Cigarette tax collections in Ky. jumped, then dropped, after tax increases; state's smoking rate has also been on the decline

Kentucky Health News graph from state data

By Melissa Patrick

Kentucky Health News

Increasing state cigarette taxes has proven to be an effective policy to decrease smoking rates, and it appears that is also true in Kentucky.

Nearly 30 percent of Kentucky adults smoked in 2011, two years after the legislature had doubled the cigarette tax to 60 cents a pack. Following a 50-cent increase to $1.10 in 2018, the state's adult smoking rate fell to 17.4% in 2022, the last year for which a rate is available. 

Shannon Baker, the American Lung Association's advocacy director for Kentucky and Tennessee, said that while she could not point to something definitive to explain why Kentucky's smoking rate has been decreasing, as has also been the case in the nation, she could speak to the impact of raising cigarette taxes:

"When taxes increase, smoking rates decline. We should take advantage of that, for goodness sake, and increase the cigarette tax in Kentucky by at least $1 and then tax all other nicotine products at parity with the cigarette tax." 

After an initial boost in cigarette-tax revenue from the rate hikes in 2011 and 2018, revenue from the tax declined 24% from 2019 to 2024.

The legislature increased the tax to 30 cents from 3 cents in 2005, but smoking rates before 2011 should not be compared with those after that because of a change in survey methodology, says the Behavioral Risk Factior Surveillance System, a continuing federal-state poll of Americans' habits.

Baker stressed that its important to take advantage of all policies that are known to decrease smoking. Beyond raising taxes, she said it's important to fund the state tobacco-control program and enforce the law against underage sales, which she said would result in fewer youth becoming addicted to nicotine and growing up to be lifelong smokers, and all the health issues that come with that. 

The new report on state General Fund receipts for the fiscal year that ended June 30 showed a 1.5% increase in receipts from other tobacco products, such as electronic cigarettes or vapes.

Asked about the impact of vaping on decreasing smoking rates, Baker focused her comments on young people, who are more likely to vape than smoke.

"We really have to get a handle on this youth vaping problem," she said, noting that Kentucky is one of about 10 states that doesn't require tobacco retailers to be licensed. "We don't even know where all of these shops are in order to enforce the law against underage sales."

Baker added, "We really need a better method of enforcing the law against underage sales. And what that looks like is licensure and routine regular enforcement opportunities that result in significant penalties all the way up to license suspension and revocation, for scofflaws that routinely violate the law. We're not talking about any onerous policy on those who are compliant with the law. We're simply talking about those who violate the law and violate it routinely." 

The 2023 Youth Risk Behavior Survey found that 5.3% of Kentucky high-school students said they currently smoked cigarettes and 19.7% said they used electronic vapor products. Among middle schoolers, the 2.2% said they smoked cigarettes and 12.8% used a vapor product. "Current use" is considered having used a product on at least one day during the 30 days prior to the survey.

Asked if she thought the new law that bans retailers from selling unauthorized vapor products would be effective in decreasing youth vaping, as it has been touted to do, Baker said, "House Bill 11 turned into . . . an industry market-share grab and nothing more; it is not a protection for kids. What we saw was a bill passing that, in effect would, if it's upheld in court, remove certain products, primarily imported products, from the market shelves, which in and of itself is not a bad thing. But, it certainly doesn't protect kids who will just switch to the other products that remain on the shelves." 

The law has been challenged in court. If it holds up, it will go into effect January 2025.

Baker also wanted to make sure people know that the funds for the state's tobacco control program come from the Master Settlement Agreement with cigarette manufacturers, not from the cigarette tax.

"We need to increase funding for tobacco control because . . .  Kentucky has the highest lung-cancer incidence and mortality rates in the entire nation and most of that is due to our high smoking rate," Baler said. "So even though the smoking rate may be declining, it isn't gone. It isn't good, even."

Studies show that comprehensive smoke-free laws and tobacco taxes are associated with lower rates of youth smoking

Kentucky Health News

Tobacco-control policies such as taxes and comprehensive smoke-free laws are associated with lower rates of youth smoking, according to recent studies. 

The purpose of the first study, published in Sage Journals, was to determine whether the presence and strength of local smoke-free ordinances was associated with cigarette and smokeless tobacco use among high school students in Kentucky, and whether use varied by urban/rural location.

The researchers used data from more than 353,000 10th and 12th graders in the 2004-2018 biennial Kentucky Incentives for Prevention Survey. The smoke-free ordinance data came from the Kentucky Center for Smoke-Free Policy at the University of Kentucky.

The center said in a news release that UK researchers "found that high-school students living in Kentucky counties with a comprehensive smoke-free law are 23% less likely to smoke cigarettes and 16% less likely to use smokeless tobacco compared to those living in counties with a partial smoke-free law or no law." 

Also, "Students in counties with moderate/weak laws did not differ in likelihood of use for either product, compared to those in counties without a law." 

Comprehensive smoke-free laws prohibit smoking inside all workplaces and public places.

The study also found that rural youth may be more likely to smoke. 

"Students in urban counties were 14% less likely to smoke, but there was no difference in likelihood of smokeless use by urban/rural location," says the report.

In conclusion, the researchers write, "Given that nearly half of U.S. youth are not protected by smoke-free laws, advocacy for comprehensive smoke-free workplace laws in all states and municipalities may be an important component in reducing the prospect of youth cigarette and smokeless tobacco use." 

In Kentucky, nearly 5% of high-school students smoke cigarettes and nearly 22% of them use electronic cigarettes, according to data from the Campaign for Tobacco-Free Kids. 

A separate study, published in the American Journal of Preventive Medicine, that looked at how changes in state tobacco-control policies impacted youth e-cigarette use in 2013-19. It found that adolescents were 55% less likely to use e-cigarettes following the enactment of a statewide comprehensive smoke-free law than before the state had a law.

 

The researchers then compared this to the impact of age-of-purchase laws and e-cigarette excise taxes and found that comprehensive smoke-free laws had the biggest impact on youth vaping. 

"Youth were 21% less likely to use e-cigarettes when their state had a minimum age-of-purchase law than when they did not," says the release. 

In addition, the study found that "while changes in tobacco excise taxes did not have a statistically significant impact, adolescents who lived in states with higher average cigarette excise taxes were more likely to use e-cigarettes." 

"This suggests that states need to consider parity and tax all tobacco products including e-cigarettes at the same rate," says the release. "These findings indicate that comprehensive smoke-free laws, tightening restrictions on youth access, and enforcing existing age-of-purchase laws can reduce the likelihood of e-cigarette use among youth."

Lawmakers returning to Frankfort to pass a budget and other bills; here are some health-related measures that could pass

UPDATE: On April 1 the General Assembly passed a state budget and related bills, including one freezing health departments' pension payments at the current level. House Speaker David Osborne said more bills are likely to pass when the legislature returns April 13, including one to help rural hospitals..

By Melissa Patrick
Kentucky Health News

As lawmakers head back to Frankfort to pass a budget -- and other bills, despite Gov. Andy Beshear's repeated request that they pass only a budget and anything related to the coronavirus -- several big bills related to other aspects of health are pending, including some controversial measures.

