Tobacco Documents Online

I I f I I I I I ! 3 I I N~.Yi N=-TING DATE: Wednesday, Cctcber 8, 1QS0 1:00 - -1:00 0.,. Nlichigan L`epartment of ~l:clic fealth Baker-Olin ~%'est Complex, Rocm iC 3500 N. Logan Street Lansing, titI 48909 CITI7E.VS' PANTEL ON SMDKING :kti'D HT-aL.TH - MItiL''I"°S Conference Room 1B Baker-Olin West Complex Michigan Department of Public Health September 11, 1930 1:00-4:00 p.m. N I DBER.S PRESEN-T : Eleanor Barber Ben Barker, D.D.S., Chairperson Donald Breckon, Ph.D. Terry Gerald (representing Rep. Raymond Thomas Hunter Walter P. Maner III Charles Mitchner Michael Sbrti:more Robert Ortwein Hood) Senator William Sederburg Scott Simonds, Dr. P.H., Vice-Chairperson Douglas ViLzius %D1BEZS ABSENT: James Howard Norbert Reinstein Virginia Kjolhede James Terrian, N1.D. Margaret Lee George Watts Janice %Seadewcroft Arthur Weaver, ~1. D. STAFF PRESENT: Kenneth Warner, Ph.D., Project Director Sur.ny Sun Nai Fong, Chief, Office of Health Education Rhonda Runner, Student Assistant, Office of Health Education Nta..~cwell Alderson, Bureau of Personal Health Services Russell Holmes, M.D., Bureau of Disease Control and Laboratory Services John Insel, Bureau of Environmental and Occupational Health George Lafkas, Office of Substance Abuse Services Walter Wheeler, Assistant to the Director for Program Develcpment Marion Vaughan, Office of Cormrnmication Services Wanda Jubb, Department of Education GUESTS : John Dernback, american Li.mg Association Brick Lancaster, Michigan Depart:nent of Public Health Bob Popp, Michigan License and Beverage Association Bob Smith, arnericsn Lung Association NSic.`zael Spaniolo, 1%Lic.higan Tobacco and Candy Distributors u`:endors Association Dcn Sweeney, Michigan Schcol Health Association -47-

I I. Call to G}ruer The meeting :,;as called to order at 1:G0 a.~. II. Aooroval of %Linutes The minutes of the August 18 meeting ,iere ,.Tani-.ously approved. III. Introduction of Visitors IV. Legal Reconmendations It was stated that Panel members would vote on the reccr^Jr.ended actions proposed by the subccrmnittees, with the full report being fornally adopted on November 9. 1. We reccrrnend that the State adopt new legislation assuring a more compre- hensive protection of the rights of nonsmokers to clear air in public places and work sites. The =de1 of a"7,Lichigan Clean Air Act" will be included in the appendix of the report as being illustrative of the reco=r.endation's intent. A point was made that OSNA may already address the clean indcor air issue. The majority were in favor of the rece=endation; with cne ocposed and one abstaining. 2. We recoTrnend that the Governor adopt auniform policy on s;,ioxing, consistent wi th proposed legislation to protect the rights of nonsnokers, to be adopted by State agencies and depar,ents. The majority were in favor with one abstaining. 3. We recornend that further study be conducted on the purchasing patterns of children and teenagers to be funded by revenue that is generated from an increase in the sales tax on cigarettes, or from an increase in the vending machine license fee. It was stated that a paper distributed to the Panel by the Tcbacco Institute indicated that vending machines were not an'umportant point of purchase for teenagers. However, the Gilbert Ycuth Researc'1 Stud,v (now outdated) shows results which differ. Current infor~nation is needed on the cigarette purchasing patterns of children and teens. The reccrmiendaticn will be reworded to include a broad survev of the cigarette purchasing patterns of children and teenagers. It was decided to delete references to funding as that issue has already been addressed in a separate reccrrsnendaticn. :Lil were in favor of the recommendation as reworded. -48- I i I I ( I j 1.. I ~ I ~ I

r I- I I I I 4. We recor,nr.er.d that the Gcvernor encourage State and local police agencies and the prosecutor's office to comply with existing legisla- ticn. Pie urge that public education be a component cf enforcement activities. Further, that the Governor encourage State agencies and deoarunents to explore alternative enforcement mechanisms. All were in favor of the recornendation. A legal recorrr endation is needed to encourage compliance with smoking legislation in restaurants. Penalty points should be assigned to restaurants for noncompliance during the inspection of the facility. All were in favor of proposing that the Public Health Code be modified to permit the adjustment of the restaurant inspection form to include the assignment of penalty points for the violation of the smoking laws. V. Ecenemic Recorrmendations Two reccrIInendations have been previously approved. They are: I I I I I i i ~ 3. 4. 1. raising the State excise tax on cigarettes 5~ per pack, earmarking 1; for smoking and health activities; and, 2. lobbying the federal government for a substantial increase in the federal cigarette excise tax, earmarking a portion of the tax for smoking and health activities. Presently there are adequate resources to support federal smoking and health activities.. It was decided to delete the earmarking portion of recomanendation #2. A Panel member felt that an increase in the excise tax would result in more bootlegging activity. Correspondence frcm the Departaent of Treasury and the State Police indicate that a S¢ excise tax increase would not be a problem. It has been shown that a tax increase deters initiation of the cigarette habit, especially among young adult males. A vote was taken on each recommendation; both passed with one opposing vote. We recomsnend that the Governor and congressional delegation work for inclusion of smoking cessation costs as allowable itemized deductions in the federal personal income tax. The majority were in favor of this reconmiendation, with one abstention. ~ We recommend that the feasibility of requiring pre:nium differentials C l1 for life, health, homeowners, and automobile insurance for snokers and ~ nonsmokers be explored by the Insurance Cartanissioner. CA Correspondence from E. C. '.fackey, Acting Commissioner, indicated that tCD p many insurers offer a non-smoker's discount for home and life insurance. W He was unaware of any major healt.'i insurer which charges different rates for smokers. -49- ~ 4 L-

