A California law that took effect in July requires health plans to offer timely follow-up appointments for mental health and addiction patients. Whether that’s happening is a point of contention in an open-ended strike by Kaiser Permanente clinicians in Northern California who say staffing shortages saddle them with stifling workloads that make providing adequate care impossible.

KP says it is making every effort to staff up but has been hampered by a labor shortage. The therapists — and the National Union of Healthcare Workers, which represents them — counter that the managed-care giant has difficulty attracting clinicians because its mental health services have a poor reputation.

The dispute has erupted at a time when demand for mental health care is increasing. The share of adults in the United States with symptoms of depression and anxiety has nearly quadrupled .

The requires health plans regulated by the state to provide return appointments no more than 10 days after a previous mental health or substance use session — unless a patient’s therapist approves less frequent visits.

The bill, which was sponsored by the union, was signed by Gov. Gavin Newsom in October and included a grace period for health plans to comply.

Kaiser Permanente has not complied, said Sal Rosselli, president of the health care workers union, which represents more than 2,000 KP mental health clinicians in Northern California and 4,000 statewide. “In fact, it’s getting worse,” he said. “Thousands of people are not getting access to the care that clinicians say they need.”

The union and its members said patients often must wait as much as two months for follow-up appointments.

Kaiser Permanente said in that the HMO’s compliance with the new law “is well underway.”

KP has bolstered its mental health care capacity by since January 2021, expanding virtual appointments, and offering more mental health services through its primary care providers, said Deb Catsavas, senior vice president of human resources in KP’s Northern California division. In addition, she said, KP has launched a $500,000 recruitment campaign and is investing $30 million to “build a pipeline for new, culturally diverse mental health professionals across California.”

But picketing clinicians, who started their strike Aug. 15, said they regularly encounter obstacles in their jobs because of what they described as persistent staffing shortages.

Alicia Moore, a KP psychologist in Vallejo who leads group therapy sessions in an intensive outpatient program, said her patients can have difficulty maintaining the progress they’ve made after the program finishes because they must wait for follow-up appointments. “Our program does a pretty good job of immediately helping folks in crisis, but then there’s no therapy appointments to discharge them to,” said Moore, who picketed Aug. 16 in front of KP’s Oakland Medical Center. “You search for an appointment, and it’s a couple of months out.”

Not only are therapists worn out, she said, but many potential new providers don’t want to work for KP. “We actually have a number of open positions in our clinic, but I think it’s very hard for Kaiser to fill positions when it is known by mental health care workers as a place where it’s really hard to do a good job because you just don’t have the appointments to offer patients,” Moore said.

The union said KP also has an attrition problem.

Mickey Fitzpatrick, a psychologist who worked at Kaiser Permanente for 11 years, said he resigned this year because he was unable to care for patients “in the way that we are trained in graduate school, in a way congruent with my passion for psychotherapy, in a way that is conducive to healing.”

The union argues that KP has the money to fix the problem if it wants to, noting that it posted last year and sits on in cash and investments.

The two sides also disagree about how much time clinicians should get to handle patients’ cases outside therapy sessions.

Catsavas said the union is demanding that clinicians’ face time with patients be reduced to allow more time than KP is willing to provide for administrative tasks. This demand, she said, contradicts the union’s “own commitments to help improve access to mental health care.”

The union says clinicians need the time for tasks that are not administrative but are an integral part of care — such as communicating with parents, school officials, and social service agencies about patients who are minors and returning emails and phone calls from anxious adults whose next appointment might be six to eight weeks away.

The strike “will only reduce access to our care at a time of unprecedented demand,” Catsavas said. “Across the country, there are not enough mental health care professionals to meet the increased demand for care,” she said. “This has created challenges for Kaiser Permanente and mental health care providers everywhere.”

In an , the California Department of Managed Health Care reminded KP that it must respect timely access and clinical standards even while clinicians are on the picket line. “The DMHC is closely monitoring Kaiser Permanente’s compliance with the law during the strike,” the statement said.

Agency spokesperson Rachel Arrezola said the state has received 10 complaints related to the new law so far — all against Kaiser Permanente.

Catsavas said that more than 30% of KP’s clinicians have continued to care for patients during the strike and that KP psychiatrists, clinical managers, and outside mental health providers have stepped in to help.

KP’s mental health woes date back many years. The organization was by the state in 2013 for failing to provide timely mental health treatment. It was cited twice after that for failure to resolve the problems and is currently being investigated by regulators, who saw a 20% increase in mental health complaints against KP last year.

