In 2015 the Greater Kansas City Chamber of Commerce—in partnership with Blue Cross and Blue Shield of Kansas City, the Health Care Foundation of Greater Kansas City, and many other business, health, nonprofit, and government leaders—launched Healthy KC, a project to improve health outcomes in our region.
Out of these discussions came Tobacco21|KC—an effort to raise the age of sale for tobacco products to twenty-one throughout Greater Kansas City as a strategy to reduce youth smoking. The effort launched in October 2015, and the community response has been overwhelming. Less than one month after our announcement, two of our area's largest local governments passed Tobacco21 ordinances, and six other cities passed Tobacco21 ordinances soon thereafter. As we write this, nearly half of our region's more than 2 million residents live in Tobacco21 communities, and many more local governments will consider the proposal this spring.
Though progress on Tobacco21|KC has been rapid, it hasn't been without some lessons learned —some of them we anticipated, but others we discovered only by misstep. Here are a few tips for smoking prevention advocates and other funders based on our experiences with Tobacco21|KC:
- Assess your community's readiness.
A few key conversations with area health departments, civic leaders, and a policy maker or two can give you a good sense about whether your community is likely to be supportive of a Tobacco21 policy. Before making the issue a matter of public debate, do your homework to make sure you understand your chance at success.
- Build a team.
Trust us, the work involved in a Tobacco21 effort is more than you would expect. Build a team of people with different backgrounds, skills, networks of contacts, and schedules. Some key constituencies to include are members of the business community, health experts, educators, youth, representatives of local health departments, and veterans and other representatives of the armed services. Each of these constituencies has a unique story to tell and role to play.
- Include the business community.
People may expect the local health community to support Tobacco21, but we also suggest recruiting businesses to stand with you. This may surprise people who don't recognize health as a key economic development engine, and this will immediately disarm anyone who claims that this effort could hurt local businesses.
- Find your champion and listen.
The right champion can be your personal tour guide through the municipal policy-making process. This champion should be a respected leader with political savvy and knowledge of the city or county council—it can be a member of the city council, a civic leader within the community, or perhaps even the mayor. Trust your champion's advice and guidance.
- Lay the groundwork.
Be sure you've done your homework so that when Tobacco21 becomes a topic of public and political conversation, you have a long list of supporters and a strategy for moving forward. The Tobacco21|KC effort had more than 100 endorsers before we publicly launched our campaign.
- Ask your elected officials where they stand—that is, don't make any assumptions.
Tobacco21 policies are nonpartisan, and support can come from unexpected places. Assign someone from your effort to speak to each elected official and present the issue to him or her for his or her reaction. Ideally, this person on your team will have an established relationship with, or some other connection to, the policy maker.
- Localize the issue.
You know the old saying about all politics being local? Well, it is certainly true with Tobacco21. Local voices impact local governing bodies, so make sure that your effort is localized as much as possible. Fact sheets, statistics, speakers providing testimony, endorsers—all of these should be as local as possible.
- Remember the power of personal stories.
The data around Tobacco21 are compelling, and it is easy to articulate them to city councils in a powerful way. However, more powerful than any data we've seen are personal stories about tobacco that can be shared at public meetings.
- Plan for opposition.
You may be lucky and have a Tobacco21 policy pass without opposition, but if opposition appears, be ready for it. In Kansas City, Missouri, the bulk of opposition was from vaping shops. Plan for such a possibility and know how you will respond.
- Pay attention to the ordinance language.
You might think that drafting a Tobacco21 ordinance is as simple as crossing out "18" and replacing it with "21." However, the changes are more complicated than that, particularly around how an ordinance treats purchase and sale versus possession and use. Some state laws also affect how Tobacco21 ordinances must be worded.
- Remember electronic cigarettes.
Electronic cigarettes (e-cigarettes) and alternative nicotine delivery systems are the wild frontier in this work. If possible, include these mechanisms in your Tobacco21 ordinances and when doing so, be thoughtful about the language that is used to define these products, as they are ever changing. The Tobacco Control Legal Consortium has a great resource here.
- Consider enforcement early on in the planning process.
This is one of the murkiest spaces, as city, county, and state laws around youth tobacco access can differ, each with their own enforcement body. As best as possible, do your homework to fully understand how your current tobacco policies are enforced and which entities are ultimately responsible for ensuring compliance. Each city is different and, depending on size, may or may not have the infrastructure and capacity to enforce a Tobacco21 policy.
To learn more about the Tobacco21|KC effort and our progress to date, click here.
Related reading:
"A Foundation's Win At Public Health Policy On Smoking," by Billie Hall of the Sunflower Foundation (Topeka, Kansas), GrantWatch section of Health Affairs Blog, June 15, 2010.
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