I Bev Niener, Director of the E'.ealth I^sL'rance CJm. l:a.^.ce nl'.;s:Cn, a letter to staff stating that she is unaware o: any studies Nhich •-cuis conclusively demonstrate the extent of the relationship bet••.eeri smm:e.l-ing and the risk assumed by the insurance ccrmpany. It was noted that actuarial data does eYist cn which insurers base differential rates for smokers and nonsmokers. - The recocrnnendation will be reworded to state that the Insur:nce Corrmissioner in cooperation with the Ntichigan Depart,.ent of ?ublic ~:ealth research the feasibility of requiring prer.iium differentials. The recommendation passed, with one opposing vote. S. We recommend that smoking cessation programs be included as an insurance reimbursable item. Bev Wiener, in her correspondence with staf:,made three points con- cerning this recommendation: 1) mandating additional coverages would result in additional premium costs, 2) low costs of smoking Writh- drawal-programs may not be of benefit to the insured who , t pay a deductible; and, 3) the cost for an irsurance company to handle small claims is high, and-it is generally considered more important for health insurance policies to cover the expensive medical services. The Panel agreed that including smoking cessation programLs as an insurance reimbursable item could result in decreased premiuuns in the future. The principle of the recomnendation is to provide an incentive for smokers to quit smoking. The smoking cessation program, as an insurance reimbursable item, can be offered as an optional coverage by insurance ccr.panies or :r,andated by the State. - A Panel member noted that requiring insurance companies to cover the cost of smoking cessation programs would add a considerable cost to the price of health insurance. It was decided to research the feasibility of including smoking cessation programs as an insurance reimbursable item. All were in favor of adopting the recommendation, to be included as part of #4. VI. Educaticn/Nedia/Publicitv Recerr~r.endaticns 1. a. We reccnunend that local health deYarr:ezts accept as their respcnsi- bility the facilitation and coordination of sm,oking and health activities. m G'1 b. We reccrmnend that the Aic.'ligan Depar*:.^ent of Public Heal th provide M skills training in the planning, i.*rmlet:enting, and evaluating ~ smoking education programs for local public health educators. M CO The local health departments can submit as part of their healt-h O;b education plan, called for cmder the cost-sharing program, their Lmplementaticn activities related to _.:cki.^.g. The NlicHigan Eepar^:ent I I l1 f I ( I I I t h t ~ I L -50-

I I I I I I ~ I of Public Health will take a leadership role in helping to direct t::cse activities. It was suggested that smoking cessation programs could become a basic (required) health service thrcugh cost-sharing. RecorrJnendation 1. a. will be reworded to state that local health departments should be encouraged to facilitate and coordinate health education activities in smoking. :U1 were in favor of both reccmr.endations 1. a. and 1. b. 2. The subcommittee supports the efforts of the Department of Education in its development of a comprehensive K-12 school health education pro- gram. . - All were in favor of adopting the recommendation. 3. We reccmmend that selected secondary schools include smoking cessation activities in their overall health program. - It was decided to merge this with recommendation #6, which provides for a grants program for demonstration projects directed toward smoking prevention or cessation. I I I t 4. We recommend that Michigan offer itself as a location for the evalua- tion of the impact of comprehensive school health education models on smoking. The me,^ibers agreed that the evaluation study should be a comparative one. :U1 were in favor of adopting the recommendaticn as reworded. S. Universities and colleges should conduct smoking education activities. The recort¢nendation should state that universities and colleges be encouraged to conduct smoking education activities. All were in favor of adopting the recomznendation as reworded. 6. We recommend that the Michigan DepartTent of Public Health be authori:ed to develop a program to fund research and demonstration projects con- cerned with smoking prevention and cessation. It was agreed that limiting program grants to serve only the high-risk populations would be too restrictive. All were in favor of adopting the recorrnnendaticn. We recommend that smoking cessation programs develop effective methccs to reinforce nonsmoking behavior. Follow-up activities should be a requirement of the grants program. The grants program should include three categories: 1) smoking pre- vention, 2) smoking cessation; and, 3) reinforcement of nonsmoking behavior. -51- ~ ~ t- - ------- -- ---- -- - -

