Maryland Reduces Tobacco Sales to Youth. Its Not a Minor Thing!

Submission Date: December 2016

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Maryland

States/Territories Involved: Maryland

Funding Source: State/local sources

Other Funding:

State funding

Domain Addressed:

Epidemiology and Surveillance, Environmental Approaches

Public Health Issue:

Nearly 90% of smokers start before they’re 18. The younger people are when they start to smoke, the more likely they are to become addicted.

Retailer behavior is the strongest predictor of the sale of cigarettes to youth and all states are required to enforce youth tobacco access laws but

• Maryland inspectors found over 31% of retailers illegally sold tobacco to minors in 2014;
• and just 37% of Maryland youth reported in 2014 being asked for photo ID when attempting to purchase cigarettes, even though retailers are required ask for photo ID for everyone under 27 & check to make sure everyone is at least 18 before selling them tobacco products.

Project Objectives:

• The Initiative aims to reduce youth tobacco use initiation and prevalence by restricting youth access to tobacco. This is achieved by increasing retailer education and enforcement of youth tobacco sales laws and in turn, increasing the number of retailers asking for and checking ID of anyone under 27 who attempts to purchase tobacco products and refusing to sell tobacco to minors.

Program Action:

Maryland’s Center for Tobacco Prevention and Control (CTPC) launched the Responsible Tobacco Retailer Initiative in 2014. The statewide concerted effort included partners from the Maryland Behavioral Health Administration, local healh departments (LHDs), Department of Health and Mental Hygiene (DHMH) leadership, statewide resource centers, and community organizations.

Key program components included:

• development and placement of media (radio, transit, and billboard) and a corresponding website, NoTobaccoSalesToMinors.com;
• development and distribution of educational materials to assist retailers with remaining in compliance with the laws (Toolkits were translated into Spanish, Korean, Chinese, Hindi, Arabic, Nepali, Burmese, and Punjabi, identified by LHDs as languages spoken by retailers. Toolkits and ancillary items were mailed to all LHDs and Minority Outreach & Technical Assistance (MOTA) groups in April and June 2016. Postcards were mailed to all licensed tobacco retailers in June and October 2016);
• statewide trainings for LHDs, law enforcement and compliance officers; face-to-face retailer education; and
• an increased number of compliance checks at the local level. The Comptroller’s office proved to be a strong partner, taking swift action to suspend licenses of retailers with reported repeat violations.

Data/Other Information Collected:

CTPC collects the following data:

• number of impressions achieved through media placements
• unique visits to the campaign website and materials requested through the online order form
• face-to-face education sessions conducted in each jurisdiction
• compliance checks conducted and citations issued (Synar, FDA, and local level)
• training/education sessions conducted, materials distributed, and MYTS/YRBS data collected in the fall of even calendar years (youth tobacco initiation and use including electronic smoking devices, percent of youth asked for photo ID when purchasing tobacco, percent of youth accessing tobacco through direct or proxy purchases, etc.)

Impact/Accomplishments:

2015 state compliance inspections show a 56% reduction from 2014 in the percentage of retailers selling tobacco to minors,indicating a successful, concerted effort between state, local, public and private entities in Maryland to reduce youth access to tobacco.
The statewide media campaign achieved over 250 million impressions from May 2015 to March 2016, with DHMH leadership conducting 14 radio interviews and issuing two press releases; the website, NoTobaccoSalesToMinors.com, had over 11,000 page views with dramatic increases in traffic during ad flights; CTPC and LHDs distributed over 12,000 toolkits; and CTPC and the Legal Resource Center hosted six statewide trainings for law enforcement and compliance officers.
From July 2014 to June 2015:

• LHDs and community groups conducted nearly 4,500 face-to-face education sessions at tobacco sales outlets, educated 73 youth cited for possession of tobacco, and held 83 community education meetings on youth access to tobacco. LHDs also conducted 3,798 compliance checks and issued 545 citations.

In 2016:

• From January- June, LHDs and community groups conducted over 6,000 tobacco retailer compliance checks, issued 350 tobacco sales citations, and visited over 2,000 stores for face-to-face education on state and local tobacco sales laws.
• From January-June, LHDs hosted 49 town hall meetings to better engage communities on improving tobacco retailer compliance and solicit input to enhance retail compliance
• From April-September, the media campaign achieved 186 million impressions and the website received over 4,000 unique page views.
• CTPC received over 20 requests for materials from store owners after mailings to all licensed tobacco retailers; the website received over 40 requests for Responsible Tobacco Retailer materials from LHDs, community groups, and tobacco retailers; and 28 community partners were funded to conduct education campaigns on youth access to tobacco products.

Challenges/Lessons Learned:

Challenges:
In Maryland, ‘vape shops’ or retailers that sell only electronic smoking devices are not required to apply for and retain a license to sell these products. The lack of contact information for these retailers has made educating and enforcing Maryland (and now Federal) law difficult. CTPC was able to create a retailer list via Yelp and Google searches. As of August 8, 2016, the FDA extended its authority to regulate all tobacco products to include electronic smoking devices.

Lessons Learned:
Collaboration and open communication are key in any complex, statewide initiative such as the Responsible Tobacco Retailer Initiave.  Success could not have been achieved without the partnerships between the Center for Tobacco Prevention and Control, Behavioral Health Administration, the Maryland Comptroller’s office, local health departments, DHMH leadership, statewide resource centers, community organizations, and the retail community.

Next Steps:

Retailer education, enforcement of youth access laws and the statewide media campaign will continue. Maintaining a presence in the retail community while reinforcing responsible tobacco retailer messaging will encourage retailer compliance with youth access laws.

All 24 LHDs were awarded funding through SFY17 to increase compliance checks and enforcement at the county level, as well as partner with community organizations to implement activities to increase community awareness of tobacco sales laws and educate retailers to ensure they remain in compliance and not sell tobacco to minors.

CTPC is currently updating materials to reflect changes to federal regulations as well as new Maryland licenses; materials will be shipped, along with a 2017 calendar, to tobacco retailers and vape shops in January 2017.

CTPC continues to maintain and update the campaign website as needed. Materials will continue to be offered for free order and download directly through the website, an online order form is available on the website to streamline the ordering process and allow CTPC to more effectively track orders received.

Program Areas:

Social Determinants of Health, Tobacco

State Contact Information:

MD
Dawn Berkowitz MPH, CHES
Maryland Department of Health and Mental Hygiene
410-767-2920
Dawn.Berkowitz@maryland.gov

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