Barbara McDonald, of Emeryville, said she tried to get help at KP for her 19-year-old daughter, who was engaging in self-destructive behavior. Numerous attempts with Kaiser Permanente in the past couple of years failed to get her daughter the help she needed, and McDonald said she ended up spending tens of thousands of dollars to get her diagnosed and treated elsewhere. She has bipolar and borderline personality disorders, as well as attention-deficit/hyperactivity disorder, McDonald said.

McDonald said that at one point, her daughter cut her own throat and ended up in a KP hospital for three days.

“The irony is that when you let mental health issues go untreated, it ends up being physical issues as well,” she said. “You can’t tell me that having my daughter in the hospital for three days costs less than regular therapy.”

This story was produced by , which publishes , an editorially independent service of the .

This <a target="_blank" href="/health-industry/kaiser-permanente-strike-mental-health-workers-access-waits-california/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Like San Jose, Sacramento County also imposed a ban this summer. Los Angeles, California’s largest city, and San Diego will implement prohibitions in January.

Even though across the state have already acted, Californians in November will decide whether to enact one of the nation’s most comprehensive statewide bans on flavored tobacco — making it illegal for brick-and-mortar retailers to sell flavored cigarettes, e-cigarettes, or vapes, including those flavored with menthol. Sales of gums or gummies that contain nicotine and are not approved by the FDA would also be prohibited.

At issue is a that would have banned the sale of those products — but never went into effect. Within days of its passage, Big Tobacco launched a referendum drive to overturn the law.

A “yes” vote on the referendum, known as Proposition 31, would uphold the law, banning the sale of flavored tobacco. A “no” vote would overturn the law.

If the measure passes, more restrictive would remain in place while the state law would override weaker bans. If the referendum fails, all local bans would remain in effect.

San Jose began prohibiting the sale of flavored tobacco products on July 1. City resident Joseph Smith, who was working in a local tobacco shop on a recent Tuesday, said he started smoking at age 12 when his friend gave him a menthol cigarette. Now 30, Smith said he quit smoking cigarettes two years ago by smoking Puff Bars — slim disposable vapes that are now illegal to sell under the city’s ban. He also said he no longer vapes.

Smith said he doesn’t support Big Tobacco’s marketing tactics but also doesn’t support taking away people’s freedom to buy their favorite product at the local store.

“They kill people; they profit off people’s lives,” Smith said about the tobacco industry. “But overall, I still feel like people have the right to do what they want.”

Proponents of local ordinances and the statewide ban say the measures are primarily intended to protect young people from getting addicted, as Smith did.

“We can stop Big Tobacco from using flavors to get kids hooked on nicotine and profiting from addiction, disease, and death,” former state Sen. Jerry Hill, who authored the 2020 law, told lawmakers at a recent legislative hearing on the ballot measure. “If we can save even a few lives by ending the sale of candy-flavored tobacco, it will all be worth it.”

by the Centers for Disease Control and Prevention found that about 75% of middle school students and 80% of high school students who use tobacco use a product with flavoring, often in “, such as berry, cherry, apple, cotton candy, and bubble gum,” which mask the harshness of tobacco and act as a gateway for underage smoking.

In 2020, an estimated 4.5 million middle and high school students used tobacco products. Before the pandemic, the number of young people surveyed on school campuses who used tobacco had been climbing steadily, rising from 3.6 million in 2017 to 6.2 million 2019, according to CDC surveys.

“It’s not good for young people’s developing brains,” said Kevin Schroth, an associate professor at the Rutgers University School of Public Health. Schroth previously worked on tobacco control policy in New York City, which banned the sale of flavored tobacco in 2009. “There’s no reason that they should be developing addictions to these products.”

If Californians uphold the state law, theirs would be the to adopt a flavor ban after Rhode Island, New Jersey, New York, and Massachusetts, according to the Campaign for Tobacco-Free Kids. About 345 localities across the nation prohibit the sale of flavored tobacco.

But some of these laws, including California’s, contain glaring loopholes, such as allowing flavors in premium cigars, hookahs, pipe tobacco, and online purchases. While some cities and states have banned internet sales, others have cited legal concerns about regulating interstate commerce — leaving it to the federal government to act. The FDA in April banning the manufacture, distribution, and sale of menthol cigarettes and flavored cigars, but the rules have yet to be finalized.

In June, the agency ordered vaping company Juul to stop selling its e-cigarettes, but a week and a half later suspended the ban, following a federal lawsuit by the company. The FDA said its order needed further scientific review. Meanwhile, legislation in Congress to ban the sale of flavored tobacco has stalled.

