FTC reports pull back smoke on 2014 tobacco product advertising

While the amount spent on cigarette advertising and promotion decreased from $8.95 billion in 2013 to $8.49 billion in 2014, spending on advertising and promotion of smokeless tobacco products in the U.S. increased from $503.2 million in 2013 to $600.8 million in 2014, according to reports released by the Federal Trade Commission (FTC) on cigarette and smokeless tobacco marketing expenditures for 2014. The FTC reports also indicated a drop in the number of cigarettes sold by large cigarette companies to wholesalers and retailers—256.7 billion in 2013 to 253.8 billion in 2014.

Cigarettes

The data on cigarette manufacturers’ expenditures comes from special reports submitted to the FTC by the largest cigarette manufacturers through a compulsory process. Those manufacturers include: Altria Group, Inc.; Commonwealth Brands, Inc.; Lorillard, Inc.; Reynolds American, Inc.; and Vector Group Ltd.The largest portion of the $8.49 billion spent on advertising and promotion of cigarettes was “price discounts” paid by manufacturers to retailers in order to reduce the “consumer price” of cigarettes. Those price discounts represented $5.56 billion or 65 percent of advertising and promotional spending for cigarettes in 2014. The FTC requires the manufacturers to report the expenditures on advertisements directed towards youth which are intended to reduce youth smoking. In 2014 the manufacturers spent $1.7 million on such advertisements.

Smokeless tobacco

The smokeless tobacco report is, like the cigarette report, comprised of data submitted to the FTC by the largest smokeless tobacco product manufacturers through a compulsory process. Those manufacturers include: Altria Group, Inc.; North Atlantic Trading Company, Inc.; Reynolds American, Inc.; Swedish Match North America, Inc.; and Swisher International Group, Inc. The total amount of smokeless tobacco sold by the manufacturers to wholesalers and retailers dropped slightly from 128.04 million pounds in 2013 to 127.81 million pounds in 2014. Over the same period, sales revenues for those manufacturers increased from $3.26 billion to $3.42 billion. According to the FTC report, the largest smokeless tobacco companies reported spending $852,000 in 2014 on advertisements intended to reduce youth use of smokeless tobacco products.

FDA warns 55 retailers about e-cigarette, e-liquid, and cigar sales to minors

Warning letters for selling newly regulated tobacco products, such as e-cigarettes, e-liquids, and cigars, to minors have been issued by the FDA’s Center for Tobacco Products against 55 tobacco retailers. The announcement of these warning letters comes approximately one month after the August 8, 2016 effective date of the Final rule (81 FR 28973, May 10, 2016) extending the FDA’s authority over all tobacco products, and making it illegal to sell e-cigarettes, cigars, hookah tobacco, and other newly regulated tobacco products to anyone under age 18 in person and online, and requiring retailers to check the photo ID of anyone under age 27 (see FDA clears the air, ‘deems’ e-cigarettes, hookah tobacco, cigars worthy of regulation, Health Law Daily, May 10, 2016).

Before the Final rule, there were no federal regulations prohibiting retailers from selling e-cigarettes, hookah tobacco, or cigars to people under age 18. The Final rule contains the following restrictions:

  • not allowing products to be sold to persons under the age of 18 years (both in person and online);
  • requiring age verification by photo ID;
  • not allowing the selling of covered tobacco products in vending machines (unless in an adult-only facility); and
  • not allowing the distribution of free samples.

The warning letters were issued after compliance checks of major retail chains, tobacco specialty stores and online retailers found that minors were able to purchase some of the newly regulated tobacco products in a variety of youth-appealing flavors, including bubble gum, cotton candy, and gummy bear. The results from compliance check inspections of tobacco retailers are available in a searchable retailer inspection database. The database lists which inspected retailers received a warning letter, a civil money penalty, a NTSO, or were found to have no observable violations.

The FDA usually issues warning letters to brick-and-mortar retailers as well as online retailers and manufacturers the first time a tobacco compliance check inspection reveals a violation of the federal tobacco laws. Failure to promptly and adequately correct all violations and ensure compliance with all applicable laws and regulations may lead to FDA enforcement actions, including civil money penalties and no-tobacco-sale orders (NTSOs).

Under applicable compliance and enforcement rules, the FDA may pursue a NTSO against retailers that have a total of five or more repeated violations of certain restrictions within 36 months. Retailers are prohibited from selling regulated tobacco products at the specified location during the period of the NTSO. Retailers who receive an NTSO complaint from the FDA may either enter into a settlement agreement with the agency that results in a final order issued by the administrative law judge (ALJ) or choose to go to a full hearing before an ALJ.

Smokeless doesn’t mean harmless: educating white rural teenage males

The FDA has announced that messages on the dangers of nicotine addiction, gum disease, tooth loss, and multiple kinds of cancer from smokeless tobacco use will be highlighted through the agency’s placement of advertisements in 35 U.S. markets.

