A Prescription for Change

Tobacco-Free Pharmacies

Tobacco in Pharmacies

The Stop Smoking Center next to the Start Smoking Center

The Tobacco Retail Environment & Point of Sale Marketing

Master Settlement Agreement of 1998

Tobacco companies agreed to restrict their advertising,

sponsorship, lobbying, and

litigation activities, particularly as those activities

were seen as targeting youth.

The Retail Environment

Stores are the main channel of communication for tobacco companies to reach new and current customers.

Studies have identified a clear link between retail tobacco marketing and youth smoking behaviors.

One-in-five high school smokers report obtaining their last pack of cigarettes from a store.

Retail environment…

In NYS the tobacco industry spends approximately $1.1 million per day to market its products.

A 2007 study showed retail cigarette marketing increased the likelihood of youth smoking initiation;1

The 2012 Surgeon Generals Report reviewed extensive evidence that “consistently and coherently points to the intentional marketing of tobacco products to youth as being a cause of young people’s tobacco use.”2

1. Sandy J. Slater et al., The Impact of Retail Cigarette Marketing Practices on Youth Smoking Uptake, 161 ARCHIVES OF PEDIATRICS & ADOLESCENT MED. 440 (2007). 2 2012 Surgeon General’s Report on Preventing Tobacco Use Among Youth and Young Adults.

Pg.5 of the Executive Summary.

Our kids are the most vulnerable

to tobacco marketing.

Studies show that exposure to cigarette advertising causes nonsmoking adolescents to initiate smoking and to move toward regular smoking.

Tobacco Promotion

•Gives kids the impression that tobacco is accepted and easy to get Source: NYS Tobacco Control Program

•Our kids are almost twice as likely to recall it

•Targets kids psychological needs -Popularity

- Acceptance - Self Image

Tobacco Product Display

Tobacco companies pay retailers to put their products in the most visible location in the store: at the point of sale where they are prominently displayed.

Contracts with retailers give the tobacco industry direct control over how products are displayed and promoted at the point of sale.

Tobacco companies use lucrative contracts to

ensure that many retailers are marketing

their deadly products.

Point of Sale: •behind cash registers •near check out lines •where all customers,

including children, are forced to see them.

Why should you care?

Smoking remains the leading cause of preventable death in New York State.

Smoking-caused illnesses cost New York State over $8 billion annually.

Approximately 15% of high school students are current smokers including 21% of high school seniors.

Studies show that exposure to retail tobacco marketing is as strong an influence as peer or parental smoking.

WE NEED TO DO MORE

Kids are twice as likely as adults to remember tobacco

advertising

Independent Pharmacists

Voluntary Changes

Cover up tobacco products….

FDA Regulation of Tobacco Sales and Marketing

On June 22, 2009, President Obama signed into law the Family Smoking Prevention and Tobacco Control Act (FSPTCA), which gives the U.S. Food and Drug Administration the authority to regulate the manufacturing, marketing and sale of tobacco products. Opens the door for local governments to do more…

From the FDA Regulations:

“[A] State or locality may enact statutes and promulgate

regulations, based on smoking and health … imposing specific bans or restrictions on the time, place, and manner, but not content, of the advertising or promotion of any cigarettes.”

The FSPTCA explicitly recognizes state and localities continued

authority to regulate the sale of tobacco products.1

1Family Smoking Prevention and Tobacco Control Act, Tub. L. No. 11-31, 123 Stat. 1776, 1823-24(2009) (codified as 21 U.S.C. §387p (2010)).

…WHAT CAN WE DO

Enact tobacco licensing requirements

New York City and Dutchess County require permits to sell

tobacco products in addition to the NYS license.

Localities can restrict tobacco retailer proximity to schools.

Localities can restrict type of retailers allowed to sell tobacco (i.e. pharmacies).

Limit Licensing….

Reducing the number of license tobacco retailers: Makes it less convenient to purchase

Would decrease point of sale promotions

Would decrease the acceptability of tobacco

Limited distribution would also reduce the likelihood of price competition thus drive up the cost.

Why Tobacco-Free Pharmacies

Pharmacies are licensed healthcare facilities

Currently the United States is the only country in the world where tobacco products can be found for sale in a pharmacy. 1

Sale of tobacco in pharmacies send an incongruent message2

Tobacco sales in pharmacies are a significant temptation to those entering pharmacies to purchase nicotine-cessation products

1See American Heart Association, Eliminating the sale of Tobacco Products in Pharmacies 1 (2009) available at http://www.americanheart.org/downloadable/heart/1254499772418Tobacco%20sales%20and %20pharmacies.pdf(“The California Department of Health notes that the United States is the only place in the world where tobacco products are sold in pharmacies.”) 2 See K. Suchanek Hudmon et al., Tobacco Sales in Pharmacies: Time to Quit, 15 Tobacco Control 35, 37 (2006).

Why Pharmacies…..