The tobacco industry has spent nearly to overturn the California law compared with $5.7 million spent by supporters of the ban. “NO on Prop 31” campaign spokesperson Beth Miller said via email that government regulation restricts adult smokers’ right to choose and takes away an alternative to cigarettes that some people use to kick the habit. Miller said the campaign agrees “youth should never have access to any tobacco products,” which have been illegal in California for anyone under 21 since 2016.

Public health officials, however, say that flavored products are clearly marketed to young kids — and that they use them. A by Santa Clara County, for example, found that 93% of high school students who had used tobacco chose a flavored product. Just over half of those surveyed who vape said they bought their own e-cigarettes.

“When products are available, youth may be able to find a way they can get these products,” said Don Tran, policy coordinator for the county’s Tobacco-Free Communities program. “But when you’re actually able to physically remove the product from being sold on the shelf, you’re going to drastically reduce that availability.”

It’s too early to tell whether the flavor ban is working in San Jose.

At Houdini’s Smoke Shop downtown, co-owner John Tokhi said the store has lost about 80% of its sales to neighboring municipalities where the sales of products are still legal. Before the ban, he said, a warm summer evening would attract a line of businesspeople and concertgoers. Those crowds have been replaced with clientele sporadically rushing in for packs of cigarettes and smoking paraphernalia.

The back shelves of his shop that once showcased flavored vapes are now nearly empty, populated only with nicotine-free vapes and a few ballcaps.

“There’s a bunch of angry customers,” Tokhi said. “They’re really upset. They don’t want to drive further. It’s slowed down a lot.”

Studies show flavored tobacco laws have worked to curb teen use. In New York City, for example, public health officials analyzed declining sales of flavored tobacco and concluded that teens were 37% less likely to try flavored tobacco four years after the local ban passed.

Dr. Achala Talati, director of tobacco policy and programs for New York City’s Bureau of Chronic Disease Prevention, said young people “use tobacco opportunistically” by sharing products with friends or smoking when it is easily available. So, decreasing the availability of flavored products lowers youth nicotine exposure, she said.

“Reducing access to products locally results in less use,” Talati said.

This story was produced by , which publishes , an editorially independent service of the .

This <a target="_blank" href="/news/california-flavored-tobacco-sales-ban-november-referendum/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

“He just has to have his YouTube,” said Garcia, 56, of West Los Angeles.

Alessandro Greco, now 11 and a soon-to-be sixth grader, watches videos even when he tells his mom that he is starting homework, making his bed, or practicing his instrument. When she confronts him, she said, he gets frustrated and says he hates himself because he feels like watching YouTube isn’t a choice.

Alessandro tells her he just can’t pull himself away, that he is addicted.

“It’s vicious — they’ve taken away my parenting ability,” Garcia said. “I can’t beat this.”

Some California lawmakers want to help Garcia and other parents protect their children’s mental health by targeting website elements they say were designed to hook kids — such as personalized posts that grab and hold viewers on a specific page, frequent push notifications that pull users back to their devices, and autoplay functions that provide a continuous stream of video content.

Two complementary bills in the state legislature would require websites, social media platforms, or online products that children use — or could use — to eliminate features that can addict them, harvest their personal information, and promote harmful content. Those that don’t comply could face lawsuits and hefty fines. One of the measures would impose penalties of up to $7,500 per affected child in California — which could amount to millions of dollars.

Federal lawmakers are making that would and target features that foster addiction. One would require online platforms to provide tools to help parents track and control their children’s internet use. The measures were approved by a U.S. Senate committee July 27.

“We have to protect kids and their developing brains,” said California Assembly member Jordan Cunningham (R-San Luis Obispo), a lead author of both bills and a father of four children, at a committee hearing in June. “We need to end Big Tech’s era of unfettered social experimentation on children.”

But Big Tech remains a formidable foe, and privacy advocates say they are concerned one of the California measures could increase data intrusions for everyone. Both bills have cleared the state Assembly, but whether they will survive the state Senate is unclear.

Tech companies, which wield immense , say they already prioritize users’ mental health and are making efforts to strengthen age verification mechanisms. They are also rolling out parental controls and prohibiting messaging between minors and adults they don’t know.

But these bills could violate companies’ free speech rights and require changes to websites that can’t realistically be engineered, said Dylan Hoffman, executive director of TechNet for California and the Southwest. TechNet — a trade association for tech companies, including Meta (the parent company of Facebook and Instagram) and Snap Inc. (which owns Snapchat) — opposes the measures.

“It’s an oversimplified solution to a complex problem, and there isn’t anything we can propose that will alleviate our concerns,” Hoffman said about one of the bills that specifically targets social media.

