Governor Carney Releases Statement on Senate Passage of Tobacco Age Legislation

DOVER, Del.Governor John Carney on Tuesday released the following statement on the vote in the Delaware Senate to pass Senate Bill 25, which would raise the sales age for tobacco products from 18 to 21:

“Preventing smoking is the best thing we can do to improve the health of our state, and reduce the growth of health care costs over time. We know that use of tobacco-related products is the leading cause of preventable death and disability in Delaware and across the country. Tobacco-related illnesses, such as lung cancer and heart disease, claim the lives of 1,400 Delawareans each year, and treatment of those illnesses costs Delaware families, businesses and the State more than $530 million annually. We expect this legislation will help curb the impact of smoking on Delaware families by preventing more young Delawareans from picking up this dangerous habit in the first place. Thank you to members of the Senate for passing this legislation, and to Senator Townsend for his leadership on this important issue.”


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Governor Carney Announces Support for Legislation to Raise Tobacco Sales Age
Support Raising the Tobacco Sales Age From 18 to 21

Op-ed: Protecting the Health of our Young People by Raising the Minimum Sales Age of Tobacco Products from 18 to 21

Protecting the Health of our Young People, and our State’s Future, by Raising the Minimum Sales Age of Tobacco Products from 18 to 21

Op-ed by Karyl T. Rattay, MD, MS, Director, Division of Public Health, Delaware Department of Health and Social Services

It’s a fact that most smokers start using tobacco as youth: Eighty-nine percent of current adult Delaware smokers started before the age of 21; and slightly over 17 percent started between the ages of 18 and 20, according to 2017 Delaware Adult Tobacco Survey (ATS) data.

Nicotine addiction keeps young people using tobacco products which increases the risk of physical damage to their bodies. Exposure to nicotine can have lasting effects on adolescent brain development, and can disrupt the formation of brain circuits that control attention, learning, and susceptibility to addiction. Youth and young adults who use tobacco are also at risk for developing early abdominal aortic atherosclerosis, which affects the flow of blood to vital organs; reduced lung growth, which increases the risk of chronic obstructive pulmonary disease (COPD) later in life; and reduced lung function. Adolescent girls and young women who become addicted to nicotine and use tobacco during pregnancy increase the risk of a premature birth or even the death of their child.

An emerging policy intervention to help reduce youth and young adult initiation of, and access to, tobacco products is to increase the legal age for the sale of these products from 18 to 21 years old. These are known as “Tobacco 21 or T21 laws.” Research shows that youth often turn to older friends and classmates as sources of cigarettes. Increasing the tobacco age to 21 in Delaware would reduce the likelihood that a high school student will be able to legally purchase tobacco products for themselves, other students, or underage friends. Adolescents age 15-17 would also have a harder time passing themselves off as 21-year-olds. As many tobacco users between 18 and 21 move from experimental use to regular, daily use, a T21 law would prevent this as well. The Institute of Medicine (IOM) estimates that increasing the age of sale to 21 would decrease long-term tobacco use by about 12 percent. And, it could decrease tobacco-related deaths by 10 percent.

Sen. Bryan Townsend introduced T21 legislation in Delaware last week. SB25, which has the support of Gov. John Carney, additionally imposes a civil penalty for sales to 18- to 21-year-olds, prohibits parents and guardians from purchasing tobacco products for minors, and prohibits individuals under age 21 from entering vapor establishments.

Seven states, including our neighboring states of New Jersey and Virginia, have passed T21 laws. Seventy percent of Delawareans surveyed by the 2017 ATS support a T21 law. A majority of current tobacco product users surveyed also support such a law.

As the Director of the Division of Public Health (DPH) and a board-certified pediatrician, I support SB25 because it is a population-based health initiative that promotes health, prevents disease, averts a lifelong addiction to nicotine and steers Delawareans away from the dangers of tobacco use.

The toll of tobacco use is staggering. Tobacco use is still the leading cause of preventable death and disability in Delaware and the United States. Our latest cancer data report lists tobacco use or smoking as risk factors for 16 cancers.

