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For the third time in the last decade, a bill for a cigarette tax increase will appear on the Nov. 6 Missouri ballot. The proposal calls for a 73 cent increase on a pack of cigarettes, and would use a portion of the raised revenue to fund state tobacco cessation and prevention programs. Supporters of the tax increase known as Proposition B say that it could generate $283 to $423 million for the state its first year. In addition to boosting state tobacco prevention programs, some of the income raised will be reserved for Missouri's grade schools and colleges. "I understand that a good portion of the money raised will go to education," said Nola Martz, Administrator at the Lafayette County Health Department. However, money is not the only benefit supporters are anticipating if the bill passes. "We're very interested in the tax because it could reduce the amount of consumption," said Toniann Richard, Executive Director of the Health Care Collaborative (HCC) of Rural Missouri. "Hopefully it will make access to the product a little bit more difficult." With more than 21 percent of Missouri's adults smoking, there are also many who oppose the bill. Ron and Tracy Nielsen of Warrensburg, MO, who each smoke cigarettes, said they are not in favor of the tax increase. "Our country was founded on tobacco," Tracy said. "There are tobacco leaves on the dollar bill. Tobacco is legal and it should be your choice if you smoke or not." "I don't think tobacco programs work, anyway," added Ron Nielsen. "You're either going to smoke or you're not. I don't think it's the government's role to get people to stop smoking." So far, Missouri has been sympathetic to smokers by taxing cigarettes less than any other state in the country. Even with the tax increase, Missouri would still be well under the national average of about $1.50 per pack. The Center for Disease Control handed Missouri a failing grade in its 2012 evaluation of each state's handling of tobacco. The topics addressed were tobacco prevention, smoke- free air, cigarette taxes and tobacco cessation programs. Missouri received an F in all categories. Martz said the Health Department's efforts to increase education and awareness of tobacco have been effective, but programs with a high level of student involvement are the most well- received. Students With a Goal, or S.W.A.G., is an organization of area high school students devoted to educating their communities about the benefits of a tobacco-free lifestyle. The Health Department helps coordinate the program, but the students are the ones sending the message, whether they're recording a public radio announcement or contacting a senator. "When the kids show up, people really perk up and listen," Martz said. These programs are funded through a Social Innovation for Missouri grant which the Health Department receives through the HCC of Rural Missouri. "For the short term, we will continue to run these programs under the grant," Martz said. If the tax increase passes, the Health Department should receive more funds to continue and expand their tobacco prevention programs. The bill focuses on cigarette prices, but there are still many other types of tobacco products heavily used in Missouri. Cigars, chewing tobacco, hookah and snus are just a few of the many other options in tobacco consumption. The 2012 Surgeon General's Report showed that 17 percent of high school seniors said they had smoked hookah in the past year. The figure among university students was even higher at 22 percent. The report also found that adolescent smoking has been linked to slow lung growth, which could increase the risk of lung disease as an adult. What's more, young smokers can become addicted to cigarettes at a much lower rate of consumption than adults. Still, tobacco companies consistently market to minors. Advertisements rely on images and themes that appeal to young people—themes of independence, attractiveness, glamour and rebellion. Banners are placed lower to ensure children see them, and convenience stores close to schools display more exterior tobacco advertising than stores farther away. Richard suggests opposing this by decreasing exposure to tobacco ads and stresses the Health benefits of living smoke free. "We should be very aware of the risks associated with that type of marketing," Richard said, "and especially the message that it sends to our kids." Whether the proposition passes or not, Martz and Richard assured they will continue to help reduce smoking and educate people on the risks of using tobacco. "We will continue to offer prevention and cessation programs," Richard said, "as well as educate children and adults on why they shouldn't smoke."

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