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.

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.

MINNEAPOLIS -- The Food and Drug Administration is exploring a ban on menthol-flavored cigarettes, a move tobacco-control advocates say is long overdue. They argued it shouldn't stop similar efforts in states such as Minnesota.

Supporters of the recently announced federal action acknowledged rules could take years to develop while facing expected lawsuits from the tobacco industry, which is why they want approval of a statewide bill to ban all flavored tobacco sales. Many municipalities in Minnesota have adopted their own bans.

LaTrisha Vetaw, health policy and advocacy manager at NorthPoint Health and Wellness Center, said the crackdown on menthol products in Minneapolis has helped, but the industry has tried to work around it.

"A corner store can no longer sell menthol or flavored tobacco products," Vetaw explained. "But now, they've put in four clear walls inside of these stores and are calling it a tobacco shop within a corner store."

Vetaw and others calling for higher-level bans contended they would help end heavy marketing of menthol products in Black communities. Opponents, including retailers, countered a ban could have unintended consequences, including the creation of more underground markets.

The proposed state ban has seen activity in recent legislative sessions, but hasn't been able to clear all the necessary hurdles.

Republican lawmakers who are skeptical of a statewide ban said it sends mixed messages amid a push for marijuana legalization. But tobacco prevention groups, not part of the legalization effort, pointed out there are a range of health effects from smoking that need to be addressed.

Laura Smith, spokesperson for ClearWay Minnesota and Minnesotans for a Smoke Free Generation, emphasized the need to press forward.

"That's why we're continuing to work statewide and on the local level to get these life-saving policies passed, because we know they can a make a big difference towards reducing these tobacco addictions and easing disparities that many people face, especially Black Americans."

The Centers for Disease Control and Prevention reports 93% of Black adults who smoke started by using menthol cigarettes.

Aside from bans, the groups say the state needs to stay committed to funding prevention efforts. Various budget proposals this spring included higher totals, with money for health equity in prevention work, but advocates stressed it still needs to be part of the final spending plan.