Of particular concern to us here in Delaware is lung cancer. Our most recent cancer statistics indicate lung cancer accounted for 14 percent of all newly diagnosed cancer cases and 30 percent of all cancer deaths. An estimated 85 to 90 percent of all lung cancer cases are caused by tobacco use, according to the U.S. Department of Health and Human Services.

Additionally, secondhand smoke is a known cause of low birthweight, Sudden Infant Death Syndrome, and lung problems, asthma, and ear infections among children.

Every year, nearly 1,400 adult Delawareans die from smoking-related illnesses, according to Centers for Disease Control and Prevention estimates. The U.S. Surgeon General warns that an estimated 17,000 Delaware youth who are now under age 18, will ultimately die prematurely from smoking-related illnesses if current trends continue.

Despite our great strides in reducing tobacco use, especially reducing youth smoking rates, we still have a long way to go. We are seeing an alarming increase in the use of electronic cigarettes. Although only 6.2 percent of Delaware high school students smoked regular cigarettes in 2017, nearly 20 percent used some type of tobacco product. Also, a 2018 Institute of Medicine report indicates young people who begin with e-cigarettes are more likely to transition to combustible cigarette use, and are at risk for suffering associated health burdens. We must take innovative actions.

For more than 30 years, Delaware has been a national leader in establishing tobacco prevention interventions that help protect the health of all Delawareans. We all breathe easier in public places and workplaces thanks to the Delaware General Assembly’s passage of the Clean Indoor Air Act. Our legislators created the Delaware Health Fund which helps the state maintain a comprehensive tobacco prevention and cessation program. The creation of the Delaware Cancer Consortium led to a large group of dedicated people who continuously make our cancer prevention, detection, and treatment system work better. The DCC recommends enacting legislation to increase the age to 21 to purchase cigarettes and other tobacco products.

DPH and our health partners have worked hard to save lives and safeguard Delawareans from a diminished quality of life by guiding them toward healthy behaviors. Delaware should join the states that are passing T21 laws – and remain a national leader in protecting the health of our citizens.

Governor Carney Announces Support for Legislation to Raise Tobacco Sales Age

Senate Bill 25 would raise the legal age to purchase tobacco products from 18 to 21

DOVER, Del. – Surrounded by members of the General Assembly, advocates, students, and health care professionals, Governor John Carney on Tuesday announced his support for Senate Bill 25 – legislation that would raise the legal age for sales of tobacco and vape products from 18 to 21.

This legislation aims to protect youth in Delaware from the dangers of tobacco use and nicotine addiction. Tobacco use remains the leading cause of preventable death and disability in Delaware and the United States, claiming 1,400 lives in Delaware each year, according to federal data. Treatment of tobacco-related illnesses costs Delaware $532 million annually.

“We know the dangers of tobacco use, and anything we can do to prevent more Delawareans from starting to smoke is a step in the right direction,” said Governor Carney. “Raising the legal tobacco sales age from 18 to 21 will help reduce the number of young people who use tobacco products, and hopefully prevent more young people from trying tobacco products in the first place. Over time, we hope and expect this change will reduce the toll of tobacco-related illness. And it should curb the cost of treating those illnesses – costs that today are funded by all Delaware taxpayers, families, and businesses through higher health insurance rates and treatment programs. Thank you to members of the General Assembly who are committed to this effort, and to our health care community for your support.”

“Everyone knows the costs of smoking: lung disease, cancer, higher insurance costs – and worst of all, a shorter life,” said Senator Bryan Townsend. “But not everyone is aware that after years of convincing more and more young people to never pick up the habit, tobacco products are now pushing their way back into our schools, reaching children as young as 12 with e-cigarette flavors like bubblegum and cotton candy. We need to explore every option we have to fight back against this trend and keep our kids healthy and smoke-free. SB 25 is a great start. Cities and states that have already enacted this policy are seeing underage smoking rates drop by a third or more. That’s more than just an impressive statistic – it’s lives saved, lengthened, and improved from middle school onward. We owe it to our constituents to take this kind of action and I look forward to working with my colleagues in the General Assembly to get this bill on the Governor’s desk as soon as possible.”

