California has become a battleground between the tobacco industry and health groups as lawmakers push proposals that include increasing cigarette taxes by $2 a pack and raising the legal smoking age from 18 to 21.
The state once led the nation in snuffing out smoking, but health activists say a strong tobacco lobby and a lack of political will have blocked new efforts in recent years.
"We used to be leaders, and we are not anymore," said Stanton A. Glantz, a professor of medicine at UC San Francisco.
California lawmakers have responded to such criticism with a flood of legislation on the issue.
In addition to making California the first state to raise the smoking age, the measures would bar electronic cigarettes from public places where smoking is prohibited, ban single-use filters on cigarettes and prohibit the use of chewing tobacco in pro baseball stadiums and recreational league games.
The state has simultaneously launched a $7-million advertising campaign warning about the health hazards of e-cigarettes.
The sweeping proposals are encouraging to Dr. Luther Cobb, a physician and president of the California Medical Assn.
"There is no question we can do a lot better, and we should," Cobb said. "This is a dangerous public health issue."
Opposition from the tobacco and "vaping" industries is already building. Ninety people, many employees of vaping parlors, rallied at the Capitol last week to oppose a measure that would prohibit e-cigarettes in many public places.
The period of 2007-14 marked a resurgence in California for the tobacco industry, which spent $64 million on political activity in the state in those years. The spending included campaign donations and lobbying, according to UCSF's Center for Tobacco Control Research and Education.
In the 2014 election, the tobacco industry made $556,665 in political contributions, including checks accepted by 32 members of the state Assembly and 15, or half, of state senators, according to Maplight, a nonpartisan organization that tracks political money.
The last 17 attempts to raise the tobacco tax in California — going back a decade and a half — have failed after heavy lobbying by the industry. Voters narrowly rejected a $1 tax increase on the 2012 ballot after tobacco interests spent $47.7 million to defeat the measure.
Richard J. Smith, a manager for tobacco giant Reynolds American Inc., said California policymakers "may best serve the public and public health by a comprehensive look at their tobacco laws and regulations rather than a multitude of bills addressing different aspects of policy in a piecemeal approach."
In the 1990s, California had the nation's most wide-ranging anti-smoking laws. When the state funded a tobacco control and prevention program, the percentage of adult smokers in California fell by half, from 24.9% in 1984 to 12.5% today, according to the state Department of Public Health.
California's smoking rate is second-lowest in the nation, right behind Utah's. But health officials say anti-smoking efforts have suffered, in large part, because the state has not increased its 87-cent tax on a pack of cigarettes since 1998.
Thirty-two other states have higher tobacco taxes and spend more on anti-smoking programs, said California Sen. Richard Pan (D-Sacramento). He wants to raise California's tobacco tax by $2 a pack, to bring in $1.5 billion a year for smoking prevention and smoking-related medical costs now borne by taxpayers through Medi-Cal, the state's healthcare program for the poor.
"The toll that tobacco continues to exact on people is staggering," Pan said, noting that 40,000 Californians die from tobacco-related diseases each year.
Last week, Pan's proposal and several others were backed by a coalition of groups including the California Medical Assn., American Heart Assn., American Lung Assn. and American Cancer Society Action Network.
On the other side, David Sutton, spokesman for tobacco giant Altria, called the bill a "very excessive tax increase proposal" that would be unfair to consumers.
The bill needs a two-thirds vote to pass, requiring some Republican support. GOP leaders have opposed similar taxes in the past. They say they have not determined a position on the new measure.
Another potentially tough sell is a proposed ban on sales of cigarettes with single-use filters, to reduce the litter of butts on beaches and sidewalks. A similar effort went nowhere last year after its author, Mark Stone (D-Scotts Valley), failed to persuade legislators that the filters, used on the vast majority of cigarettes sold in California, do not make cigarettes safer.
Other bills have broad support from lawmakers and appear to have a good chance of reaching the desk of Gov. Jerry Brown, who is noncommittal.
The bid to raise the smoking age has strong momentum, having unanimously passed the Senate Health Committee last week with bipartisan support.
Nobody testified against the bill at the hearing, although smokers'-rights advocates, noting that 18-year-olds can vote and serve in the military, say they should be allowed to smoke.
The Senate Health Committee also approved a measure that would ban e-cigarettes from workplaces, bars, restaurants and other public venues where smoking is now off-limits.
Vaping devices heat and disperse as an aerosol a liquid that may contain nicotine and is inhaled by users. E-cigarette use among adults 18 to 29 grew from 2.3% in 2012 to 7.6% in 2013, according to state data.
"This is a really serious potential health crisis," the bill's author, Sen. Mark Leno (D-San Francisco), told the panel. "Middle and high school students who have never smoked a traditional cigarette are now using e-cigarettes."
North Dakota, New Jersey and Utah have restricted e-cigarettes in smoke-free venues, as have cities including Los Angeles and San Francisco.
Stefan Didak, a spokesman for the Smoke Free Alternatives Trade Assn. in California, testified against the measure.
It would harm 110 businesses in the state and is "entirely inappropriate," he said, because it attacks a safer alternative to smoking — one that is helping some smokers quit.
The state Department of Public Health last month launched a $7-million advertising campaign with the message that e-cigarettes threaten to create new generations of addicts.
"Adolescents are especially vulnerable to the toxic effects of nicotine," said department Director Karen Smith. "They are still going through critical periods of brain development."
Another measure, the effort to ban chewing tobacco from baseball venues, has received national attention.
Assemblyman Tony Thurmond (D-Richmond) said smokeless-tobacco use has not declined as cigarette use has.
Nearly 15% of high school boys use it, according to the Centers for Disease Control and Prevention.
"Smokeless tobacco causes cancer," Thurmond said. "We know kids idolize their favorite baseball players, and we know those kids will emulate them."