Policy Initiatives

Public policy can play a major role in reducing smoking. Increasing taxes on cigarettes, prohibiting smoking in public places, and restricting tobacco marketing are examples of changes that can make a significant impact.

Do Policy Changes Work?

Research suggests that local actions can sharply reduce smoking prevalence.¹ For example, New York City's 2002 tobacco control strategy increased cigarette taxes, prohibited smoking in bars and restaurants, and increased cessation services. These policy initiatives resulted in an 11% decrease in smoking prevalence among adults from 2002 to 2003 (approximately 140,000 fewer smokers).

How Can I Get Involved?

There are various coalitions throughout the state of Maryland that focus on changing smoking policies and reducing tobacco-related illness and death. You can contact your local health department to find out how to get involved with these organizations.

• Tax Issues
• Smoke-free Initiatives
• Ordinances

Tax Issues

Research has suggested the single greatest policy determinant of youth smoking is the price of cigarettes.² Maryland's state tobacco tax increased to $2.00 per pack in January, 2008. Now Maryland, along with 5 other states, ranks 4th in the U.S. in terms of highest tax rate per pack of cigarettes. New Jersey ranks 1st with $2.58 tax per pack of cigarettes. The lowest tax is $0.07 in South Carolina.⁵

• At the time the legislation was created to increase the cigarette tax, the added revenue was intended to go toward:
• Funding comprehensive prevention and cessation program for teens
• Giving thousands of uninsured families access to care
• Helping small businesses afford health care coverage for their workers
• Increasing funding for community health centers

The MDQuit June 2009 Newsletter included the following article on the federal tobacco tax increase that went into effect April 1, 2009:

Federal Tobacco Tax Increase: Will Smokers be Encouraged to Quit?

A federal cigarette excise tax increase went into effect on April 1, 2009. This tax was implemented as part of the Children's Health Insurance Plan (CHIP) Reauthorization bill. The purpose of the tax is twofold - to increase revenue and to potentially decrease youth smoking. The federal tax on cigarettes was raised to $1.01 a pack, an increase of 62 cents.  The tax on little cigars was raised to $1.01 a pack, an increase of 97 cents. This is the first time that little cigars and cigarettes have been equally taxed. Large cigars and "cigarillos", which are still sold as single items in many states have a maximum tax of $.40 per cigar

What might this tax mean for cigarette consumption?
For Youth? From 1991 to 2005 the Youth Risk Behavior Survey showed that large tobacco increases were associated with significant reductions in smoking by youth.¹  

For Minorities? Lower-income and minority smokers are more likely than other smokers to be encouraged to quit in response to cigarette price increases.²  Eight studies in New Zealand from 1981 to 1991 revealed that cigarette taxes reduced demand. Researchers indicated that tobacco taxation will likely provide overall health benefits to low-income residents.³

For Quitline Usage? In Maine, quitline reach jumped from 5% to 6.6% with the
implementation of a cigarette tax. In years following, their quitline usage remained higher than in pre-tax years.⁴ The national quitline transfer number, 1-800-QUIT-NOW, which transfers calls to other local quitlines, registered 203,374 calls in March 2009, more than twice February's 91,316 calls, possibly reflecting smokers' interest in quitting before the tax increase would occur on April 1. An increase in quit attempts may have lasting impact; in 2000, researchers created a predictive model of tax increases and concluded that tax hikes have the ability to affect short-term smoking rates and that these effects grow over time. These findings suggest that tax increases could lead to substantial savings in health care costs, and in human lives.⁵

References
1. Center for Substance Abuse Research. (2009). Federal Tobacco Tax to Increase by 62 Cents Per Pack; Increases in Tobacco Tax Have Been Shown to Reduce Youth Smoking. CESAR Fax, 18 (6). http://www.cesar.umd.edu/cesar/cesarfax/vol18/18-06.pdf 

2. Centers for Disease Control & Prevention. (1998). Response to Increases in Cigarette Prices by Race/Ethnicity, Income, and Age Groups -- United States, 1976-1993. Morbidity & Mortality Weekly Report, 47, 605-609. http://www.cdc.gov/mmwr/preview/mmwrhtml/00054047.htm

3. Wilson, N., Thomson, G. (2005). Tobacco tax as a health protecting policy: a brief review of the New Zealand evidence. The New Zealand Medical Journal, 118.