Beshear, a Democrat, denied the request of the Republican legislative majority to call a special session after the threat abates, if they adjourned early. He said it might not be safe to call them back in time to pass a budget, which must be done by June 30. The lawmakers plan to pass the budget and other bills Wednesday, April 1, and return April 14 to reconsider vetoed bills.

Beshear indicated at his daily press conference Tuesday that the budget would be the only bill passed. “These folks need to pass a budget and get of town,” he said. “My understanding is that now, that’s the plan.”

One big health-related bill that has been expected to pass is House Bill 32, which would tax electronic cigarettes. It has been promoted as a way to reduce teen use of the products by increasing their price and to bring state government more money -- an increased concern in light of the pandemic, which is likely to cause a recession and a drop in state revenue.

HB 32 was trimmed down in a Senate committee to place a 15 percent wholesale tax on e-cig products and a $1.50 per-pod tax on Juul-type products, which is expected to bring in $25 million a year. The original bill was estimated to bring in $50 million, and that could be trimmed down even further, as two Senate floor amendments have been filed to decrease the tax to 10%.

The original version would have put a 25% tax on e-cig products, while raising the tax for "other tobacco products," such as cigars, to 25% from the current 15%, and add e-cigs to the list. It would have also doubled the per-unit tax on non-smokable products, but did not touch the tax on traditional cigarettes.

Health departments: Another health-related bill to watch is one that has been touted in the House as part of a three-phase approach to create a sustainable solution to local health departments' pension-driven financial woes.

House Bill 171, sponsored by Rep. Jim DuPlessis, R-Elizabethtown, would move health departments, regional universities and quasi-governmental agencies away from a "percentage of pay" pension formula to a model that requires them to pay only what they owe the system over a certain period, called "level-dollar funding." It is in the Senate State and Local Government Committee but has had two official readings, so it could pass quickly.

It could pass another way: in a House committee substitute to SB 249, with a change to include a new 30-year-amortization period for the pension debt, rather than the 27 years in HB 171. It also adds a layered, 20-year closed amortization period for any future increases or decreases in actuarially accrued liabilities after the 2019 valuation. SB 249 has received two readings in the House, and DuPlessis has said negotiations will likely be done through SB 249.

Rural hospitals: HB 387, sponsored by Rep. Danny Bentley, R-Russell, would create a revolving loan fund for financially distressed rural hospitals.

It would allow the Cabinet for Economic Development to provide loans to struggling hospitals for three purposes: to maintain or upgrade their facilities; to maintain or increase staff; or to provide health-care services not currently available. The bill has had two readings and is in the Senate Appropriations and Revenue Committee.

Insulin costs: Another important health-related bill would cap the monthly cost of insulin for many Kentuckians at $100. HB 12, sponsored by Bentley, would require state-regulated insurance plans to cap a patient's cost for a 30-day supply of each insulin prescription at $100 "regardless of the amount or type of insulin needed to meet the covered person's insulin needs." It does not include Medicaid, Medicare or self-insured government plans.

The Senate committee substitute for HB 12 would also establish an insulin assistance program. This language comes from SB 23, sponsored by Sen. Phillip Wheeler, R-Pikeville. HB 12 has had two readings and is in the Senate Rules Committee.

Abortion: At least one anti-abortion bill is likely to move; it has been awaiting final passage for some time. Senate Bill 9, sponsored by Sen. Whitney Westerfield, R-Hopkinsville, would require health-care providers to give "medically appropriate and reasonable life-saving and life-sustaining medical care and treatment" to any infant born alive, including after a failed abortion, and would make not doing so a felony. A House committee removed references to research, so it would not inhibit ongoing research.

Critics of the bill say the state already has laws to prevent this from happening and the bill does not account for palliative care needed when infants will not live, or will not have quality of life.

Another abortion bill that could pass is House Bill 451, sponsored by Rep. Stan Lee, R-Lexington, which would expand the power of the attorney general to shut down abortion providers. The Senate Judiciary Committee added authority for Attorney General Daniel Cameron to block abortions under gubernatorial emergency orders limiting "non-urgent" medical procedures.

Sen. Ralph Alvarado, R-Winchester, has filed a floor amendment to ban abortion from being deemed an urgent procedure in the state of emergency Beshear declared for covid-19. Democratic Floor Leader Morgan McGarvey of Louisville has filed an amendment to allow abortions in the case of a nonviable fetus, rape, incest, or threat to the mother's life.

HB 451 has had only one reading in the Senate, so it could not pass Wednesday unless the Senate suspended the readings requirement, which the state constitution allows it to do. Majority Floor Leader Damon Thayer said last week that was a possibility, but he voiced skepticism of the idea because it might set a precedent that legislative leaders would like to avoid. The legislature could pass it April 14 or even April 15, the day the session must end, but Beshear could veto it without fear of a legislative override.

Another abortion bill pending is House Bill 67, sponsored by Rep. Joseph Fischer, R-Fort Thomas, which would, in effect, ban abortion in Kentucky if Roe v. Wade is overturned. It would have the constitution say, "To protect human life, nothing in this Constitution shall be construed to secure or protect a right to abortion or require the funding of abortion." The bill has had no readings in the Senate, but is a constitutional amendment that would go directly to the Nov. 3 ballot, not to Beshear, so it could pass if the legislature met April 15 or if it suspended the readings requirement.

Here are some other health-related bills that could pass:

HB 29, sponsored by Rep. Steve Riley, R-Glasgow, would extend temporary license for long-term care administrators to nine months, not six. It awaits House concurrence with a Senate substitute that would prohibit certification or renewal of an assisted-living community if it is owned, manged or operated by a person who has been convicted of certain crimes it would also change the appeals and renewal processes.

HB 46, sponsored by Rep. Jerry Miller, R-Louisville, would allow full-time state employees a paid leave of absence of 240 hours for donating a human organ and 40 hours for donating bone marrow. This bill is on the Senate consent calendar, which is used to pass bills en masse without debate.

HB 8, sponsored by Rep. Rob Rothenburger, R-Shelbyville, would boost Medicaid reimbursements for ambulance services by setting up a trust fund to allow them to draw a federal match. This bill is on the Senate consent calendar.

SB 30, sponsored by Sen. Stephen Meredith, R-Leitchfield, would  limit the number of managed-care organizations to three, from the current five. This bill has received a reading in the House and been returned to the Health and Family Services Committee.

SB 237, sponsored by Sen. Max Wise, R-Campbellsville, would  allow collection of tissue samples from post-mortem exams of children who have died from Sudden Infant Death Syndrome to be used for research purposes, with a parent's permission. This bill is also in the House Health and Family Services Committee, with one reading.

A more comprehensive list of health bills in the General Assembly, compiled by Kentucky Health News in a Google Doc, is available here.

Bill to tax e-cigarettes whittled down; heavy tax on Juul-like pods remains; teens warned of health dangers of vaping and covid-19

The bill aims to reduce youth use of e-cigarettes. (Getty Images)

By Melissa Patrick
Kentucky Health News

A House bill aimed at reducing teen use of electronic cigarettes by increasing their price, while bringing the state more revenue, was trimmed down to its bare bones in the Senate and is now expected to generate $25 million, not $50 million.

"The amended bill only covers vaping and Juul-type products," said Sen. Chris McDaniel, chair of the Senate Appropriations and Revenue Committee. "The floor [stock] tax is eliminated as part of this. It is a 15% wholesale and $1.50 per-pod tax and that is the entirety of the bill."

