July 2017 Deschutes County Fiscal Impact Report Acknowledgments July 2017 This report was produced by the Rede Group for Deschutes County Health Services (DCHS). Stephanie Young-Peterson, MPH Robb Hutson, MA Erin Charpentier, MFA Caralee Oakey We would like to thank the following for their contribution to this project: Penny Pritchard, MPH This project was made possible through Tobacco Master Settlement Agreement grant funding provided by the State of Oregon, Oregon Health Authority to implement tobacco prevention and education Strategies for Policy And enviRonmental Change, Tobacco-Free (SPArC Tobacco-Free). Table of Contents Contents: Background & Introduction....................................................1 Retailer Survey Findings........................................................5 Estimation of TRL Implementation & Enforcement Costs.....15 Conclusion and Committee Recommendation...................21 How Other Jurisdictions are Tackling the Problem.................22 End Notes ..........................................................................23 Appendix: A. Timeline of TRL policy work..........................................26 B. Lane County TRL Ordinance.........................................27 C. Lane County TRL Application........................................37 D. Lane County TRL Inspection Form.................................38 E. Multnomah County TRL Ordinance...............................39 F. Multnomah County TRL Application.............................44 G. Multnomah County TRL Inspection Form......................48 H. Klamath County TRL Ordinance....................................50 I. TRL Matrix of Innovative Oregon & California Policies.58 J. Retailer Assessment Interview Tool................................60 K. Tobacco Retail Policies Logic Model.............................67 Background This report was created for the Deschutes County million a year advertising its products with 91% of Health Services (DCHS) Tobacco Prevention & Educa- this money spent on in-store, point of sale activities tion Program. It is a summary of the tobacco retail including price promotions and product place- environment work accomplished between July 2016- ment designed to appeal to all audiences, includ- June 2017, utilizing SPArC grant funds. There are ing youth.5,6 Higher levels of tobacco marketing at three main sections to this report: 1) The introductory the retail space, lower tobacco prices, and greater section provides background information on youth availability of tobacco coupons and promotions are tobacco use/initiation as a public health issue and the associated with product uptake among middle and evidence base for enacting policies in the retail envi- high school youth.7 Retail marketing prompts initia- ronment. Local efforts to address youth tobacco use, tion, promotes daily consumption, and discourages up to this point in time, are also discussed in the intro- attempts to quit. ductory section of this report. 2) The second section of this report covers the detailed findings of the tobac- Emerging research shows that another big contributor co retailer assessment conducted across Deschutes to youth tobacco use initiation is the exploding market County in the fall of 2016. 3) The last section of the of flavored tobacco products. Nationwide, 80% of report describes the work of the Deschutes County kids who have ever used a tobacco product started Tobacco Retail Licensure Fiscal Impact Committee. with a flavored product.8 Kid-friendly candy flavor- A detailed description of five possible ways to imple- ings including fruit, bubble gum, cotton candy, and ment and enforce Tobacco Retail Licensure across chocolate mask the harsh taste of commercial tobacco Deschutes County is provided along with program products. In an attempt to reduce youth tobacco use cost estimates and Committee recommendations for initiation, in 2009 the Federal Government banned moving this policy initiative forward. flavorings, other than menthol, in cigarettes. Big and little cigars, chew and other oral tobacco products, Tobacco use still remains the number one preventable and electronic nicotine delivery systems are not cause of death and disease in Oregon. In Deschutes currently covered by this rule. Approximately a third County one in five adults use tobacco1 and over $50 of Deschutes County 11th graders report having used million are spent annually on tobacco-related medical a flavored tobacco product.9 care costs.2 Currently Oregon is one of only nine states that do not Tobacco addiction starts in adolescence with nine require tobacco retailers to hold a license. Without of ten adults who smoke reporting that they started tobacco retail licensure, there is little the state or local before the legal smoking