Last year, the U.S. surgeon general, Dr. Vivek Murthy, highlighted the nation’s and pointed to social media use as a potential contributor. Murthy said social media use in teenagers had been linked to anxiety and depression — even before the stress of covid-19. Then during the pandemic, he said, the average amount of teenagers’ non-academic screen time leaped from .

“What we’re trying to do, really, is just keep our kids safe,” Assembly member Buffy Wicks (D-Oakland), another lead author of the California bills and a mother of two children, said at the June committee hearing.

One of Cunningham and Wicks’ bills, , would require all online services “likely to be accessed by a child” — which could include most websites — to minimize the collection and use of personal data for users younger than 18. This includes setting default privacy settings to the maximum level unless users prove they are 18 or older, and providing terms and service agreements in language a child can understand.

Modeled after a , the measure also says companies should “consider the best interests of children when designing, developing, and providing that service, product, or feature.” That broad phrasing could allow prosecutors to target companies for features that are detrimental to children. This could include incessant notifications that demand children’s attention or suggestion pages based on a child’s activity history that could lead to harmful content. If the state attorney general determines a company has violated the law, it could face a fine of up to $7,500 per affected child in California.

The other California bill, , would allow prosecutors to sue social media companies that knowingly addict minors, which could result in fines of up to $250,000 per violation. The original version would also have allowed parents to sue social media companies, but lawmakers removed that provision in June in the face of opposition from Big Tech.

Together, the two California proposals attempt to impose some order on the largely unregulated landscape of the internet. If successful, they could improve kids’ health and safety, said Dr. Jenny Radesky, an assistant professor of pediatrics at the University of Michigan Medical School and a member of the American Academy of Pediatrics, a group that supports the data protection bill.

“If we were going to a playground, you’d want a place that had been designed to let a child explore safely,” Radesky said. “Yet in the digital playground, there’s a lot less attention to how a child might play there.”

Radesky said she has witnessed the effects of these addictive elements firsthand. One night, as her then-11-year-old son was getting ready for bed, he asked her what a serial killer was, she said. He told her he had learned the term online when videos about unsolved murder mysteries were automatically recommended to him after he watched Pokémon videos on YouTube.

Adam Leventhal, director of the University of Southern California Institute for Addiction Science, said YouTube recommendations, and other tools that mine users’ online history to personalize their experiences, contribute to social media addiction by trying to keep people online as long as possible. Because developing brains favor exploration and pleasurable experiences over impulse control, kids are especially susceptible to many of social media’s tricks, he said.

“What social media offers is a highly stimulating, very fast feedback,” Leventhal said. “Any time that there is an activity where you can get a pleasurable effect and get it fast and get it when you want it, that increases the likelihood that an activity could be addictive.”

Rachel Holland, a spokesperson for Meta, explained in a statement that the company has worked alongside parents and teens to prioritize kids’ well-being and mitigate the potential negative effects of its platforms. She pointed to a variety of company initiatives: In December 2021, for example, it added supervision tools on Instagram that allow parents to view and limit kids’ screen time. And in June, it started testing new age verification tactics on Instagram, including asking some users to upload a video selfie.

Snap spokesperson Pete Boogaard said in a statement that the company is protecting teens through steps that include banning public accounts for minors and turning location-sharing off by default.

Meta and Snap declined to say whether they support or oppose the California bills. YouTube and TikTok did not respond to multiple requests for comment.

Privacy groups are raising red flags about the measures.

Eric Null, director of the privacy and data project at the Center for Democracy and Technology, said the provision in the data protection bill that requires privacy agreements to be written in age-appropriate language would be nearly impossible to implement. “How do you write a privacy policy for a 7-year-old? It seems like a particularly difficult thing to do when the child can barely read,” Null said.

And because the bill would limit the collection of children’s personal information — but still require platforms that children may access to gather enough details to verify a user’s age — it could increase data intrusions for all users, he said. “This is going to further incentivize all online companies to verify the age of all of their users, which is somewhat counterintuitive,” Null said. “You’re trying to protect privacy, but actually you’re now requiring a lot more data collection about every user you have.”

But Karla Garcia is desperate for action.

Thankfully, she said, her son doesn’t watch violent videos. Alessandro prefers clips from “America’s Got Talent” and “Britain’s Got Talent” and videos of one-hit wonders. But the addiction is real, she said.

Garcia hopes legislators will curtail the tech companies’ ability to continually send her son content he can’t turn away from.

“If they can help, then help,” Garcia said. “Put some sort of regulations on and stop the algorithm, stop hunting my child.”

This story was produced by , which publishes , an editorially independent service of the .

