Philadelphia proposes mandating antismoking ads at retail counters where tobacco is sold

One might think that smoking bans in city parks and that graphic cigarette-pack labels coming from Washington represent the extreme of government meddling.

But with statistics showing that smoking remains the No. 1 cause of preventable deaths, the Philadelphia Board of Health is considering a proposal that pushes the envelope on tobacco control: mandatory, illustrated signs on the health effects of smoking placed on the counters of every tobacco retailer in the city.

It’s not at all clear that the idea, still in draft form, would pass legal muster. A similar law enacted two years ago in New York City was struck down by a federal judge; the decision is being appealed.

Health officials in Philadelphia, however, say they are in a particularly tough spot. Smoking rates for adults (25 percent) and youths (11 percent say they smoked at least once in the last 30 days) are among the highest of major U.S. cities, with 2,468 deaths attributed to smoking-related causes in 2007 - more than the number due to homicide, suicide, accidents, diabetes, and AIDS combined.

Yet state and federal law limits what the city can do. Raising cigarette prices through excise taxes, for example, is one of the most effective strategies to reduce smoking, particularly among cash-strapped teens. But that power is held by Harrisburg, which levies a $1.60-per-pack tax, about average for states that do not produce tobacco.

New Jersey’s tax is $2.70, and its adult smoking rate was 15 percent in 2008 vs. Pennsylvania’s 21 percent, although there is no proof of cause and effect. New York imposes the highest tax of any state, $4.35 per pack, and New York City adds $1.50. Its smoking rate is 16 percent.

“I will confess to a certain amount of desperation,” Philadelphia Health Commissioner Donald F. Schwarz said when first discussing mandatory warning signs with the Board of Health two months ago. City tactics may need to be on “the leading edge,” he said, given that taxation, the “preferred approach,” is not available.

The Nutter administration has been a leader in public health, with strategies such as the nation’s strictest menu-labeling law, the failed attempt to impose a two-cents-per-ounce tax on sugary drinks, and the introduction a few months ago of Philadelphia’s Freedom Condom to increase awareness about safe sex.

“Over the last number of years, Philadelphia has been much more aggressive - in the positive sense of aggressive - in engaging the public, informing the public, and shaping community values around health,” said Jeffrey Levi, head of the Washington-based advocacy group Trust for America’s Health.

While some of the city’s efforts have been largely cheerleading, the mandates have proved controversial. Testimony to the Board of Health last week about the proposal to place illustrated signs in retail establishments divided along expected lines.

Medical groups generally liked the idea, even if graphic health warnings might upset small children who accompany their parents shopping. “People need to be shown that these things are real,” said Deborah P. Brown, president of the American Lung Association of the Mid-Atlantic.

Retailers worried that the images - none has been drawn up yet - might keep even produce-buying customers out of their stores.

When asked if he had a better suggestion, Andrew Kerstein, president of the National Association of Tobacco Outlets, suggested raising the minimum age for tobacco purchases from 18 to 19. Board members seemed intrigued, but the city believes it lacks the authority to act. (Kerstein owns tobacco shops in New Jersey, one of four states that has raised the legal age to 19.)

Board member Marla Gold, dean of the Drexel University School of Public Health, was concerned about a lack of evidence that antismoking point-of-purchase signs would make any difference. Few places in the United States have tried the approach. The handful that have in other countries - some in Australia and New Zealand and the Canadian province of Ontario, which also bans most point-of-purchase advertising by manufacturers - have not published research on the impact.

There is research evidence, however, that in-store advertising by tobacco companies is effective for strengthening brand recognition and encouraging impulse purchases. The industry spent $164 million on point-of-purchase advertising in 2008, the Federal Trade Commission reported this year, several times the amount it spent on all other categories combined.

The city hopes to counteract at least a part of that effect - and to support, by publicizing a phone number for help - the two-thirds of smokers who say they want to quit.

“There are good reasons to expect that [Philadelphia’s proposed] pictorial or graphic health warnings at the point of sale will further reduce social norms for smoking, and make smokers or recent quitters stop and think before they buy tobacco,” said Melanie Wakefield, the Melbourne, Australia, director of the Centre for Behavioural Research in Cancer, who has published several studies on the influence of tobacco-industry store ads.

By Don Sapatkin
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