As 2016 winds down, we begin our annual blog series where Health Forward associates review highlights from our work this past year. In our fifth post, Jessica Hembree examines why Tobacco 21 policies were well-received in the area. Join us as we look back on 2016.
As reflected in the national decline in smoking rates, there have been many advances in tobacco control over the past few decades leaving many to ask – what’s next? What more can we do? At the same time, use of traditional tobacco products such as cigarettes has declined, use of alternative devices, such as vapes and e-cigs, have increased dramatically. Over the past year, we’ve had a front row seat to what is the next chapter in tobacco control.
In 2005 Needham, Massachusetts became the first municipality to pass a policy raising the legal age for purchasing tobacco from 18 to 21. Advocates saw benefits not just to first-time buyers, but also to minors who began using tobacco products before 18.
Meanwhile, the Greater Kansas City Chamber of Commerce Healthy KC initiative identified tobacco prevention among its priorities in 2014 and through the engagement of broader partners, specifically Health Forward and faculty at the University of Kansas Cancer Center, Tobacco 21 was identified as a policy goal and in 2015 the Tobacco 21|KC initiative was launched.
The KC Chamber and business community played a major role in this effort. It is expected that public health advocates might support a policy like Tobacco 21, but when elected leaders see the business community and health experts stand united behind such a policy, it sends a strong message about the importance of Tobacco 21.
Last year we worked to secure endorsements from school districts, businesses, and community organizations and as we closed the year, on Nov. 19, 2015, the cities of Kansas City, Missouri, and Kansas City, Kansas, became the first to adopt Tobacco 21 policies.
I was hopeful the momentum would spread, but not even in my wildest dreams could I have predicted our success this year. To date, 21 municipalities in the KC region have passed Tobacco 21 policies. That has resulted in 85 percent of the youth in our Health Forward service area now covered by Tobacco 21 policies. It is estimated that over 3,414 lives will be saved each year because of these decisions to increase the purchase age of tobacco.
The rapid and widespread uptake of Tobacco 21 policies across the metro presented us with an opportunity to better understand the factors and processes that led to our success. Several communities and organizations in the Kansas City metropolitan area share the hope that Kansas City will continue to be a leader in health and health status.
To help understand why the Tobacco 21 effort caught on so quickly and with such enthusiasm, the University of Kansas conducted a qualitative study using stakeholder interviews to identify factors that supported or detracted from implementation of Tobacco 21 policies. Several themes emerged.
- Broader conditions helped to shape an accepting climate. They noted that municipalities want to be perceived as progressive or leaders on health issues in addition to the pressure applied from the encroaching presence of e-cigarettes and “vape shops.”
- Factors that influenced individual and organizational support. When asked what impacted their choice to support the Tobacco 21 movement, many participants noted their interest was personal, with many having had family members impacted by tobacco use. They also made the case that the issue of Tobacco 21 was “simple” or a “no-brainer” especially given the credible combination of champions that convened to support the initiative. In addition to the clear logic, participants noted they were eager to embrace a solution that limited access, without being a tax and appreciated that the messages were generally non-personal and non-partisan. Others noted the role of personal liberty influenced their perspective of whether or not to support the policy, and while some indicated it was an issue about which they felt strongly, the weighing of personal choice against the end goal of safety and protection resulted in support.
- Elements that contributed to success. Several participants characterized the thorough, planned, and rigorous preparation of partners as a critical part of the approach’s success. Conversely, cases that were not successful were attributed to the lack of groundwork and preparation. Participants reported that one of the most important strategic decisions was the purposeful unfolding of the movement at the municipal level to achieve regional impact and that its unfolding created “political coverage” by assuring support for other communities considering the policy.
- Considerations for other communities and future challenges. When asked about key lessons learned, many participants advised that preparation, along with understanding the community and political context of the city or county commission, are important for planning for adoption of Tobacco 21. Some noted that challenges that arose after Tobacco 21 adoption included clarifying policy enforcement and ensuring continued policy adoption at a municipal level to have the greatest impact regionally.
Tobacco 21 policies represent an exceptional opportunity for communities to further efforts to prevent the initiation of tobacco use. Many of the factors for success can be replicated by other communities to strengthen their efforts. Lessons learned from communities in the Kansas City metropolitan area may strengthen efforts and approaches to assuring widespread adoption of a policy that is well-positioned to have a significant impact.
Read more from authors in this series:
- Paula Cornwell on strategic planning
- Andres Dominguez on Citizens Task Force on Violence
- Jennifer Sykes on the Alliance for a Healthy Kansas
- Brenda Calvin and Adriana Pecina on Healthy Communities Leadership Academy
- Jane Mosley on theories of change
- Donna Bushur and Shannon Morris on Jackson County Children’s Fund
- Brad Hart on prescription drug monitoring programs
- Graciela Couchonnal on community health workers
- Bridget McCandless on creating a culture of health