age of 18, and almost 100 government can do to influence a change in behavior percent starting before they turn 26.3 Deschutes Coun- among those businesses that knowingly or carelessly ty youth currently use most types of tobacco products sell tobacco to underage youth. Minor decoy inspec- at a higher rate than their peers around the state. And tions of tobacco retailers in Deschutes County indi- although youth smoking rates in the state of Oregon cate varying levels of compliance with “no tobacco have declined by over 60% since the inception of the sales to minors” laws depending upon the inspection statewide Tobacco Prevention Program, youth use methodology and year. In 2014 more than a quarter of other tobacco and nicotine products (e-cigarette/ (26.7%) of the tobacco retailers tested in Deschutes vaping products, large and small cigars, hookah, snuff, County sold tobacco to an underage youth during dip and chew) is on the rise. Nearly one in four 11th inspections conducted by the Oregon Health Author- graders in Deschutes County report using tobacco ity (OHA). It should be noted that roughly 50% of products other than cigarettes.4 tobacco retailers are randomly chosen for an inspec- tion by the OHA on an annual basis and adult-only Many factors contribute to a youth’s decision to use establishments and vaping shops have not historically tobacco, including the availability, placement, and been included in these inspections. marketing of tobacco products in our communities. In Oregon, the tobacco industry spends over $111 1 Introduction Deschutes County Health Services staff and Cardiovascular Disease priority health area there community partners have, for many years, been are two measurable health indicators relating to working to reduce youth tobacco use initiation tobacco use: through tobacco policy, systems, and environmen- tal changes in the community. In 2015, several 1. Decrease the prevalence of cigarette smoking tobacco policy goals that focused on the retail among adults from 18% to 16% environment were included in the Central Oregon 2. Decrease the prevalence of smoking among Health Council’s 2016-2019 Regional Health 11th and 8th graders from 12% and 6%, respec- Improvement Plan (RHIP). The RHIP includes tively to 9% and 3% respectively measurable health indicators for several priority health improvement areas, which were identified by The tobacco retail environment policy action identi- medical professionals and community stakehold- fied to help achieve the 2019 health indicator goals ers during a six-month, strategic planning process reads as follows: throughout Crook, Deschutes, and Jefferson Coun- ties. At the completion of this planning process, the Implement a tobacco retail licensing program Central Oregon Health Council Board of Directors that will eliminate illegal sales to minors, prevent reviewed and approved the RHIP, committing to retailers from selling tobacco within 1,000 feet pursue the priorities, goals and strategies described of schools, raise the age of purchase for tobacco in the plan. to 21, and eliminate sales of flavored tobacco products. 2016 Central Oregon Health Council Board of Directors To aid in advancing the RHIP tobacco policy goal, Deschutes County Public Health applied for and Tammy Baney won competitive Tobacco Master Settlement Agree- Chair Commissioner, Deschutes County ment Funding (also known as the SPArC grant) from Mike Shirtcliff the OHA in the spring of 2016. Deschutes County’s DMD, Vice Chair President, Advantage Dental SPArC grant program plan outlined a three-pronged Mike Ahern community engagement approach to move the Commissioner, Jefferson County concept of tobacco retail licensing and the other Ken Fahlgren three identified companion policies forward: Commissioner, Crook County Megan Haase, FNP 1. Convene a work group of city (Bend, LaPine, CEO, Mosaic Medical Redmond, Sisters) and county staff to conduct Greg Hagfors a fiscal impact analysis for implementing and Chair Finance Committee, CEO, Bend Memorial Clinic enforcing a Tobacco Retail Licensure (TRL) Stephen Mann, DO program throughout Deschutes County. Chair, Provider Engagement Panel 2. Through one-on-one interviews with tobacco Central Oregon IPA Representative retail store owners/managers, learn more about Linda McCoy their current efforts to keep tobacco out of the Chair, Community Advisory Council hands of youth and gain an understanding of if/ Joseph Sluka how the tobacco policies in the RHIP would CEO, St. Charles Health System impact their businesses. Dan Stevens 3. Report the key findings from the retailer inter- Executive VP, PacificSource Health Plans views and the tobacco retail licensure fiscal impact study and committee recommendations The RHIP priority areas include: Behavioral