A11 were i.-t favor of including this reccr=endation with 46. S. 1:'e reccmr,end that the Michigan Department of A,iblic Lealth '--e authorized to pror^ote available professionally prepared med:s packages, a mechanism for their use, and an evaluaticn of their i:r,pact on target groups. The Panel felt that the Michigan Deparment of Public Health shculd not rely on available media packages, since that would prohibit the develoo- ment of their own materials. The word, "available", will be taken out of the reconnendation. All were in favor of adopting the reccrrmendation. 9. a. jle recommend that the Governor's office widely publicize the Panel's receTmendations and provide a public education component to promote support for the support of legislation relevant to smoking issues. It was agreed that this would be included in the process of submitting the recomr:endations to the Governor. b. We recommend the Governor's office form a prominent citizen's group to publicly advocate nonsmoking behavior. a11 were in favor of adopting the recerunendation. VII. Additional Recerrendations 1. We recorrmend that a well-designed evaluation protocol be a ce-,^ponent of all smoking and health activities. This is a duplicative recorrunendation; therefore, it was omitted. 2. We rec _ommend that the Governor appoint a citizens' group to advise him on a plan to implement the Panel's recomnendaticns and to monitor smking and health activities in the State. The Panel agreed that the Nlichigan Department of Public Health should be responsible for providing staff support to t;e citizens' ce=ttee. Further, the citizens' committee should recommend new directions on an annual basis to the Governor. All were in favor of adcpting this reccn~;.endatien. 3. There should be quality assurance of smoking cessation programs and possible certification requirements. A Panel member stated that we should move toward developing a quality model of smoking cessation programs..another member felt that we have no basis for certification since it is im.known what the ccrocnents of a"a,uality" program would be. Certifying programs may be a deterrent to innovation. It was pointed out that there are public policy needs that may recuire the certification of programs. For exarole, criteria should be developed for smoking cessation programs that would be -52- I I i I i I I I i I t t L

I I eligible for inclusion as insurance reir;.burseable items. I f I .A11 but one Panel member was in favor of reccrrmendinQ that the issue of certification be addressed in the final report. 4. Smoking cessation programs should be a„~,aT~dated'oasic service in local public health departments. It was felt that this is redtmdant since health education is already a basic health service in local health departments. The Education/Media/Publicity Subcommittee has already addressed this issue by recomnending that the local health departments be a focal point for smoking and health activities. The reccrrmendation was not accepted, with only two members in favor of it. S. The Michigan Department of Public Health should be given overall coordination and responsibility for smoking activities. It was agreed that the Michigan Department of Public Health is the logical unit to take a leadership role in coordinating smoking and health activities. . u I All were in favor of adopting this recommendation. The Panel asked the staff to review the reccmmendations and identify substantive areas that may have been ignored. VIII. Public CorrJnent Those who directed corrmients to the Citizens' Panel were the following: 1. Don Sweeney, President, Michigan School Health Association; and, 2. Bob Smith, Director, American Lung Association. A position paper was received from the Tobacco Institute. Walter Maner X. stated the Tobacco Institute would be sending another paper to the Panel members. The Society for Public Health Educators, Great Lakes Cl^.apter, and the 4-H Youth Programs sent position papers and these were distributed to Panel members. New Business Go ~ Receipt of correspondence was acknowledged from the following: ~ 1. E. C. Mackey, Acting Ccmmissioner, Insurance Bureau m CD 2. Bev Wiener, Director, Health Insurance Ccrrmliance Division ~ f ~ ~ 3. John Insel, Secticn Chief, Fcod Service Sanitation Division 4. Don Shopland, Technical Officer, Office on Smoking and Health S. Aic.hael Spaniolo, Chairman, Michid-,,an Tobacco Industry Advisory Council 6. Walter Maner III, Citizens' Panel member 7. Kenneth Warner, Project Director, Citizens' Panel -53- i

I :he timetable of the Citi :ens ` Panel activities .,~ill be as fo1-ci:s : September 13-16 Seute:nber 22 Sevte.nber 70 October 8 November 6 staff .:ill draft the final recort subcer.,ittee review of the draft I redraft and :^ail to Panel me,:oers { amending of final draf tt minority reports received; formal adcpticn of report A Report Review Subcorrmittee has been for-med and will meet in Ann Arbor on September 22. - The executive sumTnary, which is the substance of the final report, will include the prologue and recer,ar.ended actions. The supporting materials will be in the appendix of the report. Dissenting opinicns, ccrynents, and reservations will also be included. Setting aside thirty minutes on the agenda every meeting for public cc~Tnr,:ent satisfies the requirements of the law. However, Panel members would like to provide another opportunity for the public to cc=..ent and add to the deliberation process. The Panel will hold a public hearing on October 8 from 10:00 a.m. - 12 noon. The full Panel meeting will be held from 1:00 - 4:00 p.m. on that date. Those who present oral testimeny should also submit a written statement to be included in the record. For those who cannot attend, a written position paper can be submitted to the Office of Health Education. The meeting was adjourned at 4:30 p.m. -:4- I i I I I t L 1