“Four out of five adult smokers became addicted, daily smokers before age 21. Raising the age to buy tobacco products would mean that fewer adults would develop a lifelong habit that carries life-shortening consequences,” said Representative Melissa Minor-Brown, the lead House sponsor. “Tobacco use costs Delaware more than $500 million each year in direct medical-related costs, but it costs families much more in terms of loves ones taken far too soon.”

Ninety-five percent of adults who smoke started before the age of 21, according to data from the Centers for Disease Control and Prevention. The years of young adulthood between the ages of 18 and 21 are considered a critical period when many smokers transition from experimental smoking to regular, daily use of tobacco products. Reducing the availability of tobacco products for individuals in this age range should also decrease the number of high school-age Delawareans exposed to tobacco products, and reduce the number adult smokers in Delaware over time.

Tobacco use also has a significant economic impact on health care spending in Delaware. The Centers for Disease Control and Prevention reports that tobacco use costs Delaware $532 million each year in direct medical-related costs. Medicaid funds for $95 million of those costs annually. An estimated 17,000 Delaware youth who are alive now, will die prematurely in the future from a smoking-related illness, according to federal data.

“The financial savings in health care spending that will result from this change will certainly be significant,” said Dr. Kara Odom Walker, Secretary of the Delaware Department of Health and Social Services. “But those savings pale in comparison to the true benefits of this legislation — improved quality of life for all Delawareans and the chance to keep more people from starting a habit that will shorten their lives by 10 years, according to the CDC.”

“Tobacco products, including the liquid cartridges used in e-cigarettes and vaping pens, contain highly addictive nicotine and other chemicals known to cause cancer, heart disease, and respiratory diseases such as Chronic Obstructive Pulmonary Disease. Tobacco use remains the leading cause of preventable death and disability in our state,” said Dr. Karyl Rattay, Director of the Division of Public Health. “It is our duty to protect today’s youth and young adults from tobacco, including e-cigarettes, and vaping initiation because their brains are more susceptible to the effects of nicotine. Nicotine can disrupt the formation of brain circuits that control attention, learning, and susceptibility to addiction, an issue with which Delaware already struggles.”

“A key component of Tobacco 21 legislation is the inclusion of e-cigarettes,” said Deb Brown, Chief Mission Officer of the American Lung Association. “As stated in our ‘State of Tobacco Control’ report, the need for Delaware to take action to protect youth from tobacco is more urgent than ever, with youth e-cigarette use reaching epidemic levels due to a 78 percent increase in high school e-cigarette use from 2017 to 2018. The Lung Association is proud to stand with Governor Carney and Senator Townsend on this lifesaving legislation and our hope is that other state leaders step up and stand with us to save our next generation from a lifetime of tobacco addiction.”

“This measure is very important for the health of young adults in our state,” said Senator Anthony Delcollo. “I am proud to stand together for this bipartisan effort to limit the damaging effects of nicotine addiction and cancer in Delaware.”


Rewatch the press conference here.

Delaware Falls Four Spots in Commonwealth Fund’s 2018 State Health Scorecard; Secretary Walker Says Health Care Spending and Better Outcomes Must Be Aligned

NEW CASTLE (May 3, 2018) – Ranking in the bottom half of states in a variety of health measures, including adults who smoke, annual diabetes treatment testing, and adults who are obese, Delaware fell four spots in The Commonwealth Fund’s 2018 Scorecard on State Health System Performance released today.

Delaware ranked 22nd among all the states on the more than 40 measures, which are divided among access to health care, quality of care, efficiency in care delivery, health outcomes and income-based health care disparities. Delaware’s worst trend was in deaths from suicide, alcohol and drug use increasing from 38.2 deaths per 100,000 population in 2013 to 49 deaths per 100,000 in 2016. Delaware ranked 31st in that category among the states.

On the positive side, Delaware ranked in the top five in three categories, including the top ranking for the lowest rate of deaths within 30 days of hospital discharge among Medicare beneficiaries. The state ranked third for the lowest rate of adults with a mental illness reporting an unmet need and fourth for the lowest rate of children ages 19-35 months who did not receive all recommended vaccines.

