobacco demand and supply. Such programs should not portray tobacco use as a "normalized" behavior that is fine for adults but off-limits for youth. Education of merchants should be a first phase in a broader youth access enforcement and tobacco retailer regulation effort and be followed by strict enforcement of PC 308, the STAKE Act, and local tobacco control legislation. Periodic "booster" activities or site visits may assist in prolonging the impact of early educational efforts. NEXT STEPS Choosing Partners and Identifying Allies Not only must policy options be examined and explored carefully, but also tobacco-free youth advocates should consider the partners they select in developing and implementing them. Wendy Lesko and the Activism 2000 project encourage advocates to work closely and collaboratively with youth when planning strategies to reduce youth tobacco use. She encourages that youth be regarded as partners in all phases of programming and strategic planning (Lesko, 1996). Adequate training needs to be provided for both young people new to working in decision- making processes and for adults who are new to working with young people. Todd Clark of the Constitutional Rights Foundation asserts that "Adults need to be taught how to listen to youth and share their concerns... sharing power does not come naturally to adults - people need training in sharing power" (Lesko, 1996). The Tobacco Prevention Coalition has created a Youth Task Group and a youth mobilization effort (see below) to promote youth involvement in tobacco-free youth policy development. In addition, the 1996 survey conducted by the Tobacco Prevention Coalition of the attitude of public officials toward tobacco policies can serve to identify powerful allies who can help guide and shape local policies initiatives. Community Assessment Before implementing supply and demand reduction policies and strategies, Americans for Nonsmokers' Rights recommends that communities examine the following issues: • How receptive is the community to tobacco control policy? Have smoking restriction or youth access ordinances been passed? How strong are these ordinances? (Contra Costa County pioneered one of the strongest uniform clean indoor air ordinances) Tobacco Prevention Coalition 29 Contra Costa County,California,April 1997 • How and to what extent does tobacco industry target particular populations with ads and promotions? • What is the distribution of billboards in this community? • What sponsorship of events (cultural, artistic, athletic) does the industry engage in? • Is there advertising on public transportation vehicles or transit depots? Are there billboards in sports facilities? • What types of point-of-purchase ads; promotional displays; sales or fee distribution of logo-branded gear are in the community? (ANR-ASSIST, 1994) Community Input These policy options will be circulated to residents of the many communities that make up Contra Costa County, and to the decision-making bodies which make policy for and represent those communities, in order to facilitate discussion of tobacco and youth issues in local neighborhoods; solicit feedback; identify community priorities with regard to youth tobacco prevention strategies; and begin the process of developing local ordinances and policies which impact demand for and supply of tobacco for young people. Youth Mobilization Projects Teams of teenagers and young adults are working throughout Contra Costa County recruiting youth to become involved in this decision-making process. These youth coordinators and outreach workers will build teams of young people in East, West, and the Central/South/Lamorinda areas of the county who will identify policy or other strategies that will reduce pro-tobacco influences in a part of their community, develop an action plan to implement their strategy, identify their allies and resources available to assist them, and execute their plan. These youth participants will be trained in tobacco prevention basics, leadership development, community organizing, group facilitation, public speaking, participating in decision-making and policy development processes. Board of Supervisors and the Conference of Mayors These policy options will be presented to the Board of Supervisors and the Conference of Mayors in April, 1997. As the Board previously requested, the policy options will shortly thereafter be incorporated into a tobacco-free youth ordinance. The Tobacco Prevention Coalition will make its resources available to support the adoption and implementation of these policies in communities throughout Contra Costa County. "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that every does. " -Margaret Mead Tobacco Prevention Coalition 30 Contra Costa County,California,April 1997 BIBLIOGRAPHY US Department of Health Services, Public Health Service, National Institute for Health, National Cancer Institute. Strategies to Control Tobacco Use in the United States: A Blueprint for Public Health Action in the 1990's. Publication No. 92-3316, December 1991. NIDA, Drug Use Among American High School Seniors, College Students, and Young Adults, 1991. Tobacco Control Section, CA Department of Health Services, Youth Access to Tobacco, 1995 California Youth Tobacco Survey, 1996. Pierce, J.P., Evans N., Calvin S.W., Kealey S., Kreft, A.M., Farkas A.J., Berry C., Kaplan R.M. Tobacco Use in California: Regional vs. State Level Changes, 1990-1993, Contra Costa County. La Jolla, California: University of California, San Diego: 1994. Consumers Union. Hooked on Tobacco: Teens and Smoking, Consumer Reports, March 1995. Schooler, C., Feighery, E., Flora, J.A. "Seventh Graders' Self-reported Exposure to Cigarette Marketing and Its Relationship to Their Smoking Behavior" American Journal of Public Health, 86(9):1216-1221: September 1996. Altman, D.G., Levine, D.W., Coeytaux, R., Slade, J., Jaffe, R. "Tobacco Promotion and Susceptibility to Tobacco Use among Adolescents aged 12 through 17 Years in a Nationally Representative Sample." American Journal of Public Health, November 96:86(11):1590-1593. Myers, M.L. and Hollar, J. Tobacco