This <a target="_blank" href="/mental-health/citing-a-mental-health-crisis-among-young-people-california-lawmakers-target-social-media/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

A California law that took effect in July requires health plans to offer timely follow-up appointments for mental health and addiction patients. Whether that’s happening is a point of contention in an open-ended strike by Kaiser Permanente clinicians in Northern California who say staffing shortages saddle them with stifling workloads that make providing adequate care impossible.

KP says it is making every effort to staff up but has been hampered by a labor shortage. The therapists — and the National Union of Healthcare Workers, which represents them — counter that the managed-care giant has difficulty attracting clinicians because its mental health services have a poor reputation.

The dispute has erupted at a time when demand for mental health care is increasing. The share of adults in the United States with symptoms of depression and anxiety has nearly quadrupled .

The requires health plans regulated by the state to provide return appointments no more than 10 days after a previous mental health or substance use session — unless a patient’s therapist approves less frequent visits.

The bill, which was sponsored by the union, was signed by Gov. Gavin Newsom in October and included a grace period for health plans to comply.

Kaiser Permanente has not complied, said Sal Rosselli, president of the health care workers union, which represents more than 2,000 KP mental health clinicians in Northern California and 4,000 statewide. “In fact, it’s getting worse,” he said. “Thousands of people are not getting access to the care that clinicians say they need.”

The union and its members said patients often must wait as much as two months for follow-up appointments.

Kaiser Permanente said in that the HMO’s compliance with the new law “is well underway.”

KP has bolstered its mental health care capacity by since January 2021, expanding virtual appointments, and offering more mental health services through its primary care providers, said Deb Catsavas, senior vice president of human resources in KP’s Northern California division. In addition, she said, KP has launched a $500,000 recruitment campaign and is investing $30 million to “build a pipeline for new, culturally diverse mental health professionals across California.”

But picketing clinicians, who started their strike Aug. 15, said they regularly encounter obstacles in their jobs because of what they described as persistent staffing shortages.

Alicia Moore, a KP psychologist in Vallejo who leads group therapy sessions in an intensive outpatient program, said her patients can have difficulty maintaining the progress they’ve made after the program finishes because they must wait for follow-up appointments. “Our program does a pretty good job of immediately helping folks in crisis, but then there’s no therapy appointments to discharge them to,” said Moore, who picketed Aug. 16 in front of KP’s Oakland Medical Center. “You search for an appointment, and it’s a couple of months out.”

Not only are therapists worn out, she said, but many potential new providers don’t want to work for KP. “We actually have a number of open positions in our clinic, but I think it’s very hard for Kaiser to fill positions when it is known by mental health care workers as a place where it’s really hard to do a good job because you just don’t have the appointments to offer patients,” Moore said.

The union said KP also has an attrition problem.

Mickey Fitzpatrick, a psychologist who worked at Kaiser Permanente for 11 years, said he resigned this year because he was unable to care for patients “in the way that we are trained in graduate school, in a way congruent with my passion for psychotherapy, in a way that is conducive to healing.”

The union argues that KP has the money to fix the problem if it wants to, noting that it posted last year and sits on in cash and investments.

The two sides also disagree about how much time clinicians should get to handle patients’ cases outside therapy sessions.

Catsavas said the union is demanding that clinicians’ face time with patients be reduced to allow more time than KP is willing to provide for administrative tasks. This demand, she said, contradicts the union’s “own commitments to help improve access to mental health care.”

The union says clinicians need the time for tasks that are not administrative but are an integral part of care — such as communicating with parents, school officials, and social service agencies about patients who are minors and returning emails and phone calls from anxious adults whose next appointment might be six to eight weeks away.

The strike “will only reduce access to our care at a time of unprecedented demand,” Catsavas said. “Across the country, there are not enough mental health care professionals to meet the increased demand for care,” she said. “This has created challenges for Kaiser Permanente and mental health care providers everywhere.”

In an , the California Department of Managed Health Care reminded KP that it must respect timely access and clinical standards even while clinicians are on the picket line. “The DMHC is closely monitoring Kaiser Permanente’s compliance with the law during the strike,” the statement said.

Agency spokesperson Rachel Arrezola said the state has received 10 complaints related to the new law so far — all against Kaiser Permanente.

Catsavas said that more than 30% of KP’s clinicians have continued to care for patients during the strike and that KP psychiatrists, clinical managers, and outside mental health providers have stepped in to help.

KP’s mental health woes date back many years. The organization was by the state in 2013 for failing to provide timely mental health treatment. It was cited twice after that for failure to resolve the problems and is currently being investigated by regulators, who saw a 20% increase in mental health complaints against KP last year.

