1. A Comprehensive Approach for Reducing Illegal Tobacco Sales to Youth Kevin A. Alvarnaz, Cessation Program Manager Bureau of Chronic Diseases & Injury Prevention Division of Tobacco Prevention & Control Pennsylvania Department of Health December 11, 2003

2. Presentation Outline: Goals of the Pennsylvania tobacco control program Goals of the Pennsylvania tobacco control program History and allocation of MSA funding History and allocation of MSA funding Illegal tobacco sale rates to youth in PA Illegal tobacco sale rates to youth in PA Development and implementation of a comprehensive approach Development and implementation of a comprehensive approach Results – rate of illegal sales to youth Results – rate of illegal sales to youth Final thoughts Final thoughts

3. The Big Picture: Pennsylvania’s Goals Program goals support Healthy People 2010 objectives: Program goals support Healthy People 2010 objectives: Change community norms through state- advised, community-driven systems that create environments where it is uncommon to see, use, and be negatively impacted by tobacco products and tobacco smoke pollution Change community norms through state- advised, community-driven systems that create environments where it is uncommon to see, use, and be negatively impacted by tobacco products and tobacco smoke pollution Reduce consumption of tobacco products to youth and adults in Pennsylvania to less than 12% by 2010 Reduce consumption of tobacco products to youth and adults in Pennsylvania to less than 12% by 2010

4. CDC Best Practices Community-based programs Community-based programs Reduction of the chronic disease burden Reduction of the chronic disease burden School programs School programs Enforcement Enforcement Statewide programs Statewide programs Counter-marketing Counter-marketing Cessation programs Cessation programs Surveillance & evaluation Surveillance & evaluation Administration & management Administration & management State and local initiatives follow national best practices for building comprehensive tobacco control programs

5. Funding Levels in Pennsylvania Pennsylvania will receive $11.4 billion over 25 years as a result of the tobacco MSA. Pennsylvania will receive $11.4 billion over 25 years as a result of the tobacco MSA. Funding legislation (Act 77) appropriates 12% of the annual payment to the Division of Tobacco Prevention & Control Funding legislation (Act 77) appropriates 12% of the annual payment to the Division of Tobacco Prevention & Control $41.4 million SFY 2001-2002 $41.4 million SFY 2001-2002 $52.0 million SFY 2002-2003 $52.0 million SFY 2002-2003 $51.8 million SFY 2003-2004 $51.8 million SFY 2003-2004

6. Funding Distribution: Prevention & Cessation SFY 2001-02 Funding $41,402,000 SFY 2002-03 Funding $52,023,000 70% - $28,981,400 70% - $36,416,100 30% - $12,420,600 30% - $15,606,900

7. Primary Contractors: Identified 51 primary contractors to build comprehensive tobacco prevention and cessation programs in PA’s 67 counties Identified 51 primary contractors to build comprehensive tobacco prevention and cessation programs in PA’s 67 counties Required to coordinate a minimum of 3 enforcement checks on every tobacco retail outlet within their service area yearly Required to coordinate a minimum of 3 enforcement checks on every tobacco retail outlet within their service area yearly Engage retailers at the local level Engage retailers at the local level

8. Pennsylvania Synar Survey Results

9. A Comprehensive Campaign Increase in cigarette excise tax Increase in cigarette excise tax Ongoing enforcement checks of tobacco retail outlets Ongoing enforcement checks of tobacco retail outlets Compliance Alliance: youth-led initiative Compliance Alliance: youth-led initiative Statewide media campaign Statewide media campaign Act 112 legislation Act 112 legislation Community-based retailer education forums Community-based retailer education forums

10. Increased Cigarette Excise Tax Original cigarette excise tax of 31¢ / pack in place for 10+ years Original cigarette excise tax of 31¢ / pack in place for 10+ years Proposal to increase tax by 69¢ to $1.00 / pack Proposal to increase tax by 69¢ to $1.00 / pack 10%  in price = 7%  in youth smoking prevalence 10%  in price = 7%  in youth smoking prevalence 10%  in price = 5%  in young adult smoking prevalence 10%  in price = 5%  in young adult smoking prevalence 10%  in price = 7%  in smoking among pregnant women 10%  in price = 7%  in smoking among pregnant women

11. Increased Cigarette Excise Tax Cigarette tax raised to $1.00 / pack in June 2002 Cigarette tax raised to $1.00 / pack in June 2002 Revenue increased from $267 million to $846 million (217%  ) Revenue increased from $267 million to $846 million (217%  ) Cigarette sales (in packs) decreased from 1.07 billion to 918 million (16.5%  ) Cigarette sales (in packs) decreased from 1.07 billion to 918 million (16.5%  ) Ranked 12 th in nation (tied with Alaska, District of Columbia, Maine, & Maryland) Ranked 12 th in nation (tied with Alaska, District of Columbia, Maine, & Maryland) No excise tax presently on smokeless tobacco products in PA No excise tax presently on smokeless tobacco products in PA