Later, McDaniel said he had realized that the floor-stock tax on existing inventory had not been deleted from the amended version of the bill and said he would file a Senate floor amendment to get rid of it. The new version of House  Bill 32 is expected to generate an estimated $9 million in 2021 and $16 million in 2022.

The House version of the bill would have put a 25 percent wholesale tax on e-cigarette products, while raising the wholesale tax for "other tobacco products," such as cigars, to 25% from the current 15%, and add e-cigs to the list. It would have also doubled the per-unit tax on chewable and non-smokable products, but did not mention the tax on traditional cigarettes.

The bill, sponsored by Rep. Jerry Miller, R-Louisville, has been a priority for the Foundation for a Healthy Kentucky. President and CEO Ben Chandler told Kentucky Health News that while the foundation wanted the House version, it still considered it a win because of the pod tax.

"We think by and large this is good news," Chandler said. "We believe that the tax on pods, which is about $1.50 per pod, would put a significant dent in the youth use of cartridge-based e-cigarettes, like Juul. . . . All data shows that if the price goes up, youth use goes down, and we're interested in seeing a decline in youth use."  

According to the 2019 Youth Risk Behavior Survey, nearly 54% of Kentucky high-school students and 31% of middle-school students said they had tried an electronic "vaping" product and 26% of the high schoolers and 17% of the middle schoolers said they had used them during the 30 days before the survey.

Chandler stressed that it is especially important right now to get the word out to teens to stop using these products because they are known to damage the lungs, particularly while the coronavirus is going around.

"The coronavirus is a disease that attacks the lungs and if the lungs are damaged, it makes a person much more vulnerable," he said.

Miller also sounded a warning about smoking while this virus is going around. "The preliminary research does say that smokers as well as vapers are a little more susceptible to covid-19 because it is a respiratory disease," he said.

Chris Mooney of The Washington Post reports, "Experts note that damage to the lungs from pollutants that result from combustion -- whether inhaled deliberately by smokers, or inadvertently by those in regions with poor air quality -- may increase the risk of respiratory tract infections from viruses such as the novel coronavirus. Poor air can also cause lung inflammation that could worsen the symptoms of covid-19."

Industry was willing to accept a lower tax, might still get it

Tony Florence and Adam Seizemore of the Kentucky Smoke Free Association, an organization that represents about 300 "vape" shops in Kentucky, spoke against the bill.

Asked if the association could support the 15% tax,  Florence said, "That is still a fairly substantial burden. . . . For us, 10% was the magic number and we had discussed that with several senators, so I'm not comfortable saying whether 15% would be acceptable or not, but it is a far cry better than 25."

Some senators expressed interest in lowering the tax when the bill gets to the full Senate.

Florence said he was pleased that the new version of the bill did not include the floor-stock tax or an additional hardware tax, which McDaniel said would only be subject to the 6% sales tax.

"You all have done most of the work for me," Florence told McDaniel. "That's great."

Chandler said removal of the floor-stock tax was a mystery. He said it would have kept retailers from piling up inventory at the lower tax rate. "We're sorry that that was removed," he said.

"Vape" shops generally don't sell closed systems that use pods, like Juul, which are most popular with youth, but instead sell open-tank systems that "vapers" fill with e-liquids.

Florence cited a National Bureau of Economic Research study that found  for each 10% shift in e-cigarette price, there was a corresponding 26% reduction in e-cigarette sales and an 11% increase in combustible cigarette sales.  He also cautioned that excessive taxes on e-cigarettes would create a black market for the products. "Vape taxes drive people back to smoking," he said.

He called e-cigarettes  a "harm reduction product" and said they were "95% safer than traditional combustible cigarettes." He said it was the industry's goal to transition people off of combustible cigarettes to "a much less harmful product."

Florence referred to a British study that was debunked in a recent American Journal of Public Health article, which included an appendix of research to back up its conclusions. It said, "The evidence-lacking estimate derived in 2013 cannot be valid today and should not be relied upon further."

And a 700-page U.S. Department of Health and Human Services report says more research is needed before it can be concluded that e-cigs help people stop smoking.

The current version of the bill does not tax disposable, flavored e-cigarettes, which have become popular with youth since the FDA imposed a partial flavor ban that did not apply to these products, but Miller said he would make sure they are included in the final version of the bill.

"When we do the conference committee to reconcile the Senate and House versions of HB 32, I will make sure the final language covers disposables and non-disposables in the per cartridge tax," he said in an e-mail.

Chandler said the foundation had been able to see only snippets of the amended bill, taken on someone's cell phone, because the Capitol and Annex are closed to all but members, staff, news media and other designated persons. The committee substitute had not been posted as of 11:30 p.m. Thursday.

State House passes 25% tax on electronic cigarettes

By Melissa Patrick

Kentucky Health News

FRANKFORT, Ky. -- A bill aimed at reducing teen use of electronic cigarettes by increasing their price passed the state House 75-17 and went to the Senate Feb. 26. The bill would place a 25 percent wholesale tax on the products.

State Rep. Jerry Miller

The bill's sponsor, Rep. Jerry Miler, R-Louisville, told the House that youth use of e-cigarettes is "creating a crisis" and "The most effective way to attack underage use is through raising the price."

The Kentucky Incentives Prevention Survey found that from 2016 to 2018, Kentucky teenagers nearly doubled their e-cigarette use, with more than one in four high-school seniors and one in seven eighth-graders reporting use in 2018.

House Bill 32 would also raise the wholesale tax for "other tobacco products," such as cigars, to 25% from the current 15%, and add e-cigarettes to that list. It would also double the per-unit tax on chewable and non-smokable products, but does not increase the tax on traditional cigarettes.

Gov. Andy Beshear proposed a 10-cent-per-pack hike in the cigarette tax, estimated to raise nearly $40 million for the next two-year state budget.

Miller said his bill is projected to bring in nearly $50 million. He said the amounts were increases "that a large manufacturer" said it could live with without opposing the bill.

The original bill called for a 27.5% wholesale tax on e-cigarettes, which are the only tobacco products in Kentucky that does not have an excise tax. That would be equivalent to the current tax in cigarettes.

Terry Brooks, executive director of Kentucky Youth Advocates, applauded the bill's passage, but asked that the Senate go to 27.5%, "to make a real impact for young people." 

"E-cigarettes put our young people at risk of nicotine addiction, serious lung injury or disease, and other harmful outcomes," Brooks said in a prepared statement. "A tax on e-cigarettes equivalent to that on cigarettes is a proven way to prevent usage among youth and can reduce future healthcare costs and provide additional revenue for the state budget."

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said the 25% tax was close enough to the cigarette tax to reduce youth use of the products. Chandler noted that after the state raised the cigarette tax 50 cents a pack, to $1.10, in 2018, annual sales dropped 36 million packs.

Miller is also the sponsor of House Bill 69, which would add a long list of regulations to e-cigarettes. It passed out of committee on Feb. 12, but has not yet been called up for a House vote.

Representatives from the Kentucky Smoke Free Association, which represents about 400 independent vape shops statewide, told lawmakers at the bill's committee hearing that while they support the added regulations in HB 69 because they address teen-access issues, they did not support the tax because it would hurt their businesses and would discourage adults from using their products as a smoking cessation device.

