1. COMPREHENSIVE TOBACCO CONTROL PROGRAMS A review of progress toward key recommendations from Healthy Kansans 2010 February 16 th, 2007

2. Tobacco Programs in Kansas Review the HK2010 recommendations for Tobacco Use Prevention and Control in Kansas Review Kansas performance on the HK2010 Tobacco Use Indicators Review the progress and impact of programs related to Tobacco Use Prevention and Control in Kansas Review the barriers/challenges to implementing Tobacco programs Review the opportunities for implementing new Tobacco programs

3. I. Advocate no-compromise, statewide clean indoor air law along with achievable initiatives at the local level. Possible supporting or momentum-building steps include A.Initiate massive statewide marketing campaign to strategically build momentum. B.Implement all-or-nothing statewide survey to obtain data on public support. (Public opinion typically supports.) C. Model effective indoor air ordinances at local level. Continue to move towards “critical mass” of tobacco-free local communities. D. Support statewide law now as a means of amplifying issue to general public and as a tool to gain leverage among the public and local communities. E. Further investigate best-practices (bills, statewide laws) in other states (e.g., Washington State). F. Promote statewide tobacco-free school grounds policy through statewide law or incentives to schools. G. Monitor and take advantage of state and local opportunities as they arise.

4. II. Increase funding for comprehensive tobacco control to the CDC-identified level for best practices, $18.1 million. A.Better describe and articulate need for $18.1 for comprehensive tobacco and cost benefit of increased funding at every opportunity. (Related to III.C.) Action group recommends these funding increase options in priority order: B. Increase excise tax with at least partial increase directed to comprehensive tobacco control. Pro: Win-win situation, Kansas now ranks 27 th in nation for this tax (other state have surpassed us since last increase). Con: May not be politically viable at this time. C. Redirect master settlement agreement to tobacco prevention D. Redirect existing excise tax to tobacco prevention E. Penalty tax and/or incentives for businesses to enact clean indoor air policies (i.e., become tobacco-free establishments).

5. III. Encourage implementation of organizational-level tobacco control policies by Steering Committee members and others. A.Implement policy of tobacco-free facilities, campuses, and grounds (e.g., tobacco- free hospital campuses and grounds, tobacco-free school grounds, etc.) at the organizational level and, if an association, actively promote these policies among constituent organizations. B. Ensure every medical practice, every dental practice is familiar with and refers patients to Quitline. Provide appropriate incentives for referrals. 1. Further research reimbursement policies and provider practice related to tobacco cessation. 2. Promote improved reimbursement by Medicaid, Medicare, and insurance companies for comprehensive range of tobacco cessation options. C. Incorporate extensive cost of tobacco into every report; include economics and tie to tobacco at every opportunity (e.g. relate tobacco to causes of death, leading health indicators, Medicaid expenditures, social determinants of health, disparate populations, etc.). Help decision makers “connect the dots”.

6. D.Insist on tobacco-free facilities for publicly held meetings. E.Be community leaders. Work with Chambers of Commerce to show benefits of tobacco-free communities and effective tobacco control policies. F.Encourage local business to fully comply with youth access laws. Encourage law enforcement to fully enforce. IV. Develop state-wide, comprehensive list of tobacco-free communities, facilities, and organizations. (Related to III.A, D, and E.)

7. Kansas Performance on Healthy People 2010 Tobacco Use Indicators Tobacco Use Previous Kansas Rate Current Kansas Rate HP2010 Goal Reduce cigarette smoking by adolescents. 21% (2005 KS Youth Risk Behavior Surveillance Survey, grades 9-12) 16% (grades 9-12) Reduce cigarette smoking by adults. 20% (2004 KS BRFSS) 18% (2005 KS BRFSS) 12%

8. FY2007 Tobacco Money for Tobacco Prevention in Kansas $18.1 Million $2.1 Million $171.5 Million $119 Tobacco Tax Revenues $52.5 Million Tobacco Settlement Revenues

9. Adult Smoking Declines in Kansas 22.1% 17.8% This reduction in prevalence potentially represents 84,000 fewer adult smokers. 20% decline Data are from the BRFSS

10. Accomplishments Children in more than 31 schools and/or districts now attend schools that have adopted tobacco free school grounds policies. More than 17 communities have adopted smoke-free ordinances Middle school and 15% of high school students participated in an anti-smoking event.

