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A Unified Coalition
The Campaign for a Healthy and Responsible Tennessee (CHART) is a grassroots coalition made up of more than 50 partner organizations, including the American Cancer Society, the American Heart Association, and the American Lung Association of Tennessee, as well as thousands of individual members concerned about the impact of tobacco use on health. The coalition's mission is to improve the quality of life for all Tennesseans and lower health care costs by reducing the incidence of disease, suffering, disability and death caused by tobacco use through public education and mobilization.
Tobacco Use in Tennessee
Despite the fact that tobacco use is the leading cause of preventable death in the state, almost 1.2 million Tennesseans over the age of 18 smoke. In fact, smoking rates are higher in Tennessee than the rest of the nation -- 26 percent of Tennessee 's adult population smoke compared to 22 percent nationally. The trend is also present among Tennessee youth -- 27.6 percent of Tennessee high schoolers smoke compared to 22 percent nationally.
The consequences of the state's higher than average smoking rates are dire. Approximately 9,662 Tennesseans die as a direct result of cigarette smoking every year and thousands more suffer from tobacco-related illness. Meanwhile, according to the Campaign for Tobacco Free Kids, secondhand smoke claims the lives of 930 to 1,660 Tennesseans a year.
If the impact on health weren't cost enough, Tennessee also pays an extremely high economic burden for tobacco use. According to the Campaign for Tobacco Free Kids, the annual health care cost directly caused by smoking in Tennessee is $1.99 billion while smoking productivity losses in Tennessee amount to $2.61 billion.
Legislative Mobilization
For the past six years, CHART has taken a public stand on key issues related to tobacco policy. Among other victories, the coalition helped to secure a 7 cent increase in the state's tobacco excise tax in 2002 which has reduced youth and adult smoking rates, generated vital state revenues and provided significant health care savings.
Each legislative session, the coalition develops position statements on current tobacco issues, proposes legislation, analyzes legislation filed, and selects legislation to actively endorse or oppose. CHART activities in support of, or in opposition to, tobacco-related legislation include public education campaigns, media advocacy, mobilization of membership and direct lobbying.
Future Goals and Strategies
The legislative component of CHART'S work over the next year will focus on three clearly defined policy goals:
1) Restoring local control through a full repeal of tobacco pre-emption
Local control (also known as Home Rule) is a term used to describe the authority communities have to set policies that are tailored to meet their individual local needs. In Tennessee , local control over tobacco policy was stripped from communities by the state legislature in 1994. As a result, local governments are not allowed to set any tobacco-related policy that is more comprehensive than provisions in place at the state level.
Local control can be restored to communities through a repeal of the state's pre-emption law by the state legislature. In Tennessee , the preemption provision pertaining to tobacco ordinances is attached to the Tennessee Code Annotated Comprehensive Tobacco Control Act, Prevention of Youth Access to Tobacco . It can be found in state law at: TN CODE ANN. § 39-17-155 1.
Without repealing pre-emption communities may not, among other tobacco-related policies, declare certain public places as non-smoking sites, create a local tax on tobacco products, or increase fines levied against stores that sell tobacco product to minors.
To date, 45 communities representing more than 55.5 percent of the state's population base have asked the Tennessee General Assembly to return local control of tobacco to their communities. Resolutions urging the Tennessee General Assembly to restore local control have been passed by municipalities and counties in all regions of the state.
CHART supports a full repeal of the pre-emption law because local government officials who want to enact health policies to protect their constituents should not be prohibited from doing so by the state.
2) Enacting a comprehensive statewide smoke-free workplace law
Clean indoor air provisions are intended to protect workers and members of the public from the health hazards resulting from exposure to secondhand smoke. Momentum to provide clean air in public places including bars and restaurants is building nationwide, including in the South. To date, 10 states and almost 2,000 municipalities have implemented smoke-free provisions.
Secondhand smoke is a Class A carcinogen as determined by the U.S. Environmental Protection Agency. There is no safe level of exposure to a Class A carcinogen. Secondhand smoke causes significant health problems in thousands of smokers and nonsmokers every year.
The Campaign for Tobacco Free Kids reports that Tennessee loses between 930 and 1,660 lives annually as a direct result of secondhand smoke. Meanwhile, 3,000 nonsmokers in the United States die from lung cancer and 35,000 to 40,000 nonsmokers die from coronary heart disease annually due to secondhand smoke exposure.
Secondhand smoke also has a significant impact on the economy and our state budget. The annual health costs of secondhand smoke incurred nationally, according to the Society of Actuaries, is $4.98 billion while an additional $4.68 billion is lost in indirect costs (such as lost wages and reduced services associated with disabilities).
CHART supports a comprehensive statewide smoke-free worksite law with an additional provision allowing cities and towns to set additional local laws that are stricter than the statewide law. Under the statewide clean air law, all workplaces should provide a smoke-free environment for all employees working in an enclosed workplace. Designated smoking areas, or smoking rooms should not be permitted.
The comprehensive law should pertain to all worksites with one or more employees and smoking should be prohibited in all indoor work areas including, but not limited to, hallways, meeting rooms, employee lounges, restrooms and staircases. Worksites with one or more employees should include, but not be limited to, offices, factories, bars and restaurants, auditoriums, theaters, concert halls, convention centers, museums, libraries, schools, colleges, food courts, supermarkets, hotels, medical facilities, health facilities, child care centers, public transportation, airports, train and bus stations, as well as publicly owned buildings.