marketing and promotion, Tobacco Use in America Conference, 29-42, January 27-28, 1989. Teague, C. Research Planning Memorandum on Some Thoughts About New Brands of Cigarettes for the Youth Market", R.J. Reynolds Tobacco Company (February 2, 1973). DiFranza, J. and et al. "RJR Nabisco's Cartoon Camel promotes Camel Cigarettes to Children", JAMA, 1991:263:2784-2787. CDC "Cigarette Advertising - United States, 1988." MMWR 1990:38(16):261-265. ASSIST, ANR, USDHHS, National Institutes of Health, National Cancer Institute. Tobacco Advertising and Promotion:A Guide to Developing Policy. Butler, Judy, MS How to Counteract the Tobacco Industry's Advertising and Promotion. Stanford Health Promotion Resource Center: 1993. Foster, J. Preventing Tobacco Sales to Kids: What Communities Can Do? Minnesota Tobacco Free Youth Project, MN Association of Non-Smokers, 1991. Tobacco Prevention Coalition 31 Contra Costa County,California,April 1997 Pollay, R.W., Siddarth, S., Siegel, M., Haddix, A., Merritt, R.K., Giovino, G.A., Eriksen, M.P. "The Last Straw? Cigarette Advertising and Realized Market Shares Among Youths and Adults, 1979-1993", Journal of Marketine Vol. 60 (April 1996), 1-16. DiFranza, J.R., Norwood, B.D., Garner, D.W., Tye, J.B. Legislative Efforts to Protect Children From Tobacco, JAMA Vol. 257, No. 24, June 26, 1987. Kropp R., North Bay Health Resources, STAMP. Stopping Sales of Tobacco Products to Minors through Law Enforcement Measures and Local Ordinances:A Guide for Local Elected Officials and Government Administrators in California. 1992. USDHHS, Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Public Health Service, Centers for Disease Control and Prevention, Office on Smoking and Health, 1994. Garner, D.W. Banning Tobacco Billboards: The Case for Municipal Action, Journal of the American Medical Association, Vol. 275. No. 16, April 1996. Monardi, F.M., Balbach, E.D., Aguinaga, S., Glantz, S.A., Shifting Allegiances: Tobacco Industry Political Expenditures in California January 1995 -March 1996. UCSF Institute for Health Policy Studies, April 1996. New York State Attorney General's Office - Bureau of Consumer Fraud & Protection. No Sale: Youth, Tobacco and Responsible Retailing (Developing Responsible Retail Sales Practices and Legislation to Reduce Illegal Tobacco Sales to Minors), 1994. California Department of Health Services, Tobacco Control Section. Youth Access to Tobacco in California, 1996. USDHHS, Model Sale of Tobacco Products to Minors Control Act:A Model Recommended for Adoption by States or Localities to Prevent the Sale of Tobacco Products to Minors, May 1990. ASSIST, ANR, USDHHS, National Institutes of Health, National Cancer Institute. Youth Access to Tobacco:A Guide to Developing Policy, August 1994. Federal Trade Commission Report on Tobacco Industry Expenditures, 1996. WS Journal 12/18/96. Rigotti, 1996. DiFranza, J.R. and Brown. "The Tobacco Institute's It's The Law Campaign: Has It Halted Illegal Sales of Tobacco To Children?" American Journal of Public Health 82:1271-1273, 1992. Feighery, E. "Effects of Combining Education & Enforcement to Reduce Sales to Minors", JAMA, Vol. 266, 12/11/91. Tobacco Prevention Coalition 32 Contra Costa County,California,April 1997 Garner, D.W. Safe Streets for Children, Tobacco Advertising Control Act. Illinois Coalition Against Tobacco, 1996. DHHS, Office of Inspector General, Youth Access to Cigarettes. May 1990. Contra Costa County Tobacco Prevention Program, Survey of Candidates' Positions on Tobacco Issues, 1996. James, B. Legal Update: No policy may be the worst policy. School Safety, National Safety Center, Spring 1993. Stanford Center for Research in Disease Prevention, Tobacco Free Youth project: User's Guide for a Program to Reduce the Illegal Sale of Tobacco to Minors, Stop Teenage Addiction to Tobacco, Health Promotion Resource Center. Tobacco Prevention Coalition 33 Contra Costa County,California,April 1997 ZRCEIVED Contra Costa County Tobacco Prevention Project's7 Regional Youth Mobilization Projects Project Description: CONTRACOSIA Three regional youth organizing projects will train teams of youth to become activists who fight back against tobacco industry targeting of young people. These youth-driven projects will develop diverse local youth leadership in communities targeted by the tobacco industry. Youth will be trained in methods of community outreach & organizing, and working with policy makers, community leaders, merchants and other adult decision-makers. They will develop leadership skills that include: • public speaking; • problem-solving, • action plan/strategy development; • volunteer recruitment; • planning & facilitating meetings; • managing group dynamics & conflict; • media advocacy; and • imparting healthy values and codes of conduct among their peers. By the end of the project, youth advocates will: -> be able to recognize tobacco industry targeting in their communities and apply strategies for effectively reducing the quantity and impact of this targeting; -> have knowledge of the issues related to tobacco, how demand is created for tobacco, approaches for reducing the supply of tobacco in their communities, and ways to counter the tobacco'industry's marketing &promotions strategies; -> work with a team to develop and carry out a community organizing project that counters tobacco industry targeting in their region of the county; -r work with policy-makers and other key decision-makers to reduce tobacco industry influences in their local communities, and help train these adults in methods of working with youth as full partners, change agents, and community resources, -► broaden their experience in working in culturally and economically diverse settings and have knowledge of ways of working that honor differences. Join usl For more information, call Colleen Floyd-Carroll at 313-6834. Tobacco Prevention Project *597 Center Avenue, Ste. 115 *Martinez *CA *94553 This material made possible by funds received from the Tobacco Tax Health Protection Act of 1988-Proposition 99, through the California Department of Health services, under contract#29-396.