Barbara McDonald, of Emeryville, said she tried to get help at KP for her 19-year-old daughter, who was engaging in self-destructive behavior. Numerous attempts with Kaiser Permanente in the past couple of years failed to get her daughter the help she needed, and McDonald said she ended up spending tens of thousands of dollars to get her diagnosed and treated elsewhere. She has bipolar and borderline personality disorders, as well as attention-deficit/hyperactivity disorder, McDonald said.

McDonald said that at one point, her daughter cut her own throat and ended up in a KP hospital for three days.

“The irony is that when you let mental health issues go untreated, it ends up being physical issues as well,” she said. “You can’t tell me that having my daughter in the hospital for three days costs less than regular therapy.”

This story was produced by , which publishes , an editorially independent service of the .

This <a target="_blank" href="/health-industry/kaiser-permanente-strike-mental-health-workers-access-waits-california/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Like San Jose, Sacramento County also imposed a ban this summer. Los Angeles, California’s largest city, and San Diego will implement prohibitions in January.

Even though across the state have already acted, Californians in November will decide whether to enact one of the nation’s most comprehensive statewide bans on flavored tobacco — making it illegal for brick-and-mortar retailers to sell flavored cigarettes, e-cigarettes, or vapes, including those flavored with menthol. Sales of gums or gummies that contain nicotine and are not approved by the FDA would also be prohibited.

At issue is a that would have banned the sale of those products — but never went into effect. Within days of its passage, Big Tobacco launched a referendum drive to overturn the law.

A “yes” vote on the referendum, known as Proposition 31, would uphold the law, banning the sale of flavored tobacco. A “no” vote would overturn the law.

If the measure passes, more restrictive would remain in place while the state law would override weaker bans. If the referendum fails, all local bans would remain in effect.

San Jose began prohibiting the sale of flavored tobacco products on July 1. City resident Joseph Smith, who was working in a local tobacco shop on a recent Tuesday, said he started smoking at age 12 when his friend gave him a menthol cigarette. Now 30, Smith said he quit smoking cigarettes two years ago by smoking Puff Bars — slim disposable vapes that are now illegal to sell under the city’s ban. He also said he no longer vapes.

Smith said he doesn’t support Big Tobacco’s marketing tactics but also doesn’t support taking away people’s freedom to buy their favorite product at the local store.

“They kill people; they profit off people’s lives,” Smith said about the tobacco industry. “But overall, I still feel like people have the right to do what they want.”

Proponents of local ordinances and the statewide ban say the measures are primarily intended to protect young people from getting addicted, as Smith did.

“We can stop Big Tobacco from using flavors to get kids hooked on nicotine and profiting from addiction, disease, and death,” former state Sen. Jerry Hill, who authored the 2020 law, told lawmakers at a recent legislative hearing on the ballot measure. “If we can save even a few lives by ending the sale of candy-flavored tobacco, it will all be worth it.”

by the Centers for Disease Control and Prevention found that about 75% of middle school students and 80% of high school students who use tobacco use a product with flavoring, often in “, such as berry, cherry, apple, cotton candy, and bubble gum,” which mask the harshness of tobacco and act as a gateway for underage smoking.

In 2020, an estimated 4.5 million middle and high school students used tobacco products. Before the pandemic, the number of young people surveyed on school campuses who used tobacco had been climbing steadily, rising from 3.6 million in 2017 to 6.2 million 2019, according to CDC surveys.

“It’s not good for young people’s developing brains,” said Kevin Schroth, an associate professor at the Rutgers University School of Public Health. Schroth previously worked on tobacco control policy in New York City, which banned the sale of flavored tobacco in 2009. “There’s no reason that they should be developing addictions to these products.”

If Californians uphold the state law, theirs would be the to adopt a flavor ban after Rhode Island, New Jersey, New York, and Massachusetts, according to the Campaign for Tobacco-Free Kids. About 345 localities across the nation prohibit the sale of flavored tobacco.

But some of these laws, including California’s, contain glaring loopholes, such as allowing flavors in premium cigars, hookahs, pipe tobacco, and online purchases. While some cities and states have banned internet sales, others have cited legal concerns about regulating interstate commerce — leaving it to the federal government to act. The FDA in April banning the manufacture, distribution, and sale of menthol cigarettes and flavored cigars, but the rules have yet to be finalized.

In June, the agency ordered vaping company Juul to stop selling its e-cigarettes, but a week and a half later suspended the ban, following a federal lawsuit by the company. The FDA said its order needed further scientific review. Meanwhile, legislation in Congress to ban the sale of flavored tobacco has stalled.