11. Youth Smoking Declines in Kansas 26.0% 21.0% 19% decline Data are from the Youth Tobacco Survey and Youth Risk Behavior Survey 21.2%

12. And More Accomplishments More than 200 health care providers systematically refer pregnant women who smoke to the Kansas Tobacco Quitline Fewer vendors selling tobacco to youth More than 2,300 Kansans contacting the Kansas Tobacco Quitline for assistance

13. How Do They Do That? Locally and Statewide   State staff answered over 1,800 calls for assistance   Local grantee actions generated over 1,300 newspaper articles totaling over 23,000 column inches with a readership of over 5 million each month   A 24-hour Quitline was established   Provider training initiative to increase tobacco cessation among pregnant women

14. Strategies   By the end of 2005, 103 TASK groups   A Synar Advisory Group was formed   16 statewide training workshops conducted   Excise tax on cigarettes was raised $0.79/pack in 2003   Technical assistance to over 59 school districts

15. Kansas is Not ADEQUATELY addressing the Problem

16. Only 14% of Kansans have Comprehensive programs!

17. Communities with Clean Indoor Air Ordinances

18. What More Could Kansas Do? Additional community-based programs – –At current funding level only 45 of 105 Kansas counties have programs – –All Kansas counties deserve tobacco prevention Expansion of cessation services Comprehensive counter-marketing campaign

19. Tobacco Use Prevention is a Public Policy Issue  Funding Master Settlement Agreement Tobacco Tax

20. KANSAS HAS A FUNDING PROBLEM Not an evidence problem – we have evidence- based solutions Not really a revenue problem – we have the revenue to fund program It’s a political problem – we need the POLITICAL WILL to fund programs

21. Clean Indoor Air Policies Workplace School grounds Hospitals Cars

22. Educate, Inform and Update! Good for Public Health Good for Business Build local momentum Strengthen support for statewide policy Preemption is a deal breaker Preemption is a deal breaker maintain local control at all costs

23. Youth Access Policies Flavored Cigarettes Sale of tobacco products to youth Preemption is a deal breaker maintain local control at all costs

24. Educate, Inform and Update! FUNDING---KEY MESSAGES Tobacco costs the state in lives and dollars. Comprehensive programs for tobacco prevention and cessation are proven to work. New funding in 2008 should be used to reduce tobacco use in Kansas.

25. Tobacco Related Bills Introduced in the Kansas Senate 2007 Session Senate Bill 37 – Statewide Smoking Ban SB 37 would make it unlawful to smoke in indoor areas of public places with an expanded definition of such places that includes food service establishments (restaurants and the like) and bars, would increase the fines for violating this law, and would make the crimes of smoking in an indoor public place and failing to post no smoking signs class C non-person misdemeanors. This bill has been amended to provide an opportunity for county commissioners to “opt out” of coverage from the proposed statewide ban of smoking. Tobacco Free Kansas Coalition policy advocates are researching options to see if the bill can be improved to avoid having two separate state laws on smoking regulations. Advocates have been told that the bill will not be scheduled for debate/discussion until after next week.

26. Senate Bill 90 – Tobacco Tax Stamps SB 90 concerns taxation relating to cigarettes and tobacco products; meter imprints. SB 90 was introduced and assigned to Senate Assessment and Taxation Committee as a procedural bill relating to sales taxation and exemptions. Senate Bill 250 - Prohibiting Smoking in Motor Vehicles with Children 8 and Younger A hearing before the Senate Public Health and Welfare Committee was held on February 7 on this bill to prohibit smoking in cars transporting children eight years and younger. Tobacco control advocates spoke to the importance of protecting children from the hazards of secondhand smoke because of the illnesses such exposure causes. Data was presented on the number of Kansas children reporting such exposure. It was also noted a comprehensive approach at the community level is needed to protect children from tobacco use and secondhand smoke.

27. Senate Bill 318 – Allocating Bonus MSA Funds to Tobacco Prevention SB 318 was introduced to allocate the expected increase in Master Settlement Agreement funds from the tobacco companies to proven best practices in tobacco prevention and cessation programs for Kansas. The expected increase could be as much as $16.2 million as of April of 2008. The bill has been referred to the Senate Ways and Means Committee. Senate Resolution 1803 SR 1803 is a resolution asking the Congress of the United States to end its subsidization of tobacco production because of the health harms caused by tobacco use. SR 1803 was introduced on January 8, 2007 and referred to the Senate Federal and State Affairs Committee on January 9.

28. Tobacco Related Bills Introduced in the Kansas House 2007 Session House Bill 2105 - Prohibits the Sale of Flavored Cigarettes HB 2105 would make it unlawful to sell flavored cigarettes in Kansas adding a fine of not more than $500 for those persons who do so. The bill was referred to Judiciary Committee on January 19, 2007. House Bill 2162 - Tobacco-free School Grounds HB 2162 would make it unlawful to smoke or use tobacco products in school buildings or on school owned property, and would define a violation of this law as a cigarette or tobacco infraction with a fine of $25 to $100. The bill was referred to Health and Human Services Committee on January 24.

29. House Bill 2243 – Tobacco-free Hospital Grounds HB 2243 amends KSA 21-4017 by expanding the prohibition on smoking in a medical care facility to a prohibition on all tobacco use in a medical care facility and to include all medical care facility property. An exception is provided for licensed long- term care units. House Bill 2359 – Additional MSA Funds for Seniors’ Health HB 2359 sets up additional disposition of tobacco litigation settlement funds for a seniors’ health care fund. The bill was referred to the Appropriations Committee on February 6, 2007. House Resolution 5014 HR 5014 is a concurrent resolution that speaks to a constitutional amendment to require a super-majority vote on any measure that would create a new tax or increase the rate of an existing tax. HR 5014 was referred to the Federal and State Affairs Committee on February 5, 2007.