FRANKFORT, Ky. -- Since 1996, Kentucky has barred cities and counties from enacting tobacco control measures to govern the marketing and sale of tobacco products.

Advocates say such preemptive legislation is outdated and should be repealed. Known as preemption laws, they are currently on the books in twelve states, largely due to lobbying efforts by Big Tobacco.

Ben Chandler, CEO of the Foundation for a Healthy Kentucky, said county and city governments have ideas for reducing vape product use and exposure to secondhand smoke, yet can't take action.

"If for instance, schools in a community didn't want to vape shops right next to a school, they, today under the present law, cannot regulate that," Chandler explained.

Sen. Julie Adams, R-Louisville, and Rep. Kim Moser, R-Taylor Mill, said they plan to file a local tobacco control bill early next year that would repeal the ban.

Smoking kills nearly 9,000 Kentuckians each year and racks up $1.9 billion dollars in state healthcare costs. Kentucky continues to lead the nation in cancer rates.

Chandler said grassroots efforts across the country have sparked innovative measures to discourage tobacco use among young people, shift local social norms around smoking and vaping, and improve the health of residents. He believes municipalities in the Commonwealth should be given the same independence.

"You know, you hear all the time from politicians that they believe most things ought to be controlled at the local level," Chandler observed. "And this is a good example of a thing that should be controlled at the local level because communities know what's best for their people."

Legislators in Frankfort have passed several bills in recent years aimed at curbing tobacco use, including increasing excise taxes on cigarettes and vaping products, establishing a statewide tobacco-free school campus law, and raising the minimum legal sales age for all tobacco products to 21.

Shannon Smith, Kentucky government relations director for the American Heart Association, said while overall smoking rates in the state are on the decline, certain populations, such as pregnant women continue to be at risk.

"And in Kentucky we have a disproportionate number of pregnant women that smoke," Smith remarked. "So if we could provide tools for communities to really look at how to better address the needs of that community to control tobacco use, we could improve the health outcomes of not only just the mothers but of the babies and families as well."

She added exposure to secondhand smoke is a top public health threat, noting children exposed to secondhand smoke are more likely to experience severe asthma and respiratory infections, and babies are more likely to die from sudden infant death syndrome.

Studies also have found children living in households where adults smoke end up in hospital emergency rooms more than kids living in smoke-free homes.

Last week President Joe Biden signed legislation that allows the Food and Drug Administration to regulate synthetic nicotine, used in vape products popular among teens.

Kentucky advocacy groups say the state's high level of vape product use among young people is setting the stage for a serious public health crisis.

E-cigarettes or vapes typically contain as much or more nicotine than traditional cigarettes, but until now manufacturers have skirted government regulations by using a synthetic version of the chemical.

Dr. Scott Bickel - assistant professor of pediatrics in the Division of Pediatric Pulmonology, Allergy, and Immunology at the University of Louisville School of Medicine - explained that the nicotine and other toxic substances found in vape products can have substantial health consequences.

"Can lead to impulsivity, difficulties with brain development, and so on," said Bickel. "And then certainly the respiratory consequences of starting those things early can't be overstated."

Congress moved to give the FDA the authority to regulate synthetic nicotine in the $1.5 trillion spending bill that funds the government through September. Biden signed the legislation into law last week.

More than one in four Kentucky high schoolers use e-cigarettes. According to the Centers for Disease Control and Prevention, e-cigarette sales hit a record high last June, with more than 22 million units sold nationwide.

Allison Adams - vice president for policy with the Foundation for a Healthy Kentucky - said the experience of the coronavirus pandemic highlighted how tobacco can make individuals more susceptible to respiratory illnesses such as COVID-19.

She added the Commonwealth has one of the highest rates of tobacco use in the nation.

"And so knowing that we weren't coming into this pandemic as a healthy state," said Adams, "we were on a trajectory for loss and less ability to fight it off quickly and rapidly."