The tobacco industry has spent nearly to overturn the California law compared with $5.7 million spent by supporters of the ban. “NO on Prop 31” campaign spokesperson Beth Miller said via email that government regulation restricts adult smokers’ right to choose and takes away an alternative to cigarettes that some people use to kick the habit. Miller said the campaign agrees “youth should never have access to any tobacco products,” which have been illegal in California for anyone under 21 since 2016.

Public health officials, however, say that flavored products are clearly marketed to young kids — and that they use them. A by Santa Clara County, for example, found that 93% of high school students who had used tobacco chose a flavored product. Just over half of those surveyed who vape said they bought their own e-cigarettes.

“When products are available, youth may be able to find a way they can get these products,” said Don Tran, policy coordinator for the county’s Tobacco-Free Communities program. “But when you’re actually able to physically remove the product from being sold on the shelf, you’re going to drastically reduce that availability.”

It’s too early to tell whether the flavor ban is working in San Jose.

At Houdini’s Smoke Shop downtown, co-owner John Tokhi said the store has lost about 80% of its sales to neighboring municipalities where the sales of products are still legal. Before the ban, he said, a warm summer evening would attract a line of businesspeople and concertgoers. Those crowds have been replaced with clientele sporadically rushing in for packs of cigarettes and smoking paraphernalia.

The back shelves of his shop that once showcased flavored vapes are now nearly empty, populated only with nicotine-free vapes and a few ballcaps.

“There’s a bunch of angry customers,” Tokhi said. “They’re really upset. They don’t want to drive further. It’s slowed down a lot.”

Studies show flavored tobacco laws have worked to curb teen use. In New York City, for example, public health officials analyzed declining sales of flavored tobacco and concluded that teens were 37% less likely to try flavored tobacco four years after the local ban passed.

Dr. Achala Talati, director of tobacco policy and programs for New York City’s Bureau of Chronic Disease Prevention, said young people “use tobacco opportunistically” by sharing products with friends or smoking when it is easily available. So, decreasing the availability of flavored products lowers youth nicotine exposure, she said.

“Reducing access to products locally results in less use,” Talati said.

This story was produced by , which publishes , an editorially independent service of the .

This <a target="_blank" href="/news/california-flavored-tobacco-sales-ban-november-referendum/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

“He just has to have his YouTube,” said Garcia, 56, of West Los Angeles.

Alessandro Greco, now 11 and a soon-to-be sixth grader, watches videos even when he tells his mom that he is starting homework, making his bed, or practicing his instrument. When she confronts him, she said, he gets frustrated and says he hates himself because he feels like watching YouTube isn’t a choice.

Alessandro tells her he just can’t pull himself away, that he is addicted.

“It’s vicious — they’ve taken away my parenting ability,” Garcia said. “I can’t beat this.”

Some California lawmakers want to help Garcia and other parents protect their children’s mental health by targeting website elements they say were designed to hook kids — such as personalized posts that grab and hold viewers on a specific page, frequent push notifications that pull users back to their devices, and autoplay functions that provide a continuous stream of video content.

Two complementary bills in the state legislature would require websites, social media platforms, or online products that children use — or could use — to eliminate features that can addict them, harvest their personal information, and promote harmful content. Those that don’t comply could face lawsuits and hefty fines. One of the measures would impose penalties of up to $7,500 per affected child in California — which could amount to millions of dollars.

Federal lawmakers are making that would and target features that foster addiction. One would require online platforms to provide tools to help parents track and control their children’s internet use. The measures were approved by a U.S. Senate committee July 27.

“We have to protect kids and their developing brains,” said California Assembly member Jordan Cunningham (R-San Luis Obispo), a lead author of both bills and a father of four children, at a committee hearing in June. “We need to end Big Tech’s era of unfettered social experimentation on children.”

But Big Tech remains a formidable foe, and privacy advocates say they are concerned one of the California measures could increase data intrusions for everyone. Both bills have cleared the state Assembly, but whether they will survive the state Senate is unclear.

Tech companies, which wield immense , say they already prioritize users’ mental health and are making efforts to strengthen age verification mechanisms. They are also rolling out parental controls and prohibiting messaging between minors and adults they don’t know.

But these bills could violate companies’ free speech rights and require changes to websites that can’t realistically be engineered, said Dylan Hoffman, executive director of TechNet for California and the Southwest. TechNet — a trade association for tech companies, including Meta (the parent company of Facebook and Instagram) and Snap Inc. (which owns Snapchat) — opposes the measures.

“It’s an oversimplified solution to a complex problem, and there isn’t anything we can propose that will alleviate our concerns,” Hoffman said about one of the bills that specifically targets social media.