A recent U.S. Department of Health and Human Services report says more research is needed before it can be concluded that e-cigarettes help people stop smoking.

Democratic governor wants cigarette-tax hike, new tax on electronic cigarettes, not as much as one Republican's bill

By Melissa Patrick
Kentucky Health News

To pay for such things as a teacher-pay increase and 350 news social workers to fight child abuse and neglect, Gov. Andy Beshear wants to raise the tax on all tobacco products and add a new tax to electronic cigarettes, the only tobacco product in Kentucky that does not have an excise tax.

Gov. Andy Beshear makes his budget speech. (KET image)

The Democratic governor's taxes would have to be approved by the Republican-controlled legislature. Republicans often balk at new taxes, but comments from several leading GOP members suggest that some version of the e-cigarette tax will pass.

They are more skeptical of Beshear's proposed 10-cent tax increase on cigarettes, to $1.20 per pack from $1.10.

In his budget speech to the General Assembly, Beshear proposed a tax on e-cigarettes at 10 cents per fluid milliliter. His office said eight of the 19 states that tax so-called "vaping" products do so with a per-milliliter tax instead of a percentage of of the sales price.

The plan would also raise the tax on snuff and chewing tobacco to 38 cents per unit, from 19 cents,  and would raise the tax on other tobacco products, such as cigars, from 15 percent of the average wholesale price to 30%, which would make the tax rates on other tobacco products effectively the same as the proposed $1.20 cigarette-tax rate.

The higher tobacco taxes would raise $94.2 million for the two-year budget: $50.3 million in the fiscal year that begins July 1, and $43.9 million the following fiscal year, apparently presuming that the higher tax will decrease consumption.

If the cigarette tax were to pass, it would place Kentucky at the same rate as West Virginia, but would be noticeably higher than Indiana, Missouri, Tennessee and Virginia. The bordering states with the highest rates are Ohio, $1.60, and Illinois, $2.98. The national average is $1.81.

In 2018, Kentucky lawmakers increased the cigarette tax by 50 cents, to $1.10 per pack.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, praised the governor's proposals to raise tobacco taxes, noting the health savings that would result from them.

"In addition to raising revenue on one side of the budget, they reduce health-care and business costs and increase employee productivity on the other," Chandler said in a news release. "We know they're effective: the recent cigarette tax hike raised $140 million in new revenue its first year; at the same time, Kentuckians bought 36 million fewer packs of cigarettes."

Rep. Steve Rudy, chair of the House budget committee, said the most likely taxes to pass are those on electronic cigarettes, because “We’re trying to curtail this. . . . I’ve had a lot of school superintendents and teachers tell me it’s becoming an epidemic in the schools.”

Between 2017 and 2019, e-cigarette use more than quadrupled among the state's middle-school students and nearly doubled among its high-school students, with one in four high schoolers and one in five middle schoolers reporting monthly use; and one in 10 high school students reporting daily use.

Sen. Chris McDaniel, chair of the Senate budget committee, more cautiously said he needed to examine all of the components of Beshear's proposal before deciding how to proceed, but said he was open to looking at it.

"Any tax needs to be evaluated in the confines of its total impact," he said. "Since the last [cigarette] tax, we've seen a decline in smoking in the commonwealth. We know we've had a bit of an impact there. And we're going to take a look at it as part of the whole."

Senate Majority Floor Leader Damon Thayer said it's too soon to talk about the cigarette tax, but "I think a tax on vaping is something that needs to be considered. I don't think it should be as high as the tax on cigarettes, but I think it probably should be higher than the current 6 percent sales tax. So I think there is probably some momentum towards getting something done on that."

Thayer said he didn't think e-cigs should be taxed likewise because they are "not the same product" and added that while it's important to work toward decreasing the youth vaping epidemic, it's also important to recognize "there is evidence that vaping helps addicted adult smokers wean themselves off traditional cigarettes."

A 700 page U.S. Department of Health and Human Services report says more research is needed before we can conclude that e-cigs help people stop smoking.

"The evidence is inadequate to infer that e-cigarettes, in general, increase smoking cessation; factors contributing to the uncertainty include the changing characteristics of e-cigarettes, the many different contexts in which they are used, and the limited number of studies conducted to date," says the report, titled, "Smoking Cessation, A Report of the Surgeon General."

Rep. Jerry Miller

A bill to tax e-cigarettes in Kentucky has already been posted in the House Appropriations & Revenue Committee, chaired by Rudy.

House Bill 32, sponsored by Rep. Jerry Miller, R-Louisville, would place a 27.5% excise tax on e-cigarettes. It would apply the same rate to other tobacco products, which are now taxed at 15%, thus raising the levy by the same percentage that the cigarette tax was increased in 2018.

"I believe the tax bill will move out of the House, I feel pretty confident about that," Miller said. "We are working on modifying it to make sure it passes the Senate."

He said it was helpful that Beshear had proposed an e-cig tax, noting that the governor told him after his speech that he liked Miller's bill even better. He said that was likely because his proposal would generate more money than the governor's. "Whereas his is 20 million-ish, mine is in the 30 million range," he said.

Asked if he was willing to compromise the 27.5% rate, he said, "As I tell people, I don't pass perfect bills, I pass the best bills that can pass and I'm going to get the best bill I can pass through the Senate and onto the governor's desk."

Miller has also filed HB 69, which would further regulate e-cigarettes. Heunsuccessfully sponsored an e-cigarette tax bill in the 2019. In 2018, an e-cig tax was included in legislation that raised the tax on traditional cigarettes, but was removed in the Senate just before final passage and after lobbying by Altria Group, the largest tobacco company and 35% owner of Juul Labs, the largest e-cig company.

A recent Kentucky Health Issues Poll found that 75% of Kentucky adults support such a tax.

After 2018 tax hike, cigarette sales in Ky. dropped 10%, more than the national decline; bill would tax e-cigs, sales of which are rising

The tax hike made cigarettes noticeably more expensive in Kentucky than in Indiana and Tennessee, and narrowed price differentials with Ohio and West Virginia; that may have reduced Kentucky sales.

By Melissa Patrick
Kentucky Health News

The year after Kentucky increased its cigarette tax by 50 cents, to $1.10 per pack, 36 million fewer packs were sold in the state. That was a decrease of about 10 percent, more than the national decline of 6.1%.

According to an Aug. 9 report from the state budget director, in fiscal year 2019, which ended June 30, 321.1 million packs of cigarettes were sold in Kentucky, down from 357.1 million in fiscal 2018.

The report notes that from calendar year 2016 to 2017, cigarette sales in the state dropped 3.5%.

That's a "big deal." said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which lobbied for the tax increase and is now pushing for a tax on electronic cigarettes.

"It is pretty clear to us that a lot of these packs of cigarettes were not purchased as a result of the rise of the cigarette tax," Chandler said. "You can never completely prove it, but the fact that we had such a decrease . . . the size of the decrease was unusual right after the cigarette tax went into effect."

The last Kentucky Health Issues Poll, taken Aug. 24-Oct. 21, 2018, found that half of Kentucky smokers said they smoked less, or considered or tried to quit smoking, following the tax hike; 39% of Kentucky smokers said they reduced their smoking, 33% considered quitting, and 26 % tried to quit.

Chandler called those results "pretty good data that would suggest that the price increase does affect people's behavior."