4. Woods, S. S. (2007). Increasing reach of quitline services in a US state with comprehensive tobacco treatment. Tobacco Control, 16(suppl), i33-i36.

5. Levy, D.T., Cummings, K.M., Hyland, A. (2000). Increasing taxes as a strategy to reduce cigarette use and deaths: results of a simulation model. Preventive Medicine, 31, 279-86.

Smoke-free Initiatives

• According to the U.S. Surgeon General, there is no safe level of exposure to secondhand smoke, and even brief exposure can have immediate harmful effects.³ The only way to protect nonsmokers from the dangerous chemicals in secondhand smoke is to eliminate smoking indoors.
• All of the best designed studies report no impact or a positive impact of smoke-free restaurant and bar laws on sales or employment.⁴
• All bars and restaurants in Maryland now provide 100% smoke-free environments for workers and patrons!!
• To learn more you can visit the website for Maryland's Clean Indoor Air Act (CIAA):

Smoke-free Hospitals 

• Many Maryland Hospitals are already smoke-free! To see which have already made the commitment to make their campus a more healthy place for patients, employees, and visitors, click here.

• The Maryland Hospital Association has developed a tool-kit of resources to provide resources for Campuses that plan to go smoke-free. Implementation plans, media relation templates, letters to community groups, resources for employee and client smokers, FAQs for enforcement, and more is available via their website.

Ordinances

• Fourteen states and DC and Puerto Rico have laws that require smoke-free restaurants, bars, and workplaces.
• Fifteen additional states have 100% smoke-free policies in one or two of the three categories of businesses (restaurants, bars, workplaces).
• For more detailed information on smoke-free polices & ordinances in the United States, check the Americans for Nonsmokers' Rights website.
• A University of Maryland report demonstrated that the smoke-free ordinance in Montgomery County had no impact on the restaurant tax revenue or employment in all restaurants after the law went into effect in 2003. For more information, read the full report.
• It is illegal to smoke in most indoor workspaces in Maryland unless confined to an enclosed and separately ventilated room [COMAR 09.12.23.03]. An employer may allow smoking in a designated area if that area meets certain requirements. EMPLOYERS MAY ADOPT TOUGHER STANDARDS TO PROHIBIT SMOKING.

Maryland Legal Resource Center for Tobacco Regulation, Litigation, and Advocacy

• The Legal Resource Center is a great resource for Maryland residents concerned about tobacco laws. The Director of the Legal Resource Center, Kathleen Dachille, is an active member of the MDQuit Advisory Board and is available to answer questions you may have about tobacco-related bills, legislation, and legal advocacy in Maryland: (410) 706-1294; kdachille@law.umaryland.edu.
• In 2009, several tobacco-related bills were proposed before the Maryland General Assembly. Kathleen Dachille of the Legal Resource Center provided MDQuit with a presentation on these important bills and the results of the Spring General Assembly voting: view the slides here. This presentation provides a glimpse at the types of tobacco issues that are being addressed at the Legal Resource Center and how these issues sometimes are viewed at the legislative level.
• Staying up-to-date on tobacco-related legal issues in Maryland is an important part of tobacco control advocacy.

References:
¹ Frieden, T.R. et al. (2005). Adult tobacco use levels after intensive tobacco control measures: New York City, 2002-2003. American Journal of Public Health, 95, 1016-1023.

² Federation of Tax Administrators (2006). Internet source: http://www.taxadmin.org/FTA/rate/cigarett.html

³ U.S. Department of Health and Human Services (2006). The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the U.S. Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

⁴ Scollo, M., Lal, A., Hyland, A., & Glantz, S. (2003). Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry. Tobacco Control, 12, 13-20.

⁵ Campaign for Tobacco Free Kids. (Nov. 27, 2007). State cigarette excise tax rates and rankings. Retrieved from: http://www.tobaccofreekids.org/research/factsheets/pdf/0097.pdf on January 9, 2008.