Last year, the U.S. surgeon general, Dr. Vivek Murthy, highlighted the nation’s and pointed to social media use as a potential contributor. Murthy said social media use in teenagers had been linked to anxiety and depression — even before the stress of covid-19. Then during the pandemic, he said, the average amount of teenagers’ non-academic screen time leaped from .

“What we’re trying to do, really, is just keep our kids safe,” Assembly member Buffy Wicks (D-Oakland), another lead author of the California bills and a mother of two children, said at the June committee hearing.

One of Cunningham and Wicks’ bills, , would require all online services “likely to be accessed by a child” — which could include most websites — to minimize the collection and use of personal data for users younger than 18. This includes setting default privacy settings to the maximum level unless users prove they are 18 or older, and providing terms and service agreements in language a child can understand.

Modeled after a , the measure also says companies should “consider the best interests of children when designing, developing, and providing that service, product, or feature.” That broad phrasing could allow prosecutors to target companies for features that are detrimental to children. This could include incessant notifications that demand children’s attention or suggestion pages based on a child’s activity history that could lead to harmful content. If the state attorney general determines a company has violated the law, it could face a fine of up to $7,500 per affected child in California.

The other California bill, , would allow prosecutors to sue social media companies that knowingly addict minors, which could result in fines of up to $250,000 per violation. The original version would also have allowed parents to sue social media companies, but lawmakers removed that provision in June in the face of opposition from Big Tech.

Together, the two California proposals attempt to impose some order on the largely unregulated landscape of the internet. If successful, they could improve kids’ health and safety, said Dr. Jenny Radesky, an assistant professor of pediatrics at the University of Michigan Medical School and a member of the American Academy of Pediatrics, a group that supports the data protection bill.

“If we were going to a playground, you’d want a place that had been designed to let a child explore safely,” Radesky said. “Yet in the digital playground, there’s a lot less attention to how a child might play there.”

Radesky said she has witnessed the effects of these addictive elements firsthand. One night, as her then-11-year-old son was getting ready for bed, he asked her what a serial killer was, she said. He told her he had learned the term online when videos about unsolved murder mysteries were automatically recommended to him after he watched Pokémon videos on YouTube.

Adam Leventhal, director of the University of Southern California Institute for Addiction Science, said YouTube recommendations, and other tools that mine users’ online history to personalize their experiences, contribute to social media addiction by trying to keep people online as long as possible. Because developing brains favor exploration and pleasurable experiences over impulse control, kids are especially susceptible to many of social media’s tricks, he said.

“What social media offers is a highly stimulating, very fast feedback,” Leventhal said. “Any time that there is an activity where you can get a pleasurable effect and get it fast and get it when you want it, that increases the likelihood that an activity could be addictive.”

Rachel Holland, a spokesperson for Meta, explained in a statement that the company has worked alongside parents and teens to prioritize kids’ well-being and mitigate the potential negative effects of its platforms. She pointed to a variety of company initiatives: In December 2021, for example, it added supervision tools on Instagram that allow parents to view and limit kids’ screen time. And in June, it started testing new age verification tactics on Instagram, including asking some users to upload a video selfie.

Snap spokesperson Pete Boogaard said in a statement that the company is protecting teens through steps that include banning public accounts for minors and turning location-sharing off by default.

Meta and Snap declined to say whether they support or oppose the California bills. YouTube and TikTok did not respond to multiple requests for comment.

Privacy groups are raising red flags about the measures.

Eric Null, director of the privacy and data project at the Center for Democracy and Technology, said the provision in the data protection bill that requires privacy agreements to be written in age-appropriate language would be nearly impossible to implement. “How do you write a privacy policy for a 7-year-old? It seems like a particularly difficult thing to do when the child can barely read,” Null said.

And because the bill would limit the collection of children’s personal information — but still require platforms that children may access to gather enough details to verify a user’s age — it could increase data intrusions for all users, he said. “This is going to further incentivize all online companies to verify the age of all of their users, which is somewhat counterintuitive,” Null said. “You’re trying to protect privacy, but actually you’re now requiring a lot more data collection about every user you have.”

But Karla Garcia is desperate for action.

Thankfully, she said, her son doesn’t watch violent videos. Alessandro prefers clips from “America’s Got Talent” and “Britain’s Got Talent” and videos of one-hit wonders. But the addiction is real, she said.

Garcia hopes legislators will curtail the tech companies’ ability to continually send her son content he can’t turn away from.

“If they can help, then help,” Garcia said. “Put some sort of regulations on and stop the algorithm, stop hunting my child.”

This story was produced by , which publishes , an editorially independent service of the .

This <a target="_blank" href="/mental-health/citing-a-mental-health-crisis-among-young-people-california-lawmakers-target-social-media/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">