Preventing the Habit Anchors the Big Apple's Tobacco 21 & Minimum Price Laws

 

Seeing youth smoking rates stall at 8.2 percent in 2013 after slashing them by half in the early 2000s, New York City took big steps in 2013 to regain the upper hand in fighting tobacco use. The Big Apple boosted the minimum sales age for tobacco products from age 18 to 21—the first big city to do so—and raised the minimum sales price on cigarettes and little cigars to $10.50 a pack throughout the five boroughs.

The Tobacco 21 minimum age law—along with another law that sets minimum pricing and prohibits discounts, rebates and other pricing workarounds—took effect in August 2014. Chicago and Los Angeles have followed New York City’s lead on minimum age as a way to prevent youth and young adults from starting a smoking habit. More than 100,000 young adults (ages 18-24) in New York City smoke, along with an additional 21,000 public high school students, according to the city’s Department of Health & Mental Hygiene.

“About 80 percent of New York City smokers started before the age of 21,” says Kevin Schroth, Senior Legal Counsel in the department’s Bureau of Chronic Disease Prevention and Tobacco Control. “The idea was to help delay and prevent initiation,” notes Schroth, adding that the transition from experimental to regular smoking frequently occurs around age 20.

In the spring of 2015, department officials said it was too soon to see any impact of the changes. Yet, data from elsewhere provides reassurance. A 21-minimum age effort in Needham, Mass., for example, cut youth smoking rates more than 50 percent between 2006 and 2012, and studies show minimum age increases to lower than age 21 have produced less dramatic results. 

The Institute of Medicine projected in its March 2015 report, Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products, that if the rest of the nation followed New York City’s lead and raised the minimum legal age to 21, there would be a 12 percent decrease by the time today’s teenagers were adults. In other words, “there would be 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,” the IOM estimated.

The Tobacco 21 law prohibits retailers from selling cigarettes, cigars, chewing tobacco, powdered tobacco, other tobacco products or electronic cigarettes to customers under age 21. At the same time, the city approved a “sensible tobacco enforcement law,” says Schroth. Along with establishing a price floor on cigarettes and small cigars, the law had several other provisions to deter “unintended consequences of having high prices,“ such as the practice of shifting to use tobacco products that are less expensive than cigarettes or dual use cigarettes and other tobacco products. The law also:

  • Sets a flat minimum price of $10.50 on cigarettes and requires changes in packaging of little cigars (which have to be sold in packs of at least 20 for at least $10.50 per pack) and cigars (which requires cigars to be sold in a pack of four cigars or more among other changes);
  • Prohibits city retailers from redeeming manufacturers’ coupons, multi-pack deals, buy-one-get –one bargains or any other price-reduction promotions, as well as giving away or discounting lighters or other tobacco-related swag;
  • Clamps down on cigarette tax evasion in several ways, including by increasing the monetary amount of individual penalties and by decreasing the number of penalties that can result in the suspension or revocation of a license to sell cigarettes; and
  • Requires the clear posting an age-restriction sign and tax stamp sign by retailers.

Schroth says that while nearly half the states have minimum price laws, they were designed to prevent unfair competition—not to promote public health. As a result, those laws involve complex pricing and mark-up schemes making them less effective than New York City’s “flat and easy” law. Another benefit of the price floor: “it alerts people to the black market,” which can lower the price of cigarettes for youth—undermining the deterrent of higher prices—and robs the city of tax revenue to the tune of more than $500 million annually. 

The department continues to use the tobacco control playbook—which highlights the use of high taxes, legal authority and actions, cessation programs, education and evaluation—introduced by former Mayor Michael Bloomberg and Dr. Thomas Friedan, the city’s former health commissioner and current director of the CDC. “Tobacco control had a real strong evidence base,” notes Elizabeth Kilgore, the bureau’s Communications Director. “Starting in 2002,” she continues, “we had a very supportive Michael Bloomberg, who was a game changer in tobacco control.” Along with vibrant collaborations with community partners and flexibility given to the department, the City’s innovative approach to tobacco lives on.  

In the spring of 2015, San Jose (Santa Clara County) also raised the legal age to purchase tobacco products from 18 to 21 years old.

New York City residents and visitors may be familiar with Ronaldo Martinez, aka the man with the hole in his throat, from the powerful anti-smoking public service announcements run on television by the City’s Department of Health & Mental Hygiene.

Produced in Massachusetts, the ads ran in the mid-2000s, some of the first graphic ads that have become part of the department’s decade-long mass media campaign to show the impact of smoking. Ads show Martinez, who had his larynx removed and talks via an artificial voice box, cleaning the hole in his throat, showering and showing the effects of his smoking.

“We had never seen our call volume to 311, our general information line, for quit smoking assistance go up like we did then,” says Elizabeth Kilgore, the bureau’s Communications Director. Since 2006, the department has rolled out four to five different media campaigns a year. “We have a lot of ads that range from the graphic to the emotionally provocative,” she says.

The mass media effort became a staple at the department when evidence emerged from Australia and the state of Massachusetts in the mid-2000s on the efficacy of campaigns that aggressively show the health effects of smoking.