Summit County Public Health (SCPH) is the local health district serving people of Summit County, Ohio. The mission of SCPH is to protect and advance the health of the entire community through its policies, programs and activities that protect the safety, health and well-being of the people in Summit County. Summit County is comprised of nine townships, nine villages and thirteen cities. As of 2015, it consisted of 541,968 persons, making it the 4th largest county in Ohio. The largest proportion of residents are between the ages of 45 and 64 years (28.4%). This group is closely followed by those who are 18 to 34 years of age (21.7%), those under 18 years of age (21.5%) and those 65 and older (16.7%).
Tobacco use contributes to many of Ohio and Summit County's greatest health challenges, including cardiovascular disease, cancer and infant mortality. In addition, tobacco use is a cost driver for Medicaid and employers. Tobacco use by youth under age 18 is a serious problem in Summit County and throughout the nation. Those who begin using tobacco products at an early age run a significant risk of being lifelong tobacco users. Just 2% of tobacco sales (those to individuals under 21) produce 90% of new smokers. More than one-third (37%) of high school students and 16% of middle school students who smoked said they could purchase tobacco at a store, restaurant, or bar. Another 25% say they were able to give money to someone else to buy tobacco for them. Underage kids commonly obtain tobacco from those in their social circle who can legally purchase it (ages 18-20).
In the past year, SCPH has pursued passage of T21 legislation in local municipalities to raise the minimum purchase age of tobacco products from 18 to 21. T21 laws reduce minors' access to tobacco products and prevent kids from becoming lifelong smokers. The immediate goal of this practice is to enact T21 legislation in all Summit County municipalities. The ultimate goal is to reduce youth smoking rates, reduce access to tobacco products, improve health outcomes, and to create a generation of healthy adults in Summit County.
SCPH began holding initial meetings with representatives from local jurisdictions to assess their openness to pursuing T21 legislation. Simultaneously, SCPH Board of Health began the process of determining logistics for enforcement, including setting the fee structure and planning inspection protocols. SCPH developed educational materials, identified community champions and began meeting with city councils. Since October 1, 2018, there have been 119 compliance checks in the jurisdictions with T21 laws. Thirty percent of businesses failed but are now working with SCPH to offer education and training to their staff to ensure future compliance.
Since April 2018, SCPH has facilitated the passage of T21 legislation in six communities. Almost half of all Summit County residents (49%) and 20% of smokers live in jurisdictions covered by T21 laws. The first city to pass T21 legislation, Akron, holds the highest percentage of heavy smokers (9 or more packs a week). Additionally, there are seven communities who are in progress of considering T21.
Summit County is the process of meeting the immediate objective of passing T21 legislation in all of Summit County municipalities. Long term objectives will be measured over time through ongoing monitoring of tobacco use trends.
Political will and community partnerships have been the foundation for success in passing T21 legislation in six municipalities. A variety of community partners from different sectors, city council members, parents, students and school administrators all provided support for T21 passage. This community effort, supported by local data and a growing body of strong supporting evidence, helped to convince local legislators of the potential positive impact of T21 on the health of their communities.
Nationally, T21 legislation has reduced youth tobacco use in the communities that have adopted it. Needham, Massachusetts showed a 48% drop in high school smoking rates after policy implementation. Chicago also saw a 36% decrease in 18-20 year olds that currently smoked. Although it is too early to measure the effects of T21 in Summit County, this strong evidence-basis gives us hope that it will have a positive impact. Because SCPH is conducting the Youth Risk Behavior Survey (YRBS) in most Summit County schools, we will be able to closely measure T21's effectiveness in reducing youth access to tobacco. Long term reduction in tobacco use will have positive impact on chronic disease rates, health care costs and individual and community wellness.