Some critics of cigarette-tax increases argue that governments shouldn't rely on revenue sources that are declining. Chandler said that any loss in revenue from fewer tobacco sales will result in a significant long-term savings to the state's health budget. He said the state Medicaid program pays $600 million a year in smoking-related costs.

Chandler said he thought a proposed tax on electronic cigarettes would have a similar effect on teenagers' use of the products.

"I think particularly among young people, the tax will have a profound effect," he said. "One thing this information shows you is that when you raise the price, consumption does go down. And we believe that the people who are more likely to be susceptible to a price increase are kids because they don't have a whole lot of disposable income."

Kentucky lawmakers have pre-filed legislation (Bill Request 32) for the 2020 legislative session to tax electronic cigarettes like other tobacco products, as a way to curb surging youth use of the devices.

Map by Stateline, a service of the Pew Charitable Trusts, shows in
green states that tax e- cigarettes. (Click on map for a larger version)

Use of e-cigarettes nearly doubled among Kentucky youth from 2016 to 2018, with more than one in four high-school seniors reporting last year they they had used e-cigs, and experts say that is part of a national epidemic.

At a July news conference, state Rep. Jerry Miller, a Louisville Republican and House State Government Committee chair, announced a bipartisan proposal to levy an excise tax of 27.5% on electronic cigarettes.

E-cigarettes are the only tobacco product not subject to a state excise tax in Kentucky. The bill would also raise the excise tax on tobacco products such as snuff and chewing tobacco to equal the tax on cigarettes.

In its 2014 report, "The Health Consequences of Smoking: 50 Years of Progress," the surgeon general said increasing prices is "one of the most powerful tobacco control interventions" because price hikes are proven to reduce smoking, especially among teenagers.

An e-cigarette tax was in the 2018 bill that raised the cigarette tax, but was removed in the Senate, just before final passage and after lobbying by Altria Group, the largest tobacco company and 35% owner of Juul Labs, the largest e-cig company. Altria outspent all other lobbying interests in the 2018 legislative session, spending about $380,000 to influence legislators.

Between Jan. 1 and April 30 of this year, Juul Labs has spent around $43,000 for lobbying the General Assembly, according to a report from the Kentucky Legislative Ethics Commission.

Stateline reports that 17 states and the District of Columbia have specific taxes on e-cigarette products, with half of those taxes implemented in 2019, according to the Public Health Law Center at the Mitchell Hamline School of Law in St. Paul, Minnesota.

Cigarette sales decrease as Juul sales increase

A graph on the Juul Labs website shows that since the end of 2017 the quarterly decline in cigarette sales has steadily accelerated, going from 3.5% to 7.2%, while Juul sales surged, with the quarterly increases rising from 1% to 6.3%. The Juul analysis notes that a 1% annual decline in cigarette sales represents about 125 million fewer packs of combustible cigarettes.

"These changes in the U.S. tobacco market are a testament to the success of Juul products in switching adult smokers off combustible cigarettes," Juul CEO Kevin Burns said in the report.

Chandler pushed back on that assertion, saying that research does not show that adults who switch to an e-cigarette product are more likely to quit -- and that it also shows that those who use e-cigarettes often use both products. He added that the U.S. Food and Drug Administration has not approved e-cigarettes as a smoking cessation device.

He said research shows that teenagers who would never have smoked a traditional cigarette are using e-cigarettes at alarming rates. Other studies show that those who use e-cigarettes end up smoking traditional cigarettes at about the same rate as teens who first start with traditional smokes.

"I don't buy into the notion that Juul suggests, that the e-cigarettes have been central in cutting down smoking," Chandler said. "What I see is young people taking up e-cigarettes who would have never smoked otherwise."

After state cigarette tax rose 50 cents, half of Kentucky's adult smokers cut back, considered quitting or tried to quit, poll finds

By Al Cross
Kentucky Health News

Half of Kentucky's adult smokers say they smoked less, or considered or tried to quit smoking, following the increase in the state's cigarette tax on July 1.

That's according to the latest Kentucky Health Issues Poll, taken Aug. 26 through Oct. 21, in approximately the third and fourth months after the tax rose to $1.10 a pack from 60 cents.

"The cigarette tax increase is changing thinking and behavior about smoking in Kentucky," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll.

The poll found that 39 percent of Kentucky smokers reduced the number of cigarettes they smoked, 33 percent considered quitting, and 26 percent actually tried to quit.

The poll did not ask them if their efforts to quit had succeeded, because “It typically takes several attempts to quit,” said Bonnie Hackbarth, the foundation's vice president for external affairs.

While many tried to reduce their smoking, "Cutting back the number of cigarettes smoked per day . . . is not an effective strategy for quitting," said Ellen Hahn, a University of Kentucky nursing professor and a leading tobacco-treatment advocate. "Even low levels of smoking increase heart disease risk. Reduction in the number of cigarettes does not totally eliminate health risks."

The poll is an annual telephone survey of Kentucky adults, co-funded by Interact for Health, a Cincinnati-area health foundation. It found that Kentucky adults' use of tobacco cigarettes and electronic cigarettes remain much higher in Kentucky than the national average.

Nearly one in four (23 percent) of Kentucky adults smoke, according to the poll. The highest rates are among lower-income adults; 35 percent of those eligible for Medicaid (earning up to 138 percent of the amount the federal government considers poverty) said they currently smoked cigarettes. Among those with higher incomes, the rate was 16 percent. The national rate is 17 percent.

Chandler chairs the Coalition for a Smoke-Free Tomorrow, a group of 180 Kentucky businesses, advocacy groups, health-care companies and other organizations working to improve health by reducing tobacco use and secondhand smoke exposure in Kentucky. The Coalition led the campaign during the 2018 legislative session to increase the cigarette tax by $1 per pack.

"We knew we wouldn't get all the health benefits we sought when the legislature opted for 50 cents instead of a dollar and decided to exempt e-cigarettes completely, but we hoped it would have some positive effect. . . . This poll shows it did," Chandler said.

In lobbying the legislature, the coalition argued that tobacco companies would counter it with consumer coupons and retailer discounts so the effective price would rise more gradually, providing less incentive to quit. The largest tobacco-cigarette manufacturer, Altria Group, seemed willing to accept a 50-cent hike, but successfully opposed a 15 percent tax in electronic cigarettes. Now Altria is buying 35 percent of Juul, by far the leading maker of e-cigarettes,

Chandler said the coalition has "amped up our efforts to encourage Kentuckians to quit, and we'll keep on advocating for policies and funding to help them do just that. Meanwhile, congratulations to those who have taken the opportunity to quit. Quitting smoking is one of the most beneficial steps individuals can take to improve their own health, and reducing tobacco use is the single most impactful thing the Foundation for a Healthy Kentucky can do to improve health in the commonwealth."

For information and assistance in quitting smoking, call 1-800-QUIT-NOW or visit https://quitnowkentucky.org.

Altria, No. 1 U.S. cigarette maker, buying 35% of top e-cig maker; got Ky. legislature to drop proposed tax on e-cigs this spring

Photo by Eva Hambach, Agence France-Presse, via Getty Images

"Altria Group Inc. is nearing a deal to take a 35 percent stake in e-cigarette startup Juul Labs Inc. at a roughly $38 billion valuation, according to people familiar with the matter," The Wall Street Journal reports. "It would more than double what Juul was valued at just a few months ago, a sign of how quickly the startup has been growing and Altria’s desire to find growth outside its shrinking cigarette business. . . . The investment would give the Marlboro maker greater access to a rapidly growing but increasingly controversial segment of the nicotine market."