Tobacco sales in pharmacies imply that pharmacists approve of tobacco use

Yet pharmacists have historically

and consistently been opposed to the sale of tobacco products in pharmacies

March 2010—The American

Pharmacists Association adopted as official policy the goal of discontinuing tobacco sales in pharmacies.

Tobacco-free pharmacy policies:

Canada As of May 2010, all but 2

Canadian jurisdictions have banned the sale of tobacco in pharmacies

Banned in Ontario for 17 years

Year following the ban—50 pharmacies closed, 120 opened

Banned in Quebec & New Brunswick for >10years

San Francisco, California -- 2008

Tobacco-Free Pharmacies!

San Francisco -- July 17, 2008 Board of Supervisors approved 8-3,

Ordinance 194-08

October 1, 2008 --San Francisco became the first municipality to remove tobacco products from pharmacies.

Did not apply to General Grocery Stores & Big Box Stores & Walgreens challenged this

November 2010 amended to include all stores that have a pharmacy

Before midnight at the drugstore

After Midnight at the drugstore…

Massachusetts

December 2008– Boston’s Public Health Commission passed a regulation that prohibited the sale of tobacco products by health care & educational institutions.

As of Feb. 2014, 80 other municipalities have passed legislation that bans tobacco sales in pharmacies.

50.5% of state’s population (3.3 million residents) now live in municipalities that no longer allow the sale of tobacco in pharmacies

Massachusetts

More than 497 businesses are complying with the ban

155 - CVS

77 - RiteAid

81 – Walgreens

3 – Costco

18 – Walmart

35 – Stop and Shop

5 - Hannaford

4- Price Chopper

Massachusetts (con’t)

Only one of the municipalities that approved the ban encountered opposition at a public hearing.

No enforcement issues

No claims that the ban has resulted in economic hardships

Ban has not led to an increase in local tobacco sales permits

Myths & Facts of Tobacco-Free Pharmacies

Myth #1: Banning sales will result in economic loss to retailers

• There is no evidence of a negative impact in any of the 8

provinces where a ban is in place (over 80% of the Canadian population)

• Tobacco sales account for ~ 8% of pharmacy revenue

• National chains are already operating a model, without tobacco, that works

Myths & Facts of Tobacco-Free Pharmacies

Myth #2: Banning tobacco is only the start of move to target other products that might pose personal risk

• Tobacco products are unique in the ability to cause harm to

individuals and costs to the healthcare system and economy when used as intended

• Tobacco is the only product that used as intended will cause morbidity and mortality to users

Myths & Facts of Tobacco Free Pharmacies

Myth #3: Selling tobacco in pharmacies will expose smokers to cessation products and counseling when buying cigarettes

• Tobacco sold at front of shop while pharmaceuticals dispensed

at back of shop

• Selling tobacco in pharmacies is likely to tempt those trying to quit smoking

• It has been described as similar to holding an AA meeting in a bar

Myths & Facts of Tobacco-Free Pharmacies

Myth #4: Government shouldn’t tell pharmacy owners what to do

• The pharmacy business is already guided by standards and

licensing in order to protect patients

• The goal of pharmacists is to put the patients first

• Tobacco use has a high social and economic cost if allowed to continue

Myths & Facts of Tobacco-Free Pharmacies

Myth #5: The prevalence of smoking is not related to the availability of cigarettes

• The more cigarettes are available in our communities the more

people will be enabled to continue smoking

• Studies show an association between product availability, or greater point of sale or outlet density, and increased youth smoking and overall smoking

Support for Tobacco-Free Pharmacies

85% of independent pharmacies in NYS are already tobacco-free

All of the independent pharmacies in Albany, Schenectady and Rensselaer counties are tobacco free

Organizational support…..

American Cancer Society

American Heart Association

American Lung Association

American Medical Association

American Pharmacists Association

Americans for Non-Smokers Rights

American Public Health Association

International Pharmaceutical Federation

National Community Pharmacist Association

Pharmacists Society for the State of New York

Physicians for a Smoke-Free Canada

U.S. Centers for Disease Prevention & Control

World Health Organization

Capital Region Support

Q14. Do you think that the following types of stores should or should not sell tobacco products? (cigarettes, cigars, etc.)

Pharmacies? Albany Rensselaer Schenectady

Should 36.8 36.1 39.3

Should not 60.7 62.5 59.0 Don’t know/ 2.5 1.4 1.7 No opinion

Tobacco Free Coalitions Survey:2011, Siena Research Institute (SRI), July 2011, pg. 16.

Summary

• Banning tobacco products from stores containing pharmacies is good public health policy

• The public supports a ban on tobacco sales in pharmacies

• Pharmacists support a ban and have done so voluntarily where they have control

• Some major chains have already removed tobacco from their shelves and remain profitable

• The remaining stores containing pharmacies will only remove tobacco from their shelves if forced to

What can you do….

Thank You

Judy Rightmyer

(518) 459-2388

judith.rightmyer@sphp.com

www.smokefreecapital.org