CHART does not support any exemptions to the comprehensive law with the exception of the following three circumstances and only after certain conditions are met: retail tobacco stores established prior to enactment, religious ceremonial smoking rituals, and laboratories or testing facilities conducting medical or scientific research on tobacco.
3) Increasing the state's tobacco excise tax to the national average
Increasing the cigarette excise tax is advantageous to Tennessee for two critically important reasons - it will improve the health and quality of life of Tennesseans and provide significant economic benefits for the state. Raising the tobacco tax is proven to reduce smoking rates and saves lives while at the same time increases state funds and cuts health care costs.
A higher cigarette tax is potentially the most effective way to reduce smoking among both youth and adults. Raising taxes is a strong deterrent for youth smoking in particular. A need that is critical since 14,600 Tennessean children (under the age of 18) become new daily smokers every year and Tennessee children purchase or smoke 21.4 million packs of cigarettes annually.
The U.S. Surgeon General reports that children are two to three times more responsive to cigarette price increases than adults and are more likely to never start, quit or cut back to avoid paying higher prices. Meanwhile, the Journal of Health Economics reports that every 10 percent increase in the price of cigarettes reduces the number of children who smoke by 6 or 7 percent.
In addition to the health benefits, every state that has increased its cigarette tax has enjoyed substantial increases in revenue. These funds have helped balance budgets and fund essential services. Increasing the tobacco tax would reap critically important economic benefits for Tennessee because our current 20 cent per pack tax is far below the 91.7 cent national average. Tennessee 's cigarette tax is the 48 th lowest in the nation.
CHART supports a 72 cent per pack increase in the state tobacco excise tax to bring Tennessee in line with the national average. According to the Campaign for Tobacco Free Kids, the increase would generate $295.5 million in state funds annually as well as prevent 28,500 premature smoking deaths and 2,060 negative birth outcomes related to tobacco (such as low-birth weights, still born births or babies born with respiratory disease). In addition, a 72 cent increase would cause 38,700 adults to quit within a year and prevent 57,100 youths from becoming smokers over their lifetimes.
On top of the $295.5 million is new funds generated annually, a 72 cent increase would also reap significant health care savings. According to the Campaign for Tobacco Free Kids, TennCare would save $7.3 million in pregnancy costs and $4.4 million in heart and stroke costs over the five year period following a 72 cent increase. The overall long-term savings to TennCare would total $268.1 million (based on lifetime savings for those who quit or do not start smoking as a result of the increase).
CHART also recommends at least a portion of the increased revenues generated by a tobacco tax increase be directed to health care programs. With 9,662 Tennesseans dying from tobacco use every year, much prevention and cessation work must be done to help smokers quit and to prevent a new generation from starting to smoke. The Centers for Disease Control and Prevention recommends $32 million be spent on a comprehensive program each year. However, Tennessee contributes just $200,000 in state funds to what is a $1.36 million tobacco control program (funding above the $200,000 level is met through federal matching monies provided by the CDC).
Sources:
American Cancer Society, Cancer Prevention & Early Detection Facts & Figures 2005.
Youth Risk Behavior Surveillance System, 2003, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2004; 53 (SS-2).
Centers for Disease Control and Prevention. Data Highlights 2004: State Tobacco Activities Tracking and Evaluating.
Campaign for Tobacco Free Kids, The Toll of Tobacco in Tennessee .
Campaign for Tobacco Free Kids, The Toll of Tobacco in Tennessee .
American Cancer Society, unpublished report, Tennessee health initiatives department. October 2005.
American Cancer Society, Cancer Prevention & Early Detection Facts & Figures 2005.
U.S. Environmental Protection Agency. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Washington , DC : US Environmental Protection Agency; 1992. EPA/600/6-90/006F.
Campaign for Tobacco Free Kids, The Toll of Tobacco in Tennessee .
U.S. Environmental Protection Agency. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Washington , DC : US Environmental Protection Agency; 1992. EPA/600/6-90/006F.
Steenland K. Passive smoking and the risk of heart disease. JAMA. 1992; 267:94-99.
Society of Actuaries. Behan F. Donald, Eriksen P. Michael and Lin Yijia. Economic Effects of Environmental Tobacco Smoke. March 31, 2005.
Campaign for Tobacco Free Kids, The Toll of Tobacco in Tennessee .
US Department of Health and Human Services, Center for Disease Control and Prevention. Report from the Surgeon General. Reducing Tobacco Use: A Report of the Surgeon General. August 2000.
Emery, S., et al., "Does Cigarette Price Influence Adolescent Experimentation?," Journal of Health Economics 20:261-270, 2001.
Campaign for Tobacco Free Kids, State Cigarette Excise Tax Rates & Rankings. July 20, 2005.
Campaign for Tobacco Free Kids. Eric Lindblom. Projected Medicaid Program Savings in Tennessee From a 72-Cent Cigarette Tax Increase. October 12, 2005.
Campaign for Tobacco Free Kids. Eric Lindblom. Projected Medicaid Program Savings in Tennessee From a 72-Cent Cigarette Tax Increase. October 12, 2005.
Centers for Disease Control and Prevention.Data Highlights 2004: State Tobacco Activities Tracking and Evaluating .
Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society, American Lung Association. A Broken Promise to Our Children: The 1998 State Tobacco Settlement Five Years Later. November 2003.
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