Public Health: Tobacco Triumph
By Sean Price Texas Medicine August 2019


Charting Medicine's Statehouse Progress

Texas physicians got the kind of huge win on tobacco issues they haven’t seen in decades – a law to keep tobacco products away from young people.

Aug_19_TM_CoverStory_Sidebar1The Tobacco 21 measure, or Senate Bill 21, raises the minimum age to purchase tobacco and vape products to 21 years, except for military personnel.

“It’s going to be one bite out of the elephant to help eliminate tobacco addiction among some of our youth,” said Rep. John Zerwas, MD, (R-Richmond), who sponsored the legislation in the House of Representatives.

Research shows that about 95% of smokers become addicted to tobacco before age 21, and areas that raise the age for tobacco purchases usually see declines in sales to young people.

Representative Zerwas says the goal of the law, authored by Sen. Joan Huffman (R-Houston), is to prevent teens 17 and younger from smoking because “kids who become addicted at a very young age have a dismal opportunity for kicking the habit ultimately.” The law takes effect Sept. 1.

Texas joins 14 other states and more than 475 cities and counties across the country in raising the age for purchasing tobacco products.

“We’re the first major ‘conservative’ state to pass this for sure,” Representative Zerwas said. “That will help blaze the trail for others to follow suit.”

Representative Zerwas also authored House Bill 39 and House Joint Resolution 12, with sponsors Sen. Jane Nelson (R-Flower Mound) and Sen. Kirk Watson (D-Austin), to help renew the Cancer Prevention and Research Institute of Texas (CPRIT). Since it was founded in 2008, CPRIT has awarded about $2.2 billion in more than 1,300 grants to promote cancer-fighting efforts.

With the legislature’s blessing, Texas voters will decide on Nov. 5 if the state’s cancer-fighting agency will be able to issue another $3 billion in taxpayer-backed grants for research and prevention.

“I’m very happy that will happen,” said Marian Y. Williams-Brown, MD, chair of TMA’s Committee on Cancer and an assistant professor of obstetrics and gynecology at Dell Medical School at The University of Texas at Austin.

She says CPRIT has drastically improved Texas’ ability to do cancer research. For instance, the 2018 Nobel Prize in Physiology or Medicine was co-awarded to a Texas researcher brought to Texas using CPRIT funds. And Dr. Williams-Brown herself is one of many physicians participating in screening initiatives paid for by the agency.

“It’s through these types of programs that we’re able to provide health care to so many people throughout Texas – particularly those who are underserved and might not otherwise have access,” she said.

Public health also won new funding for the Texas Department of State Health Services (DSHS), says David Lakey, MD, vice chancellor for health affairs and chief medical officer for The University of Texas System. He serves on TMA’s Council on Science and Public Health.

Because the majority of budget requests were met, “This will allow [DSHS] to address a variety of issues, including support of their lab, tuberculosis control, and extra funding to address maternal mortality and morbidity in Texas,” he said.

Maternal health roadblock

One setback for TMA’s public health agenda: Preventing maternal illness. TMA advocated for extending Medicaid eligibility for new mothers from the current 60 days to 365 days. While the Texas Legislature did not fund this reform, it did approve Senate Bill 750 by Sen. Lois Kolkhorst (R-Brenham), which directs the Texas Health and Human Services Commission (HHSC) to look for other ways to extend coverage through the Healthy Texas Women program.

Also, House Bill 253 authored by Rep. Jessica Farrar (D-Houston) directs HHSC to develop a five-year plan to address post-partum screening and depression, and Senate Bill 749, also by Senator Kolkhorst, establishes level-of-care designations for hospitals that provide maternal and neonatal care.

Similarly, there was little movement on childhood vaccines policy. Neither pro-vaccine groups like TMA nor anti-vaccine groups were able to advance their agendas. However, TMA did enjoy success on adult vaccine measures, garnering support for more vaccine information and tracking for first responders in House Bills 1418 and 1256 by Rep. Dade Phelan (R-Beaumont).

Texas also built on recent gains in mental health by funding further construction on state mental health facilities in Austin, Rusk, and San Antonio. Also, Senate Bill 11, which is designed to improve school safety, establishes Texas Child Psychiatry Access Networks, giving pediatricians and other primary care physicians ready access to a greater range of psychiatrists and other licensed behavioral health professionals.

The Legislature also passed bills designed to fight obesity. Senate Bill 952 requires that child care facilities’ physical activity, nutrition, and screen time rules comply with science-based standards, and House Bill 455 directs school districts to adopt recess policies. However, Gov. Greg Abbott vetoed House Bill 455, saying the bill had “good intentions” but was “just bureaucracy for bureaucracy’s sake.”

Likewise, the governor vetoed House Bill 448, which would have required people to transport a child younger than 2 in a rear-facing car seat unless the child met certain height and weight thresholds. The governor said the bill was “an unnecessary invasion of parental rights and an unfortunate example of overcriminalization.”

Tex Med. 2019;115(8):19-20 
August 2019 Texas Medicine  
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Last Updated On

February 19, 2020

Originally Published On

July 22, 2019