12. Increase in Enforcement Checks Between October 2001 and June 2002, over 4600 enforcement checks were conducted Between October 2001 and June 2002, over 4600 enforcement checks were conducted Primary contractors under contract in May 2002 – more than 25,000 enforcement checks performed in SFY 2002-2003 Primary contractors under contract in May 2002 – more than 25,000 enforcement checks performed in SFY 2002-2003 Generated a significant increase in media at the local level Generated a significant increase in media at the local level

13. Youth-led, anti-tobacco movement in PA Youth-led, anti-tobacco movement in PA Focus on exposing the manipulative and deceptive marketing practices that Big Tobacco uses to target teens Focus on exposing the manipulative and deceptive marketing practices that Big Tobacco uses to target teens Supported by primary contractors and their service providers (subcontractors) Supported by primary contractors and their service providers (subcontractors)

14. Compliance Alliance: Summer 2002 First major initiative of BUSTED! First major initiative of BUSTED! Youth attempt to purchase tobacco products, interrupt the buy, and educate the retailer on PA youth access to tobacco laws Youth attempt to purchase tobacco products, interrupt the buy, and educate the retailer on PA youth access to tobacco laws Statewide media campaign created to support Compliance Alliance Statewide media campaign created to support Compliance Alliance

15. Statewide Media Campaign Developed through focus group research with: Developed through focus group research with: Retail store owners Retail store owners Clerks Clerks Law enforcement agents Law enforcement agents Youth under age 18 who smoke Youth under age 18 who smoke Parents of youth who smoke Parents of youth who smoke Included statewide media buy & series of 3 interactive retailer mailings Included statewide media buy & series of 3 interactive retailer mailings

16. Community-Based Initiatives Tobacco retailer luncheons held: Tobacco retailer luncheons held: 28 luncheons throughout Pennsylvania 28 luncheons throughout Pennsylvania 1000+ total attendees reached 1000+ total attendees reached Engaged owners & clerks of retail store chains, “Mom & Pop” stores, Hispanic bodegas, and other population groups Engaged owners & clerks of retail store chains, “Mom & Pop” stores, Hispanic bodegas, and other population groups Evolution of innovative partnerships Evolution of innovative partnerships Primary contractors partner with retailers to educate about and enhance store policies Primary contractors partner with retailers to educate about and enhance store policies Youth & primary contractors partner to educate retailers Youth & primary contractors partner to educate retailers

17. Act 112: Major Provisions Restricts placement of vending machines Restricts placement of vending machines Establishes a separate fine structure for clerks and retailers Establishes a separate fine structure for clerks and retailers Restricts displaying or offering for sale a cigarette out of a pack of cigarettes Restricts displaying or offering for sale a cigarette out of a pack of cigarettes Expands enforcement authority Expands enforcement authority Authorizes youth ages 14 to 17 to participate in compliance checks Authorizes youth ages 14 to 17 to participate in compliance checks Establishes youth penalties for purchase or attempt to purchase of a tobacco product Establishes youth penalties for purchase or attempt to purchase of a tobacco product

18. Increased Fines Previous fines- $25-$300 Previous fines- $25-$300 New fine structure: New fine structure: Clerks $100-$250 1 st offense$100-$250 1 st offense $250-$500 2 nd offense$250-$500 2 nd offense $500-$1000 3 rd and subsequent offenses$500-$1000 3 rd and subsequent offenses Retailers $100-$500 1 st offense$100-$500 1 st offense $500-$1000 2 nd offense$500-$1000 2 nd offense $1000-$3000 3 rd offense and license suspension for 30 days$1000-$3000 3 rd offense and license suspension for 30 days $3000-$5000 4 th offense and license revocation for 60 days$3000-$5000 4 th offense and license revocation for 60 days

19. Youth Penalties Youth under age 18 who purchase or attempt to purchase tobacco are subject to: Youth under age 18 who purchase or attempt to purchase tobacco are subject to: Up to 75 hours of community service and/or Up to 75 hours of community service and/or Completion of a tobacco prevention and cessation program approved by the Department of Health and/or Completion of a tobacco prevention and cessation program approved by the Department of Health and/or A fine up to $200 and/or A fine up to $200 and/or 30 day suspension of driver’s license 30 day suspension of driver’s license

20. Additional Provisions of Act 112 Affirmative Defense Affirmative Defense Retailers may use an affirmative defense 3 times in a 24 month period Retailers may use an affirmative defense 3 times in a 24 month period Provides incentive for retailers to run a “tight ship” Provides incentive for retailers to run a “tight ship” Compliance checks no more than once every 30 days Compliance checks no more than once every 30 days No prohibition on law enforcement No prohibition on law enforcement

21. Did The Approach Work? 14.5% 10.8%

22. Take-Home Message #1 Retailer and community education combined with ongoing enforcement of youth access to tobacco laws are important components of a comprehensive tobacco control program that can effectively change community norms.

23. Take-Home Message #2 Integration of a statewide media retailer education campaign with initiatives that engage local communities through customized retailer and community- specific youth access education works!

24. Take-Home Message #3 Involvement of youth in retailer and community education is a WIN / WIN !!!

25. Take-Home Message #4 Innovative partnerships at the local Level are cost-effective in reducing the illegal sale of tobacco products to youth. It takes a village to change community norms!

26. Questions will be answered after the next presentation. Thank you for your consideration!