The advertisements (using television, radio, print, public signs, billboards, digital advertising, and social media) are part of the agency’s award-winning The Real Cost campaign (launched in 2014) to educate rural, white male teenagers about the negative health consequences associated with smokeless tobacco use. The central message of the campaign is “smokeless doesn’t mean harmless,” which aims to motivate these teenagers to reconsider what they think they know about smokeless tobacco use.

The campaign messaging focuses on cosmetic and health consequences, loss of control due to addiction, and the danger of chemicals found in smokeless tobacco products, all topics that the FDA’s research has found to resonate with at-risk youth.

This summer the campaign will also collaborate with Minor League Baseball teams across the country to promote tobacco-free lifestyles by displaying campaign advertising and providing opportunities for fans to meet and interact with players who support the campaign’s public health messages.

According to the FDA, smokeless tobacco, which includes dip, chew, snus and other types of tobacco that dissolve when placed in the mouth, are culturally ingrained in many rural communities and, for many,  has become a rite of passage. Its use is more than twice as likely in rural areas compared to metropolitan and rural youth, particularly white teenage males, are more likely to use smokeless tobacco than other youth. In  fact, the FDA’s Population Assessment of Tobacco and Health (PATH) study found that 32 percent of rural, white teenage males (629,000 nationwide) are either experimenting with, or at-risk for, using smokeless tobacco.

In October 2015, the FDA also launched another campaign, the Fresh Empire campaign, targeting multicultural youth who identify with the hip-hop peer crowd, specifically African American, Hispanic, and Asian American/ Pacific Islander youth.

Highlight on Alabama: Public health officials fighting to balance access, safety, and costs

Alabama health news lately has focused on maintaining access to certain health care services, including abortion services and mental health. This priority, however, is coming up against concerns regarding safety and adequate funding, and the need to balance these issues extends to the expansion of the Medicaid program.

Abortion safety and access

Abortion clinics in Alabama must still involve a doctor who maintains hospital admitting privileges. The State Committee of Public Health just rejected a new rule suspending this requirement in an 8-5 vote. Currently abortion doctors must have local admitting privileges, although an alternative allows clinics to contract with an outside doctor with such privileges. The new rules would have provided an exception for some clinics to simply have doctors available for consultation with additional training for employees to handle abortion complications.

Those opposing the new exception state that it’s important to maintain uniformity in standards of care to ensure patient safety. Yet one doctor in support of the rule felt that it would protect patient safety by ensuring access to a medical procedure in a safe, controlled environment. The vote on the new rule stemmed from a temporary restraining order on enforcing the existing regulations sought by the West Alabama Women’s Center and its doctor, located in Tuscaloosa. The clinic claimed that the only local hospital was not willing to grant the doctor admitting privileges, and that no other doctor in the area wants to contract with the clinic. This issue arose only recently, as the Tuscaloosa clinic’s prior doctor (now retired) had maintained admitting privileges. The committee’s decision will not affect any of the state’s other clinics, which meet the requirements for admitting privileges, and the Tuscaloosa clinic will continue to operate under a waiver for most of 2016. What will happen when the waiver expires remains to be seen.

Mentally ready for change

The National Alliance for Mental Health (NAMI) released its third annual report on the state of mental health care across the country. A NAMI lobbyist pointed out that in the last five years, Alabama has seen a $40 million hit in general funding for mental health services and closed three mental health hospitals. Alabama has many opportunities for improvement in mental health treatment, and the prison system intends to do its part.

The Alabama Prison Reform Task Force initially focused on changing parole and probation, and saw its recommendations passed by state legislature in May. Now, the task force hopes to reduce the crime rate by providing better mental health treatment for inmates, including drug treatment. The Alabama Department of Corrections has diagnosed about 12 percent of current state inmates with a chronic mental illness and spends about $12 million each year on mental health treatment. Task force members think that providing better mental health treatment to inmates will lower costs in the long run and reduce the crime rate.

However, the issue extends outside the walls of prisons. Officers involved in parole, probation and community corrections say about 39 percent of offenders returning from prison are unable to find adequate mental health care upon release. Substance abuse services are also limited. One effort to reduce overcrowding and recidivism is mental health courts, which review cases involving some nonviolent felonies and provide treatment plans. The task force also intends to focus on referral processes for mental health services, including those for juvenile offenders.

More Medicaid would help, too

Providing affordable access to mental health care is a consideration in the argument for expanding Alabama’s Medicaid program. Another task force, this time the Alabama Health Care Improvement Task Force, recommended Medicaid expansion as soon as possible to close the “coverage gap.” Those in this gap are too poor for Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) coverage, but make too much to qualify for Medicaid as it currently operates. The task force pointed out that Alabama ranks at the bottom or extremely low on many health outcomes compared to the rest of the nation. It stressed the importance of improving opportunities to obtain primary care. The task force anticipated that expansion would cover 290,000 more Alabamans. Of these, 185,000 are part of the state’s workforce. Funding is an issue as always, but a tobacco tax hike to help cover expansion costs is on the table.