Juul has about 75 percent of the electronic cigarette market. Its devices can hold as much nicotine as a pack of cigarettes and have become highly popular with young people, prompting warnings that Juul is developing a new generation of smokers, not just of e-cigs but tobacco. "One out of every five high-school students—more than three million teens—reported using e-cigarettes recently, according to a federal survey conducted this past spring," the Journal notes. In Kentucky, at least as many high schoolers use e-cigs as tobacco cigarettes.

"Juul says its products are designed to help adult cigarette smokers switch to a less-harmful way to inhale nicotine," the Journal reports. "But the company’s own research shows its sleek device has hooked many people who had never smoked or had quit smoking."

The surgeon general has called youth e-cig use an epidemic, and the Food and Drug Administration "recently imposed restrictions on the sale of certain flavors of e-cigarettes that it says appeal to teens," the Journal notes. "Juul refills with non-tobacco flavors such as mango and cucumber account for a sizable chunk of its sales, according to analysts. Juul has taken steps to restrict sales to minors, including pulling all but its mint, menthol and tobacco-flavored products from bricks-and-mortar stores. It continues to sell all its flavors on its website, which it says has age verification technology. The company has discontinued its use of U.S. social media."

The company's stake in Juul "would also expand Altria’s reach beyond the U.S,," the Journal notes. "Philip Morris International Inc. sells Marlboro and other Altria brands outside the U.S. Juul products are sold in Canada, the U.K., Israel and Russia, and the company has expansion plans in Europe and Asia." Philip Morris USA, another Altria subsidiary, is the No. 1 U.S. cigarette maker.

After a visit from Altria's chief lobbyist this spring, leaders of the state Senate removed a proposed 15 percent tax on electronic cigarettes from the bill that raised the state cigarette tax 50 cents a pack, to $1.10. The company's apparent objectives were to limit the tax to that amount and keep it from applying to e-cigs and smokeless tobacco. It has a smokeless plant in Hopkinsville.

After the session, Altria reported spending $379,760 to lobby it. That was more than double the sum spent by any other business, and about three times more than the average the company spent in each of the previous four legislative sessions, according to the Kentucky Legislative Ethics Commission.

Op-ed calls for smoking bans to include e-cigs and for an e-cig tax to decrease teen use; new e-cigs are easy for teens to hide

A used package of Juul cartridges, found on a
Frankfort sidewalk. (Photo by Al Cross)

As students head back to school and concerns about their increasing use of a new electronic cigarette product called Juul emerge, anti-smoking advocates call for school districts and locales to enact 100 percent smoke-free laws that include electronic cigarettes and for state officials to tax e-cigarette devices and their liquids at the same rate as conventional tobacco products.

"It is alarming that children are not allowed to chew gum in class, but they are using e-cigarettes in school," Ellen J. Hahn and Melinda J. Ickes write in an op-ed for the Lexington Herald-Leader.

Hahn is a professor in the University of Kentucky College of Nursing and the director of BREATHE (for Bridging Research Efforts and Advocacy Toward Healthy Environments) and the Kentucky Center for Smoke-free Policy. Ickes is an associate professor in UK’s Department of Kinesiology and Health Promotion and director of Go Tobacco-free, an initiative to promote tobacco-free college campuses.

The worries Hahn and Ickes write about are widely shared. In April, the U.S. Food and Drug Administration was so concerned about the inappropriate sale of e-cigarettes to kids that it conducted an undercover "blitz" that particularly targeted the hugely popular Juul products. The Washington Post reported that the blitz found dozens of violations of the laws and issued 40 warning letters related to Juul sales.

Taxing e-cigarettes was an idea considered but dropped this year by the Kentucky General Assembly. The legislature raised the state cigarette tax by 50 cents a pack, to $1.10, but in the final hours of the legislative session, a plan to add a 15 percent tax on electronic cigarettes was dropped.

Hahn and Ickes write that the Juul product appeals to youth because it "rids the noxious taste and sensation of the initial smoking experience" and because the devices are easy to hide from parents and teachers because they look like computer USB drives.

The authors add that "the proportion of U.S. high-school students using e-cigarettes went up 800 percent from 2011 to 2014," and that while there was a slight reduction in smoking, or vaping, e-cigarettes in 2016 among youth, "today more youth in Kentucky and the U.S. smoke e-cigarettes than smoke traditional cigarettes."

They also point out that the aerosol in e-cigarettes is not a harmless water vapor as advertisements suggest, but instead "contains nicotine, tiny particles, sweet appealing flavorings and toxic chemicals." They write, "One pod is equivalent to the nicotine content in 20 conventional cigarettes. Nicotine harms brain development in children and young adults, and it is highly addictive."

Experts also worry that the use of these products will lead to use of conventional cigarettes and that they are being used to inhale other drugs.

Some schools have banned the use of USB drives as a way to curb the problem, but the authors write that there is little schools can do to thwart the aggressive e-cigarette advertisements found on social media and at venues, like music festivals, that are frequented by teens. It is also hard to battle the appealing flavors in the products that users say are the main reason they started using them.

Also, "Tobacco companies offer scholarships of $250 to $5,000 to students who write essays on the potential benefits of e-cigarettes," the authors write.

That said, there has been some progress. All 17 companies that were warned in May to stop marketing their electronic cigarette liquids in packaging that resembled "kid-friendly food products", like juice boxes, have stopped doing so, though the FDA warned the companies that it is still watching.

Foundation for a Healthy Kentucky report documents its change from a small philanthropy to 'an influential statewide advocate'

Under new leadership, the Foundation for a Healthy Kentucky "led or funded work to change dozens of state and local laws and policies in 2017 to help make Kentuckians healthier," including much greater efforts to "reduce smoking and exposure to tobacco emissions," the foundation says in its annual report.

The foundation is "making tremendous strides in transitioning from a relatively small health philanthropy toward an influential statewide advocate for policies that improve health across large populations," said Mark Carter, chair of the foundation's board of directors and CEO of Passport Health Plan.

Foundation CEO Ben Chandler and Gov. Matt Bevin announce
a plan to help keep Medicaid beneficiaries keep their coverage
under Bevin's changes in the program. (AP photo by Adam Beam)

Ben Chandler, a former congressman and state attorney general who became president and CEO of the foundation two years ago, said the effort accomplished "the largest cigarette tax increase in the history of the commonwealth, from the first Republican-led legislature in a century!" (Chandler is a Democrat.) The tax was raised 50 cents a pack, to $1.10; the foundation and its Coalition for a Smoke-Free Tomorrow wanted a $1 increase, saying tobacco companies would mask the increase with temporary coupons and discounts, which they are offering.

Carter says in the report, "We’re now moving into a front-line role" as "an influential advocate for policies that improve health. . . . We’re excited about the potential of this coalition to tackle one of the significant health issues in the commonwealth – high tobacco use."

​

Kentucky's health problems are broad and deep, and the foundation lacks the resources to tackle them all, so it must be selective, Carter says: "We must set challenging health improvement goals, but we also must narrow our focus so we can achieve them. In addition, we must engage community and health leaders in working together to be successful."