“This is another national health scorecard that indicates we are not a top state for overall health, despite being one of the top-ranked states in terms of per-capita health care spending,” said Delaware Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker, a board-certified family physician. Last June, a Centers for Medicare and Medicaid Services (CMS) analysis found that Delaware ranked third among the states for per-capita health care spending in 2014 at $10,254, or 27 percent above the U.S. average of $8,045. If that rate is maintained, CMS estimated that Delaware’s overall health care spending could double by 2025.

In September, Gov. John Carney signed House Joint Resolution 7 authorizing DHSS to develop a health care spending benchmark to bring transparency to how Delaware’s health care dollars are spent across the system – commercial insurers, Medicare and Medicaid. In February, Gov. Carney signed an Executive Order creating the Health Care Delivery and Cost Advisory Group to advise Secretary Walker on the creation of statewide health care spending and quality benchmarks.

“Across the health care spectrum, our goal is to examine health care costs and how to slow the growth of those costs, while improving the overall health of Delawareans at the same time,” Secretary Walker said. “The Commonwealth Fund rankings provide us with valuable insights into the areas where we need improved health outcomes.”
Dr. Karyl Rattay, director of DHSS’ Division of Public Health, said the rankings show there is more work to do to improve population health across the state. In a note of caution, Dr. Rattay said The Commonwealth Fund appeared to report Delaware’s infant mortality rate incorrectly at 9.1 deaths per 1,000 live births in 2015. Dr. Rattay said Delaware’s rate peaked at 9.3 deaths per 1,000 live births for the five-year time period ending in 2005 and has declined to 7.5 deaths per 1,000 live births for the five-year time period ending in 2016. “Our rate is still significantly higher than the U.S. average of 5.9 deaths, with higher disparities among populations and in specific geographic areas,” she said.

“While we are pleased to see Delaware ranked sixth among the states in the broad category of prevention and treatment,” Dr. Rattay said, “the Commonwealth Fund’s results indicate the areas where we must seek further improvement, especially in the healthy lives and disparity indicators.”

In another national health scorecard released earlier this year, Delaware ranked 30th in United Health Foundation’s 2017 America’s Health Rankings Annual Report, exceeding the national average in drug deaths per 100,000 population, obesity and physical inactivity rates among adults, cancer deaths per 100,000, diabetes rate among adults and violent crime offenses per 100,000. Delaware’s 2017 ranking improved one spot from 2016.

To read The Commonwealth Fund’s 2018 Scorecard on State Health System Performance:


The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.

The Great American Smoke Out Set for Nov. 16, 2017

Great American Smoke Out button DOVER – You’d like to quit smoking. Maybe you’ve tried before. But it can feel hard. The American Cancer Society estimates it takes between eight to ten attempts for the average person to quit smoking. When trying to quit, support can make all the difference. That’s why the Cancer Society has set Thursday Nov. 16, 2017, as the date for the annual Great American Smoke Out. Each year, thousands of people across the county use the Great American Smoke Out as their date to quit.

If you or someone you care about smokes, the Division of Public Health (DPH) asks you to use Nov. 16, 2017 as your quit date, and use the days leading up to it to create a plan to do so. A good first step is to call the Delaware Quitline (1-866-409-1858) for advice. By quitting, smokers take an important step toward reducing their risk of heart disease, cancer and lung diseases. And, even quitting for one day can put smokers on the path to recovery.

In Delaware, rates of cigarette use continue to decline. Cigarette smoking by adults dropped again to an all-time low of 17.7 percent, according to the 2016 Behavioral Risk Factor Survey (BRFS). But total tobacco use among Delaware adults in 2016 was 24.2 percent or approximately one in four Delawareans. Total tobacco use includes cigarettes, cigars, little cigars, smokeless tobacco products, e-cigarettes, and all other tobacco products.

Smoking is the leading cause of preventable death. Eighty-five percent to 90 percent of lung cancer cases are caused by smoking, and lung cancer makes up one-third of all cancer deaths.