Adams said the state could allow local communities to make their own decisions about how tobacco products are marketed, sold and distributed at the local level to help protect the health of young people.

Hannah Abdon is a senior at Boone County High School. She said she believes her classmates have gravitated toward vape products because of heavy advertising in her community.

"On my drive to school," said Abdon, "I think I pass three different places, and these places all sell vapor products, and they have advertisements in their storefronts that I can see when I'm driving past."

Tobacco and e-cigarette industries spent more than $788,000 lobbying Kentucky lawmakers in 2020, according to state data.

With 2022 underway, more than 20 Minnesota cities now have local ordinances restricting or banning the sale of flavored tobacco products, and the new year will likely see another run at adopting a statewide law.

Cities like Bloomington have added new regulations, including a ban on the sale of all flavored tobacco products, along with a sunset of new tobacco retail licenses.

Jeanne Weigum, president of the Association for Nonsmokers-Minnesota, said although the federal government is taking steps to crackdown on products such as menthol, there are many flavored items appealing to teens and young adults.

"You don't find some 50-year-old guy going out and buying 'Unicorn Juice' to vape," Weigum observed. "That's not the target audience."

She predicts even more action at the local level. Last month, St. Paul enacted higher tobacco prices and banned discounts. And advocates say they will once again ask legislators for a statewide flavored tobacco ban.

Apart from industry pushback, retailers have often opposed restrictions, arguing they hurt businesses and create dangerous underground markets.

Weigum countered Minnesota has enough legal protections to thwart illegal sales. She feels even with a groundswell of local laws, there is still opportunity to create more demand for a state ban on flavored tobacco.

"I guess the questions comes up, 'Are we at critical mass on these issues?' " Weigum stated. "And, I'd like to say we are, but there are many communities across the state where there have not been these discussions."

The Association noted other barriers in 2022 include a shorter session at the State Capitol, and an election year for state lawmakers. Growing calls for tighter restrictions follow the 2020 Minnesota Youth Tobacco Survey. The report's authors found an 80% increase in frequent vaping among respondents compared to 2017.

State lawmakers are expected to file a tobacco-control bill next year. Healthcare advocacy groups and local elected officials say communities must have the right to implement their own, stronger smoke-free protections.

Since 1996, Kentucky and a dozen other states have enacted so-called preemption laws, which bar cities and counties from deciding how tobacco products are marketed, sold and distributed at the local level.

Meanwhile, more than one third of Kentucky students report the pandemic has increased their use of e-cigarettes and vapes. McCracken County high school student Katharine Morrison said she sees her friends relying on tobacco to cope with stress and isolation during the COVID-19 crisis.

"I feel like people used it more because they were depressed and they thought that it was helping them," said Morrison.

Kentucky's rates of tobacco use are among the highest in the nation, and lawmakers have responded by implementing a statewide tobacco-free school policy, increasing tobacco taxes and raising the legal minimum age to buy tobacco products to 21.

The tobacco and vaping industries and some retailers continue to oppose local control, arguing it hurts sales and independent businesses.

Mayor of Prestonsburg Les Stapleton said he'd like the opportunity to implement measures to reduce smoking and improve the health of residents in his community.

"And I understand that a lot of laws have to be statewide," said Stapleton. "But it's a lot easier for some communities to be able to govern themselves on some issues."

State Sen. Paul Hornback - R-Shelbyville - said nicotine addiction will continue to be a costly public health issue if the cycle of tobacco use among young kids isn't stopped.

"And they're getting their hands on them in some way and go out and resell them to other kids," said Hornback. "There needs to be better control on that, you know. The flavors and everything else need to be eliminated."

In its "2022 Blueprint for Kentucky's Children," the group Kentucky Youth Advocates calls on the state to allow city and county governments to regulate the display, sale and distribution of tobacco products.

According to state data, last year, tobacco and e-cigarette companies spent more than $788,000 lobbying Kentucky lawmakers.