The 18-year-old foundation says that while it shifted "to more of a focus on front-line policy advocacy than philanthropy," it still made $1,002,724 in grants in 2017, supporting "access to health care, active living, healthy eating, and resilience in children," the report says. It put $1,635,339 into programs, advocacy and research on tobacco policies, health disparities, the substance-use crisis, the Patient Protection and Affordable Care Act and Gov. Matt Bevin's proposed changes in Medicaid.

An event of the Clinton County Healthy Hometown Coalition

The foundation divides its work into three areas: tobacco use reduction, health policy, and "Investing in Kentucky's Future," a five-year-old program aimed at improving children's health through local pilot projects. Those include the Breathitt County Health Planning Council for Children, the Clinton County Healthy Hometown Coalition, Fitness for Life Around Grant County, Louisville's Bounce Coalition, the Partnership for a Healthy McLean County Coalition, the Healthy Paducah Chapter of the Purchase District Area Connections for Health Coalition and the Perry County Wellness Coalition.

The foundation's report identifies four major recipients of its help for work in health policy:

Ky. Center for Smoke-Free Policy T-shirt 

The Kentucky Center for Smoke-Free Policy, which provides "science-based strategies for advancing smoke-free policies on the local level and educating citizens and policymakers about the importance of smoke-free environments," the report says. The center conducts research on the topic and is run by University of Kentucky nursing Professor Ellen Hahn, the state's leading anti-smoking advocate.

The Kentucky Equal Justice Center, an advocate for low-income Kentuckians and other vulnerable members of society, which reaches out to them with educational programs, helps them enroll in Medicaid, and advocates policies that help them. It was one of the nonprofit poverty-law centers that got a federal judge to block Gov. Matt Bevin's plan to change Kentucky Medicaid.

Kentucky Voices for Health, a coalition of lobbying and other advocacy groups that support the 2010 Patient Protection and Affordable Care Act and the state's 2014 expansion of Medicaid under the act. It also advocates "policies to increase access to care, improve children’s health and increase the number of smoke-free jurisdictions in Kentucky," the foundation's report says.

Kentucky Youth Advocates, which "supports the foundation’s policy priority area of improving the health of Kentucky’s children through statewide policies," the report says.

The foundation co-sponsors the Kentucky Health Issues Poll, the Howard Bost Memorial Health Policy Forum, research such as the recent study of health in Appalachia, and independent health journalism by KET and Kentucky Health News. KHN is also supported by UK's Institute for Rural Journalism and Community Issues, which publishes it.

The report for 2017 is available as an interactive website here. The foundation is funded by an endowment created from the charitable assets of Kentucky Blue Cross Blue Shield when it ceased to become a mutual insurance company and became part of Anthem Inc. Its mission is to address the unmet health needs of Kentuckians by developing and influencing policy, improving access to care, reducing health risks and disparities, and promoting health equity," it says. Its website is www.healthy-ky.org.

Fewer Ky. teens smoke, but the rate is still high, and new vaping products like the Juul create worry that this trend will reverse

By Melissa Patrick
Kentucky Health News

Kentucky's high-school students continue to smoke at higher rates than their national counterparts, but the good news is that their rates continue to drop. The bad news: An influx of new vaping products could reverse this downward trend.

2017 Youth Risk Behavior Survey

The recently released 2017 Youth Risk Behavior Survey found that 14.3 percent of Kentucky high-school students reported smoking cigarettes; 14.1 percent said they smoked e-cigarettes, 10.6 percent used smokeless tobacco; 11 percent smoked cigars; and 26 percent of those who reported using tobacco products use more than one product.

All of these numbers are "significantly higher" than the national averages for the same measures, which Foundation for a Healthy Kentucky President and CEO Ben Chandler says is a real problem, because most adult smoking habits are "hard-wired" by the age 18 -- and Kentucky has the second highest adult smoking rate in the nation, 26 percent.

"The cigarette smoking rate for Kentucky high schoolers remains 62 percent above the national average, and nearly twice as many use smokeless tobacco. A third more Kentucky youth are dual users, which exacerbates their exposure to nicotine and the damage tobacco use does to their developing brains," Chandler said in a news release.

Chandler commended the state's efforts to keep young people from smoking, but cautioned that Kentucky's progress is slower than other states.

"We have proven measures to ensure the trend in youth tobacco use continues downward, but we have to have the courage to enact them and the common sense to fund them," he said. "We need smoke-free laws, higher tobacco taxes, including taxes on new tobacco products, and more youth tobacco prevention funding."

A look at some of the state's most recent anti-smoking efforts shows there is room to do more to protect children from smoking:

• Only 70 of the state's 173 school districts have adopted 100 percent tobacco-free school policies and only 49 of those have included electronic cigarettes in their policies, Elizabeth Anderson-Hoagland, youth tobacco-policy specialist with the state health department, told Kentucky Health News.
• Bills to require school properties and school events to be tobacco-free were introduced but not called up in the legislature's education committees this year. The Senate passed a similar bill last year, but the House didn't take it up. A recent Kentucky Health Issues Poll found that 87 percent of Kentucky adults support such a law, and the poll has shown consistent support for such policies since 2013.
• A strong lobbying effort by the Coalition for a Smoke-free Coalition to get lawmakers to raise the cigarette tax by $1, to $1.60 per pack, failed. The coalition, chaired by Chandler and staffed by the foundation, said among other health benefits, such a hike would have kept more than 23,000 Kentucky teens from ever smoking and would have resulted in over 29,000 adults quitting. The tax was raised 50 cents, to $1.10, but Chandler said tobacco companies will be able to ease its impact with coupons and discounts.
• Though 71 percent of Kentucky adults support a statewide smoking ban, the last bill to get any traction on this issue was introduced in 2015, when the House passed a ban that was not called up in the Senate. Republican Gov. Matt Bevin, who took office in December 2015, has said this should be a local decision, so it's not likely such a bill would pass while he is in office. Only 35 percent of Kentuckians are protected from exposure to secondhand smoke by local smoke-free ordinances, according to the Kentucky Center for Smoke-free Policy.

On top of all of that, Chandler said he worries that teens' use of electronic cigarettes will undermine all the progress the state has made. About 45 percent of the state's high school students in the survey said they had ever tried an electronic vapor product.

A vaper uses a Juul device. (Photo by Adrian Leuthauser, Kentwired)

"And the explosion in teen popularity of new e-cigarette products threatens to undermine all the progress we've made by hooking teens on nicotine products that are proven gateways to smoking," Chandler said. "How sad it would be if we ended up back where we were a generation ago!"

One such product is the Juul device, a highly popular vaping tool that packs a powerful nicotine punch, with dozens of flavors that attract teens. And because it is small and looks like a USB drive, they are easy to hide them from parents and teachers.

The sale of these products to minors has become such a problem that the Food and Drug Administration conducted a nationwide undercover "blitz" to crack down on their sales. "They are a huge problem in the schools because they are so easy to conceal," Hoagland said. "Teens themselves are saying they are a problem, as well as administrators."

Chandler concluded, "Tobacco-related illness already costs the commonwealth 8,900 lives and $1.92 billion a year in health care expenditures. And even with the progress we've made, 119,000 kids currently under age 18 will die prematurely from smoking. That's nearly a thousand kids per county in Kentucky!"

