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			 Even in states where tobacco has played an important role in the 
			economy - including North Carolina, Kentucky and Missouri -chambers 
			have endorsed cigarette tax hikes, raising the smoking age and other 
			efforts to curb tobacco habits. 
 The shift has accelerated since 2016, driven by a growing awareness 
			that smoking drives up healthcare costs for employers, business 
			groups said.
 
 Smoking restrictions often are part of broader wellness initiatives, 
			such as promoting exercise and nutrition, aimed at improving health 
			- and business.
 
 "Smoking isn't just killing us, it's bankrupting us," said Ashli 
			Watts, a spokeswoman with the Chamber of Commerce for Kentucky, 
			where one in four adults uses tobacco, the lung cancer rate is the 
			nation's highest and related healthcare and lost productivity costs 
			nearly $5 billion a year.
 
 "Companies do look at the health of a workforce," Watts said. An 
			unhealthy workforce "is a deterrent."
 
			
			 
			In Kansas City, Missouri, the chamber joined the local Blue Cross 
			and Blue Shield insurer in 2015 in launching a smoking cessation 
			effort.
 They hoped to persuade five communities to raise the legal tobacco 
			age to 21 by 2018. Within a month, two of the largest cities in the 
			area had signed on, and now more than 20 communities with 1.4 
			million people have raised the age.
 
 Pam Whiting, a spokeswoman for the Greater Kansas City Chamber of 
			Commerce with members in Kansas and Missouri, said the group was 
			"happily stunned" by the results.
 
 "It is a real concern for our business members, for their employees 
			and their bottom line," she said.
 
 In Indiana, where smoking costs an estimated $7 billion in 
			healthcare and lost productivity, the state chamber is pushing for a 
			$1-a-pack increase in the state cigarette tax, to raise the smoking 
			age to 21 and for more spending on cessation.
 
 "It's not typical for a chamber to advocate for a tax increase," 
			said Kevin Brinegar, president and chief executive of the Indiana 
			chamber. But, he added, the cost of smoking "gives us a black eye."
 
 TOBACCO FIGHTS BACK
 
 Cigarette makers are spending tens of millions to fight the efforts, 
			according to a Reuters review of campaign spending data and 
			interviews, healthcare groups and the companies.
 
 Brittany Adams, a spokeswoman for Camel cigarette maker Reynolds 
			American Inc, said the local chambers' efforts go against their core 
			mission and could hurt businesses outside the tobacco industry.
 
 "Chambers of commerce are supposed to protect the interests of 
			businesses in their communities, and supporting these kinds of bills 
			may negatively impact local wholesalers and retailers," Adams said.
 
			
			 
			Last fall, the industry spent almost $100 million to fight cigarette 
			tax ballot measures in several states. More than $70 million of that 
			was spent in California, where voters approved Proposition 56, 
			raising state taxes by $2 to $2.87 per pack.
 Business groups in San Francisco and Los Angeles supported the 
			measure. Tax increases failed in Colorado and North Dakota.
 
 Although adult smoking rates in California are the second lowest in 
			the country, its large population makes it the single biggest U.S. 
			market with 8.5 percent of cigarette sales.
 
 Marlboro cigarette maker Altria estimated tax hikes enacted in 
			Pennsylvania and California would hurt industry sales volumes by 
			about 1 percent this year.
 
			
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			Wall Street analysts say the bigger risk is that more states follow 
			suit.
 At least 215 states and municipalities - including Hawaii and 
			California, as well as New York City, Chicago and Boston – have 
			raised the age to 21, according to the Campaign for Tobacco-Free 
			Kids.
 
 A spokesman said Altria wants to see the battle return to Congress, 
			where it believes it has gotten a better hearing. With the Tobacco 
			Control Act of 2009, Congress set a national minimum smoking age of 
			18.
 
			In 2015, an Institute of Medicine study concluded that raising the 
			national minimum to 21 would prevent about 223,000 premature deaths 
			among people born between 2000 and 2019.
 A group of Democratic senators introduced a bill to raise the age 
			nationally to 21, but it never got a vote.
 
 "This is a complex issue, and Congress has established a thoughtful 
			process to better understand it," Altria spokesman David Sutton 
			said.
 
 Tobacco products already "are very heavily taxed," Sutton said. He 
			also said sales taxes were a particular burden on the poor and 
			created incentives "for criminals to engage in contrabrand."
 
 The U.S. Chamber of Commerce has not taken a position on the bill in 
			Congress to raise the smoking age, and, as a rule, it leaves local 
			issues to local chambers, said chamber representative Blair Latoff 
			Holmes.
 
			
			 
			In Kentucky, a recent survey found more than 90 percent of the 
			state's chamber members support bans on smoking in the workplace. 
			But the chamber decided against pushing for a statewide ban because 
			it believes the politics are stacked against it.
 The industry has spent more than $3.7 million the last five years 
			lobbying Kentucky state legislators, records show. And, in November, 
			Republicans won control of the legislature with the support of many 
			constituents who consider smoking a personal prerogative.
 
 For now, the Kentucky chamber is putting its clout behind a doctor-sponsered 
			bill that would ban tobacco products from schools. Currently, less 
			than 40 percent of Kentucky school districts ban tobacco.
 
 "Generation after generation of people in Kentucky have smoked," 
			said Watts, the chamber spokeswoman. "There are people who don't 
			know anyone who has ever quit."
 
 For graphic on rising taxes on tobacco products, click: http://bit.ly/2m0MMpr
 
 (Reporting By Jilian Mincer; Editing by Michele Gershberg and Lisa 
			Girion)
 
			[© 2017 Thomson Reuters. All rights 
				reserved.] Copyright 2017 Reuters. All rights reserved. This material may not be published, 
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