1. Legal Age, Location Restriction, and Licensing FPMU120: HEALTH POLICY FOR HEALTHY LIFESTYLES YUYAN SHI, PHD DEPARTMENT OF FAMILY MEDICINE AND PUBLIC HEALTH UNIVERSITY OF CALIFORNIA, SAN DIEGO SPRING 2016

2. Lecture Outline  Announcements Homework assignment #2 due 4/28/2016 12:00pm Group presentation: please sign up  Individual presentation on health policy topics  This lecture: Learning objectives Legal tools: legal age, location restriction, and licensing

3. Previously in FPMU 120…  Defined legal tools to impact risky health behaviors: Prohibition Harm reduction Legalization  Provided examples of different legal tools to impact Illicit drug use Alcohol Tobacco Sex behavior

4. Learning Objectives  Describe the age restrictions for tobacco, alcohol, and marijuana  Discuss the public health implications of minimum legal sale age  Define key elements and describe rationale of location restrictions (zoning and consumption in public)  Define key elements and describe rationale of licensing policies

5. Legal Age  Recognize distinctions between Minimum legal sale age Minimum legal age for consumption

6. *Legal Age for Alcohol  Minimum legal sale age: 21 years of age Applied to all states Applied to both on premise and off premise alcohol outlets  Minimum legal age for consumption: Varied state-by-state Some states ban under-21 consumption Some states have no regulation Some states allow consumption under 21 but with restrictions on locations and presence of family member

7. Minimum Legal Sale Age for Alcohol in 190 Countries

8. *Legal Age for Tobacco  Minimum legal sale age: 18 years of age in most states A few states raised to 19 Hawaii (California?) and more than 100 cities (New York, Chicago, Boston, etc.) raised to 21 Applied to cigarettes AND alternative tobacco products  Minimum legal age for consumption: Varied state-by-state https://www.youtube.com/watch?v=0TFg_zYICUo http://publichealthlawcenter.org/sites/default/files/resources/tclc-guide-minimumlegal-saleage-2015.pdf

9. *Legal Age for Marijuana  Minimum legal sale age: 18 or 21 years of age for medical marijuana Minors can be qualified if certain conditions are met 21 years of age for recreational marijuana No exceptions can be made to minors  Minimum legal age for consumption and possession of small amount: 18 or 21 or none, varied state-by-state

10. Rationale for Minimum Legal Sale Age  Public health benefits of increasing minimum legal sale age : Helps delay smoking initiation among youth Reduces smoking prevalence, especially among youth Saves healthcare costs Increases length and quality of life  It is projected that: Raising minimum legal sale age to 21 would result in a 12 percent decrease in tobacco use, approximately 223,000 fewer premature deaths, 50,000 fewer deaths from lung cancer, and 4.2 million fewer years of life lost for those born between 2000 and 2019 http://publichealthlawcenter.org/sites/default/files/resources/tclc-guide-minimumlegal-saleage-2015.pdf

11. Location Restriction: What is Zoning  Zoning is created for land use planning  Zones can be designated as residential, commercial, industrial, agricultural, or mixed-use  By dividing areas into zones, local jurisdictions can control the types and characteristics of businesses that are allowed to operate https://www.youtube.com/watch?v=sigdOUQDt0M http://countertobacco.org/licensing-zoning-and-retailer-density

12. *Location Restriction: Zoning Laws  Zoning laws primarily regulate WHERE retail outlets can be located Restrict retail at certain zones or limit them to certain zones Limit the number or density of retailers in certain zones Restrict how close retail outlets can be to each other Restrict how close retail outlets can be to schools or residential areas https://www.youtube.com/watch?v=v2p9nbRlWCE http://publichealthlawcenter.org/sites/default/files/resources/tclc-guide-regulating-retailer-locations- 2014.pdf

13. *Rationale for Zoning Policy  Higher density of retail outlets, easier for youth to obtain products  Higher density of retail outlets, higher concentration of marketing, point-of-sale advertising, and promotion (retail outlets are a key marketing channel)  Higher density of retail outlets perpetuates social norms about the behaviors  Disproportionally high density of retail outlets in socioeconomically disadvantaged neighborhoods increases health disparity https://www.youtube.com/watch?v=Q3PNJigz1vg http://countertobacco.org/licensing-zoning-and-retailer-density

14. *Location Restriction: Consumption in Public  Tobacco: Smoke-free laws have been adopted by most states in Worksites Restaurants Bars Smoke-free vehicle laws have been adopted by 8 states (Arkansas, California, Louisiana, Maine, Oregon, Utah, Vermont, Virginia) Only 16 states have state-wide laws banning e-cigarettes in smoke-free places https://www.youtube.com/watch?v=CsK6XH8psZM

16. Location Restriction: Consumption in Public  Alcohol: State-level open container laws prohibit the existence of open containers of alcohol in certain areas as well as active consumption in those areas. Sidewalks Parks Vehicles Does not include private spaces which are open to the public

17. Location Restriction: Consumption in Public  Marijuana: State-level laws prohibit the consumption of marijuana at public places. This includes but is not limited to areas accessible to the public such as transportation facilities, schools, amusement/sporting/music venues, parks, playgrounds, sidewalks and roads and outdoor and rooftop cafes. It is also illegal to smoke at indoor-but-public locations like bars, restaurants and common areas in buildings. https://www.colorado.gov/pacific/marijuanainfodenver/residents-visitors

18. *Rationale for Banning Consumption in Public  Reduces secondhand exposure  Prevents act of operating a vehicle while intoxicated  Minimizes negative impacts on social norms

19. Licensing  Licensing: certain types of businesses are required to purchase government-issued retail licenses that grant license-holding businesses permission to sell certain products under certain conditions https://www.youtube.com/watch?v=GvXUTAFCmek

20. *Rationale for Licensing  Restrict businesses located near schools or youth oriented facilities from selling certain products  Reduce the density or number of retailers  Prohibit distribution of licenses in residential zones  Restrict the types of businesses that can sell certain products  Maintain a list of retailers for monitoring and safety control  Allow for more comprehensive control of the products http://countertobacco.org/licensing-zoning-and-retailer-density

21. This Lecture  Described the age restrictions for tobacco, alcohol, and marijuana  Discussed the public health implications of minimum legal sales age  Defined key elements and described rationale of location restrictions  Defined key elements and described rationale of licensing policies

22. Next lecture Policy Making Policy making and content analysis Problem definition and agenda setting Interest group Policy Strategies Mass media tools Economic tools Legal tools Regulatory tools Healthcare financing Policy Evaluation Quasi-experimental design Cost-effectiveness Cost-benefit Non-experimental and RCT Criteria selection