Paducah cardiologist Pat Withrow receives a Healthy Kentucky Policy Champion award for his promotion of health

L-R: Chris Roty, president, Baptist Health Paducah; Dr. Pat Withrow;
 Ben Chandler, president/CEO, Foundation for a Healthy Kentucky;
Charlie Ross, immediate past foundation chair; and Dona Rains,
director of community outreach, Baptist Health Paducah. 

The Foundation for a Healthy Kentucky has named cardiologist Pat Withrow of Paducah a Healthy Kentucky Policy Champion.

Withrow is the director of outreach for Baptist Health Paducah and the governor-elect of the Kentucky Chapter of the American College of Cardiology.

"He is known locally and statewide for his advocacy of improved health. I know firsthand he is a health champion for our area," Dona Rains, director of community outreach at Baptist Health Paducah and a member of the foundation's board of directors, said in the news release.

Withrow's most recent advocacy to promote a $1 increase in the state's cigarette tax follows a long history of health-promotion efforts in the state, says the release.

When he served as the director of the heart center at Baptist Health Paducah, Withrow focused on reducing childhood obesity through an elementary school "Wizard of Health" presentation that focused on healthy eating, exercise and not smoking. He also advocated for CPR training in high schools and worked with area EMS teams to provide student instruction. He also tours middle schools with a police office and recovering addict to discuss the dangers of opioids.

"Pat is certainly an advocate for policies that will help make people healthier," said foundation president and CEO Ben Chandler. "But he goes beyond advocacy to education and implementation. He engages in the work from beginning to end . . . He keeps on advocating, keeps on teaching and keeps on working to ensure his Kentucky neighbors and colleagues have the best chance at a healthier life."

Withrow is now eligible for the Healthy Kentucky Policy Champion of the Year award, which comes with a $5,000 grant from the foundation to go to a Kentucky-based nonprofit of the winner's choice.That winner of that award will be announced Sept. 24 at the foundation's Howard L. Bost Memorial Health Policy Forum in Lexington.

Nominations for the Healthy Kentucky Policy Champion Award are accepted at any time; details are on the foundation's website.

50-cent cigarette-tax hike largest ever in Ky. but will do little to cut smoking, advocates say; new tax on e-cigs a late scratch

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- As part of a larger tax bill, the Kentucky General Assembly voted April 2 to increase the state's cigarette tax by 50 cents, to $1.10 per pack. That fell short of the $1 increase wanted by health advocates, who bemoaned "a missed opportunity" to improve the health of Kentuckians. And in the final hours, legislative leaders dropped a plan to tax electronic cigarettes.

Still, the advocates said the tax increase is historic.

"It's the biggest increase in Kentucky history, and there is something to be said for that," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. "Having said that, I think it's apparent to anybody who knows anything about this that it's not going to get the health benefits that we had been seeking . . . and that's a missed opportunity."

And that's "a huge understatement," said Amy Barkley, a regional advocacy director for the Campaign for Tobacco-Free Kids. "They voted for a tax increase that is just a tax increase," she told Kentucky Health News after a news conference with Chandler.

Coupon attached to cigarette packs
(American Cancer Society Action Network)

Barkley's group is part of the Coalition for a Smoke-Free Tomorrow, a group of more than 150 organizations chaired by Chandler. It argued that unless the price of a pack of cigarettes goes up by at least $1, tobacco companies can keep smokers hooked by giving discounts to retailers and coupons to consumers, and then gradually raise the price to make up the difference.

Chandler said the "price shock" of a $1 increase would have led to more than "50,000 people here in Kentucky either quitting or not starting."

At 26 percent, Kentucky has the second highest smoking rate in the country. It also has the nation's highest cancer rate, and cancer death rate. Chandler has often said that this is not a coincidence, since 34 percent of Kentucky's cancer deaths are related to smoking.

"We are the cancer capital of this country and we've got to do something about it. . . . and I think every method available ought to be on the table to try to do that," he said.

Despite the coalition's lobbying and a recent poll that found nearly 70 percent of registered voters would support a $1 cigarette-tax increase, a 50 cent hike was the best the lawmakers could do. After the House passed it, the Senate rejected it, but after the House passed a surprise pension-reform bill, the Senate accepted the tax as part of a package of tax cuts and increases.

"We failed to make our case, or Philip Morris made theirs better," Barkley said. The Altria Group subsidiary's chief state-government lobbyist met with top legislative leaders in an effort to make sure the tax didn't include smokeless tobacco (made in an Altria plant in Hopkinsville) or electronic cigarettes, in which the company has invested.

"It''s really discouraging, to say the least, that legislators continually yield to the tobacco industry, which we know no longer fights for no tobacco increase," Barkley said. "They fight for a low tobacco increase that they can manage by doing the discounting and so forth."

One version of the tax bill included a 15 percent tax on electronic cigarettes, which are now more popular among teenagers than cigarettes, but was removed before the final vote. -- apparently not long before, because the list of effective dates for various provisions mentioned both cigarettes and e-cigarettes. One clause in the bill excludes e-cigs from the definition of cigarettes.

John Cox, spokesman for Senate Republican leaders, declined to say why the late changes were made, and Philip Morris declined to comment. Rudy didn't return an e-mail seeking comment.

The tax measure, House Bill 366, narrowly passed the Senate 20-18 and out of the House 51-44, with no Democrats voting for it. Its main sponsor, House Appropriations and Revenue Committee Chair Steven Rudy, R-Paducah, said during his April 2 floor pitch that the 50-cent tax hike on cigarettes would improve Kentuckians' health.

The increase is estimated to generate about $132 million in 2019, and decline to $112 million in 2020, apparently on the fact that smokers are dying off and a belief that the tax hike will make some of them quit.

Asked if a 50 cent hike was better than nothing, Chandler said the foundation's view is that "It is better than zero," but also said there are differences of opinion inside the coalition.

For example, Barkley said in an email, "Nothing would have been better from a health standpoint because we have lost our chance. They aren't going to raise it by $1 or more so soon after the 50 cents."

Chandler said the coalition and the foundation would keep working for a higher tax. "We don't believe that it's over because that's not been the history of the cigarette tax in Kentucky," he said, noting that this is the third time the cigarette tax has been raised since the last 20 years. "I don't think it's accurate to say that once you've had an increase somehow it's over."

Chandler said the foundation supports the increase because it raises revenue, which is often spent on things that improve "social determinants of health," like providing school transportation. "It's a good thing for health to have added revenue," he said.

He said the foundation will also continue to work on tobacco-cessation efforts and "ramping up our efforts" on local smoke-free policies.

This is the first year the foundation has actively lobbied. Tom Loftus of the Louisville Courier Journal reported the foundation was the second-largest spender on lobbying for the first two months of the session, at $107,336, and that Altria spent "far more" than any other lobby, spending $156,000.

Asked why the foundation had made a shift to lobbying, Chandler said, "We believe that you can make a bigger impact on health through getting the government to act in certain ways, and adopt certain policies to get their people to be healthy, than you can by simply making grants and through solely philanthropic efforts. . . . We believe that we can have an outsize impact, we can punch above our weight if we are active in public policy matters."

The Foundation for a Healthy Kentucky funds Kentucky Health News but plays no other role in it.