Michigan continues to struggle to protect residents from tobacco products' harmful effects.
As a typical overachiever, receiving any grade lower than an “A” has always been terrifying. However, Michigan recently did just that. Across three out of five domains, Michigan failed the American Lung Association Tobacco Control Report Card.
Michigan Receives Not One, Not Two, But Three F’s
F Tobacco Prevention and Cessation Funding
F Tobacco Taxes
F Flavored Tobacco Products
C Smokefree Air
D Access to Cessation Services
As a pediatrician, my biggest concern is in the context of the recent increases in adolescent and young adult use of electronic cigarettes. Decades of declines in youth tobacco use were reversed in a few short years.
Michigan’s legislators have the power to improve these grades and protect Michiganders from the dangerous and addictive nature of tobacco and nicotine products.
Three Steps to Better Grades
- Require retail tobacco licensure. A simple first step in improving tobacco control in the state of Michigan is creating and requiring licensures for all retailers selling tobacco products, including e-cigarettes. Currently, thirty-three states and the District of Columbia have licensure laws. Tobacco retail licensure is an evidence-based strategy supported by the Surgeon General in combatting tobacco use, particularly in teens. Given the recent federal tobacco law raising the legal age of purchasing tobacco products to 21 (fondly called Tobacco 21), this progressive step forward in limiting youth access must be backed by adequate monitoring efforts.
To those who argue that this may increase administrative costs, this is often mitigated or completely covered by the licensure fee paid by tobacco retailers. Without an adequate regulatory agency, any policy (including current tobacco and e-cigarettes) will have limited enforcement potential and, thus, inadequate impact.
- Increase funding for tobacco prevention and cessation efforts. Currently, Michigan uses only 3.8% of the CDC-recommended level of funding and around 10% of the nearly $1.2 billion revenue related to tobacco sales.Without adequate funding, efforts to combat the rising adolescent and young adult use of electronic cigarettes and promote cessation in our adult population have been stymied.
Services such as the Michigan Tobacco Quitline need to be expanded to meet technological logic changes of the present, including expanding services to youth, and adding more online services. Engaging and far-reaching health marketing campaigns must begin to combat the ongoing use of social media portrayals of positive tobacco messaging. These are just two examples of the many currently being modeled and created throughout the country that could be replicated and enacted in Michigan.
The relatively minor investment can have profound health and economic efforts in Michigan, where the healthcare cost due to smoking is estimated at nearly $4.6 billion.
- Remove preemption for tobacco legislation. Preemption is an archaic set of laws that prevents local governments from regulating tobacco or nicotine and has historically been a tactic of the tobacco industry to avoid regulation. The removal of such preemption laws is a goal of the U.S. Department of Health and Human Services Healthy People 2030 objectives. It will help to remove another barrier to healthy living for Michiganders.
Grand Rapids and Detroit have had significant movement and interest in passing laws eliminating the sale of flavored tobacco products, including menthol. However, they have been hampered by the preemption laws of the state. Often the most effective and successful policies begin at the local level, and we need to support this.
Many areas in Michigan may be hesitant to authorize such broad bans and enacting them at the local level can help prove their effectiveness and feasibility across the state.
Michigan has a lot of work to do to protect its residents from the harmful effects of tobacco products and earn passing marks from the American Lung Association Tobacco Control Group. Fortunately, there are several simple and effective ways for the state to make up this lost ground and bring Michigan in line with other states, such as California, Maine, and Massachusetts, which currently lead the way in implementing evidence-based tobacco policies.
These suggestions are not an end-all-be-all; there are numerous ways to combat the tobacco industry’s dangerous products and practices. The above methods give Michigan its best chance at improving itself from within. In terms of tobacco control, Michigan needs to put in some time, effort, and maybe even some extra credit if it hopes to achieve anything close to a passing grade.
April 17, 2023
Brittany Tayler, MD, is an Alice Hamilton Scholar with the Michigan State University-Hurley Children’s Pediatric Public Health Initiative, Charles Stewart Mott Department of Public Health. She is Co-Chair of the Keep Michigan Kids Tobacco Free Alliance. Tayler is pursuing her Master of Public Health degree with research interests in asthma management, tobacco and vaping, health literacy, gender-affirming care, improving access to sexual health care, and substance abuse treatment.