California: Achieving Health Equity Through Tobacco Control

The Tobacco Education and Research Oversight Committee (TEROC) has just unveiled a strategy to help the state of California achieve health equity[1]. A goal that involves strengthening tobacco control measures. TEROC's mission is to support the right of all Californians to enjoy the highest level of health by eliminating tobacco-related disparities and combating the actions of the tobacco industry.

The tobacco control movement in California has been a major contributor to reducing smoking prevalence. In the 30 years since Proposition 99 was passed, Tobacco Tax and Health Protection Act 1988, the prevalence of smoking among adults in California increased from 23.71% of adults in 1988 to 101% of adults in 2019[2]. During the same period, lung cancer death rates were reduced by almost half.

In his strategy, the Tobacco Education and Research Oversight Committee states that additional efforts in tobacco control are needed because tobacco use affects certain populations differently in the United States. Certain groups suffer disproportionately from the tobacco epidemic. Through this document, the organization wishes to engage in the fight against tobacco in California with a view to completely phasing out these products and considering their ban on sale. TEROC thus sets three objectives in its 2021-2022 strategy:

- Better information and involvement of different stakeholders to eliminate existing disparities in tobacco consumption;

- Reducing the prevalence of smoking to 8% for the entire population;

- Strengthening the control of other products (electronic cigarettes, smoked cannabis) and a reduction in their consumption.

Tobacco control: a question of social justice

While the incidence and mortality of tobacco-related cancer have declined significantly, tobacco use remains the leading cause of preventable death in the United States and disproportionately affects certain communities. This is partly due to deliberate and widespread targeting by the tobacco industry. Flavored tobacco products, such as menthol, are used by manufacturers to target youth, low-income communities, LGBT communities, and ethnic minorities.[3]. These populations are highly affected by preventable deaths and diseases caused by smoking. In this perspective, ending the tobacco epidemic is part of the fight for health equity. Reducing social inequalities in health requires making the fight against smoking a priority and accelerating the decline in tobacco use among these highly exposed populations. This also leads to removing the obstacles that hinder the adoption of restrictive policies concerning the sale, marketing, distribution and bans associated with the product.

California, a leader in tobacco control, attacked by tobacco industry

California has long been a leader in tobacco control. It has one of the lowest smoking rates in the United States (10%), just behind Utah (9%).[4]. Measures have been gradually strengthened in recent years, both at the state and city levels. On January 1, 2021, two California cities, Beverly Hills and Manhattan Beach, implemented a complete ban on the sale of all tobacco products within their jurisdictions. They thus became the first localities in the United States to completely eliminate tobacco sales.[5].

This tobacco control policy is, however, under attack from the tobacco industry. On August 29, 2020, a bill was introduced to ban the sale of flavored tobacco and nicotine products in California, but tobacco industry-affiliated groups quickly lobbied heavily to block its entry into force. They were able to push the legislation back to the 2022 midterm elections.[6].

A similar appeal was filed on July 9, 2020 by RJ Reynolds Tobacco Co.[7]. in the Federal District Court for the Southern District of California against the County of San Diego. The cigarette company claims that the Family Smoking Prevention and Tobacco Control Act (the federal law that authorizes the FDA to regulate tobacco products) expressly prohibits state and local governments from enacting a sales ban on tobacco products. On March 29, 2021, the judge dismissed RJ Reynolds' claims[8] stating that the San Diego County law was not incorporated into the statute Family Smoking Prevention and Tobacco Control Act. Therefore, this does not prevent states or local governments from enacting age-restricted tobacco sales or use laws. This decision has been welcomed by the public health community and by all localities seeking to ban the sale of flavored tobacco and nicotine products.

Keywords: California, Health, Equity, Tobacco Control, Social Justice©Tobacco Free Generation

---

[1] Tobacco Education and Research Oversight Committee. Achieving Health Equity: Toward a Commercial Tobacco-Free California, 2021-2022. Sacramento, CA: Tobacco Education and Research Oversight Committee. 2021.[2] California Department of Public Health, California Tobacco Control Program. 30 Years of Success and Innovation: Celebrating the Past, Present, and Future of Tobacco Control in California. Sacramento, CA: California Department of Public Health;2020.[3] Generation Without Tobacco, At the heart of the tobacco companies’ strategy: menthol, May 20, 2020, accessed April 1, 2021[4] Truth Initiative, Tobacco use in Utah 2020, October 27, 2020, accessed 1^er April 2021[5] Generation Without Tobacco, Two California cities ban the sale of tobacco products, January 8, 2021, accessed April 1, 2021[6] Generation Without Tobacco, California: ban on flavors postponed following appeal by the tobacco industry, January 28, 2021, accessed April 1, 2021[7] Thomas A. Briant, Lawsuit Filed Against San Diego County Flavor Ban Ordinance, CSP Daily News, July 23, 2020, accessed April 1, 2021[8] Emily Field, RJ Reynolds Loses Bid To Strike San Diego Flavor Ban, Law360, March 30, 2021, accessed April 1, 2021National Committee Against Smoking |