About 36.5 million Americans still smoke cigarettes, and tobacco use remains the single largest preventable cause of disease and premature death in the world. Nationally, while cigarette use also declined (from 42 percent in 1965 to 15 percent in 2015), cigar, pipe, and hookah – other dangerous and addictive ways to smoke tobacco – are very much on the rise.

“Smoking kills people – there is no “safe” way to consume tobacco,” said Department of Health and Social Services Secretary Dr. Kara Odom Walker. “Delaware has been a leader in the effort to create healthy, smoke-free, indoor workplaces and public places for our citizens, yet there is still more we can do to reduce smoking and save lives.”

Secondhand smoke can aggravate the symptoms of chronic diseases such as asthma and COPD. DPH continues to remind smokers of the dangers of secondhand smoke, both to children and other adults, particularly pregnant women.

While smoking makes it harder for a woman to get pregnant, those who are pregnant and continue to smoke face:

  • increased risk of miscarriage;
  • potential problems with the placenta – the oxygen and food supply for the baby;
  • increased risk of birth defects;
  • increased risk of Sudden Infant Death Syndrome (SIDS); and
  • potentially preterm or low birthweight babies.

Delaware data from a recent Women of Childbearing Age Report shows that an estimated 1,400 women smoked during the last three months of pregnancy. Women who smoked during that time frame were approximately three times more likely to deliver a low birthweight baby as compared to those who did not smoke

“If you are pregnant and are smoking, talk to your doctor immediately about ways to safely quit,” said DPH Director Dr. Karyl Rattay. “You can have fewer health problems, breathe better and have more energy. Your baby will have fewer problems too, such as wheezing, fewer coughs, colds and ear infections, and a reduced risk of SIDS.”

The Division of Public Health has a variety of resources to help you start and be successful in your journey to leading a tobacco-free life. The Delaware Quitline provides free tobacco cessation counseling services for Delaware Residents who are 18 years of age and older. When a person calls the toll-free Quitline (1-866-409-1858), they have the option to receive cessation counseling over the phone and, unique to Delaware, can opt to receive counseling in person by a local health care professional trained in cessation. Some participants may qualify for free pharmaceutical cessation aids such as patches, gum, nasal spray and prescription medicine such as Chantix. The Delaware Quitline also has special materials for pregnant smokers trying to quit.

For those who may need some assistance and don’t feel the Quitline is right for them, offers a free web-based option. This online cessation counseling service makes Quit Coaches available to provide tips on quitting tobacco. For individuals under the age of 18, NOT on Tobacco (NOT) is a cessation service available at most school wellness centers. Contact 1-800 LUNGUSA for more details on the NOT program.

Research shows that most people try to quit smoking several times before they succeed. (It’s called a relapse when smokers go back to smoking like they were before they tried to quit.) If a relapse happens, think of it as practice for the next time. Studies show that most people who don’t succeed in quitting are ready to try again in the near future. Things a person learns from a failed attempt to quit may help them quit for good next time. It takes time and skills to learn to be a non-smoker.

In 2014, Delaware banned the sale of e-cigarettes to minors and in 2015, Delaware’s Clean Indoor Air Act was expanded to include prohibiting the use of e-cigarettes and other electronic vapor devices in workplaces and indoor public places. Additionally, smoking is not permitted on State property.

For more information about tobacco cessation, visit DPH’s Tobacco Prevention and Control Program at

A person who is deaf, hard-of-hearing, deaf-blind or speech-disabled can call the DPH phone number above by using TTY services. Dial 7-1-1 or 800-232-5460 to type your conversation to a relay operator, who reads your conversation to a hearing person at DPH. The relay operator types the hearing person’s spoken words back to the TTY user. To learn more about TTY availability in Delaware, visit

Delaware Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. DPH, a division of DHSS, urges Delawareans to make healthier choices with the 5-2-1 Almost None campaign: eat 5 or more fruits and vegetables each day, have no more than 2 hours of recreational screen time each day (includes TV, computer, gaming), get 1 or more hours of physical activity each day, and drink almost no sugary beverages.