Youth smoking trends in Philadelphia are changing. Now the city’s lost a major tool to stop that.
Youth smoking trends in Philly are changing rapidly, and now thanks to a new state policy, the city has lost a major tool to address the problem.
Vine Woods has never smoked a cigarette. "Dirty," he calls them. But cherry-flavored Black & Mild cigarillos are different. The North Philadelphia teen has been smoking about one a day since he was 16.
Now 18, Woods says the flavoring makes the cigarillo smoother, so the smoke doesn't irritate his throat.
"A lot of young people are afraid of cigarettes. But starting with Black & Mild is different," Woods said about the brand of tobacco products popular in his community.
Philadelphia teens are increasingly ditching cigarettes in favor of flavored cigarillos, cigars about the size of a cigarette. Data from the city's health department shows cigarette use decreased nearly 3 percent from 2011 to 2015. Yet cigar use (including cigarillos) doubled overall, and nearly tripled among black teens, a city survey showed.
Wood's friend Terrell Bullock said it's because the flavors make people think the products are safer than cigarettes. Bullock, 17, doesn't smoke. But as executive youth director for a North Philadelphia group called Positive Images Apparel, he knows a lot of kids that do. "Even though they know it's the same ingredients [as cigarettes], the flavor gives people leeway to rationalize it," he said.
But cigarillos, which contain three times as much tobacco as a cigarette, are just as addictive and just as threatening to the health of smokers and bystanders.
Recognizing this trend, City Council moved to ban flavored tobacco products. But before the final vote, the Pennsylvania state budget was passed with a last-minute attachment that restricts Philadelphia from passing new regulations on tobacco sales.
Pennsylvania is one of about a dozen states with this type of law. But city health officials say it's particularly troubling for Philadelphia, which already has the highest adult smoking rate among the country's 10 largest cities.
Policies credited for cutting cigarette smoking, from limits on advertising to higher taxes, have not been applied to cigarillos or other flavored tobacco products. And now Philadelphia has lost the power to do so.
"It's hugely concerning," said Cheryl Bettigole, director of chronic disease prevention at the health department. "Tobacco is still the leading preventable cause of death and now the state steps in and really cuts us off at the knees."
A spokesperson for Gov. Wolf said this component of the state budget was added in by Republicans in the House and Senate, and he signed it to complete the budget process. The Republican caucuses of the House and Senate said the law brings Philadelphia closer in line with the rest of the state, though laws the city already has enacted will remain in place.
Selling by the thousands
Mike Patel, owner of a 7-Eleven in South Philadelphia, said he sells about 2,500 cigarillos a week. People in their early 20s, he said, buy a variety of flavors, including mango, grape and pineapple.
He said price could be a key factor. A two-pack of cigarillos typically costs 99 cents, while a pack of cigarettes in Philadelphia can run upward of $10.
The difference is largely driven by taxes. Philadelphia enacted a $2 tax on cigarettes and little cigars (a different product than cigarillos) in 2014, but traditional cigars and cigarillos are taxed at just 3 cents an item. And Pennsylvania is one of three states that has no tax on cigars or cigarillos — attributed to the cigar industry's large presence in the state.
Studies have shown that raising the price of tobacco products deters smoking, especially among young people who are more sensitive to price.
Nick DiDonato, owner of Maggie's Puff n Stuff in Passyunk Square, can attest to that. Since the city's cigarette tax went into effect, young people are buying significantly fewer cigarettes, he said. But flavored Djarum products are popular.
The fruit and candy flavors appeal to youths, too. One study found two-thirds of teenagers who had smoked a cigar had used a flavored one their first time.
In 2009, the federal Food and Drug Administration banned flavored cigarettes, but not cigars. Since then, a handful of cities, like New York and San Francisco, have passed laws restricting flavored tobacco products.
Councilman Curtis Jones Jr. said that despite the state action, "we will adapt and continue this battle against tobacco," likely with education and media campaigns.
>>READ MORE: The problem with kids and flavored tobacco
Another factor that sets Philadelphia apart is how many businesses sell tobacco products, especially in low-income areas. The city has almost twice as many tobacco retailers per resident as other major cities. And while state law prohibits tobacco sales to children under 18, teens say that's easy to get around.
Harmony Ellerbe, 18, said she used to buy cigarillos from a gas station in North Philadelphia when she was just 11. "It's easy to get your hands on tobacco, no matter what age you are," she said.
In 2016, the Philadelphia Board of Health passed regulations aimed at cutting down the density of tobacco retailers and keeping them away from schools. But City Council is considering amending those — the state action does permit the city to ditch tougher tobacco rules in favor of more lenient laws.
Councilman Mark Squilla, who sponsored a bill easing regulation, said current policies are hurting small business owners without decreasing youth smoking. He proposes finding a way to crack down on retailers that sell to kids under 18 and revoking those licenses, which is current law. While the bill was not voted on last session, he plans to revive it.
The lifelong costs
Even as an 11-year-old, Ellerbe said she preferred wine-flavored products that made her feel grown up. After three years of smoking several a day, she quit at 14.
But as many former smokers can attest, it's not easy to stay away. "I'm not going to lie, I still crave them," Ellerbe said. "Sometimes when I'm stressed, I think about just running to the store and getting them. But I have to keep myself disciplined because I know if I buy one, I'll want another."
Health officials say the potential for lifelong addiction is what makes teen tobacco use so concerning. Nearly 90 percent of adult smokers begin smoking in their teens. Black adults already have the highest rate of smoking in the city, Bettigole said, a situation unlikely to change given teen cigarillo use.
Ellerbe has seen the health consequences of cigarillos first-hand. Once an avid singer, she's lost her singing voice because of smoke damage to her throat. She also suffers from alopecia; research has connected tobacco use with hair loss.
Quitting, however, boosts her chances of escaping the many consequences of longer-term tobacco use, including a variety of cancers, lung conditions, and heart disease.
Ellerbe now is a youth advocate with the nonprofit Public Health Management Corp., often traveling to Harrisburg to push for stricter tobacco laws — which now, will have to be statewide changes.
Staff writer Ian Haydon contributed to this article.