Dawn S. Berkowitz, MPH, CHES Director, DHMH Center for Tobacco Prevention and Control 10 th Annual MDQuit Best Practices

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1 Dawn S. Berkowitz, MPH, CHES Director, DHMH Center for Tobacco Prevention and Control 10 th Annual MDQuit Best Practices Conference

2

3 Under 2% $9.6 Billion/Year

4 Ranks 23 rd in nation in dedicating state dollars to tobacco control programs. Spends less than 2% of $519.6M collected in 2015 from the MSA. Annual costs of tobacco in Maryland: 7,500 lives $2.7 BILLION in health care costs (+) Leader in strong smoke-free workplace laws (+) Above average $2 cigarette tax ( ) Has not increased tobacco tax in nearly eight years

5 American Lung Association State of Tobacco Control, 2015 (01/21/15) Evaluates funding, smokefree air, tobacco taxes, and access to cessation services 2016 Report slated to be released February 2 nd Don t anticipate changes

6

7 Twenty-nine percent decrease in adult cigarette use since % in % in % in 2014 Sixty-four percent decrease in youth cigarette use since % in % in % in 2014

8 Next 30 Days 31.5% Next 6 Months 25.6% 57.1% Next 12 Months 17.6% More than 1 Year 10.9% Unknown 14.3% 0% 5% 10% 15% 20% 25% 30% 35% Less than 15% of Maryland adults currently smoke cigarettes, and of those who do, more than 70% would like to quit smoking.

9 Non-Smokers Smokers 100% 90% 84.0% 87.7% 93.3% 93.5% 94.2% 80% 70% 62.8% 66.7% 60% 55.8% 56.4% 50% 48.5% 40% 30% 20% 10% 0% Maryland

10 % Not Expsoed to Secondhand Smoke Indoors 100% Underage Maryland Youth Not Exposed to Secondhand Smoke Indoors Maryland Public Middle and High School Youth, % 70.6% 73.5% 72.0% 76.2% 60% 56.4% 44.3% 49.6% 40% 20% 0%

11 Features: Toolkit Fact sheets and customizable templates Mailers Videos Digital Toolkit

12 % of Adults Who Smoked Whole Cigarette 80% 60% 62.3% All Adults Nearly half of those who try cigarette smoking will become every day cigarette smokers. 40% 20% 0% 24.5% 8.2% 5.0% Less than 18 years old 18 to to years old or older Age at Which Smoked First Whole Cigarette The younger a person is when they smoke their first whole cigarette, the more likely it is they will become a cigarette smoker. 86.8% of those who ever smoked a whole cigarette did so before they were 21 years of age.

13 35% 30% 29.4% Changes in Underage Use of Tobacco Products: (Underage Less than 18 Years of Age) Fall 2000 Spring 2013 Fall % 23.0% 20% 17.7% 15% 10% 5% 14.9% 12.5% 11.0% 11.5% 9.9% 8.2% 4.7% 6.9% 5.5% 0% Any Tobacco Cigarettes Cigars Smokeless Tobacco

14 Percent Currently Using a Tobacco Product 35% Jurisdictions 30% 30.0% Maryland 25% 20% 24.0% 23.6% 23.2% 22.9% 22.3% 22.1% 21.6% 21.5% 21.0% 20.8% 19.7% 19.3% 18.7% 18.0% 17.7% 17.7% 19/24 jurisdictions ABOVE state average 15% 16.0% 15.3% 14.8% 14.5% 14.9% 11.6% 10% 9.9% 9.3% 5% 0% Source: Maryland Youth Tobacco & Risk Behavior Survey

15 Smoking Status Currently Drinks Alcohol Currently Uses Marijuana Currently Abuses Prescription Drugs Ever Used Other Illegal Drugs Non-smokers 20.5% 13.3% 4.2% 9.6% Cigarette Smokers 82.3% 70.8% 38.2% 63.2% Increased Likelihood of Smokers Engaging in Behavior* 4x 5x 9x 7x * The increased likelihood represents the relative risk of an adolescent smoker engaging in the behavior vs. that of a non-smoking adolescent. Note that the data above represent observed correlations in risk behaviors and are not presented as evidence of causality. Source: Maryland Youth Tobacco & Risk Behavior Survey

16

17 100% 90% Direct/Proxy Purchase Some Other Way 80% 70% 66.4% 65.2% 60% 54.3% 50% 45.7% 40% 30% 33.6% 34.8% 20% 10% 0% Smokes 1 to 5 Days a Month Smokes 6 to 19 Days a Month Smokes 20+ Days a Month Source: Maryland Youth Tobacco & Risk Behavior Survey

18 Retailer Non-Compliance Rate State Retailer Non-Compliance Rates: High, Low, Avg., and MD Highest State Rate Lowest State Rate Weighted National Avg. Maryland 80% 72.7% 70% 60% 58.8% 55.8% 50% 46.9% 41.9% 40% 30% 20% 36.0% 33.7% 30.2% 38.0% 19.2% 22.7% 22.5% 17.0% 18.8% 16.8% 19.3% 17.9% 24.1% 31.4% 10% 0% 7.2% 5.5% 6.3% 6.0% 4.1% 4.5% 5.4% 3.9% 0.9% 2.2% 3.2% 4.1% 1.6% 2.2% 1.1% 1.8% 1.0% Federal Fiscal Year Synar Report

19 Nearly 4,000 compliance checks and 4,500 additional educational visits. Provided regional trainings to over 100 LHD staff/partners, covering all jurisdictions in state and TA to retailers, LHDs, community-based organizations. Three direct mailings from DHMH to over 8,500 retailers and multiple press releases. Meeting with Sec. of DHMH, Office of the Comptroller, and retailer association representatives.

20

21

22 Radio, billboard, transit, Pandora, Facebook, and web ads

23 New creative developed as result of focus groups. Responsible Tobacco Retailer ads running on billboards, transit, and will be sent to licensed tobacco retailers throughout the State. Radio advertisements will airing across the state began January 2016 statewide. Radio interviews furthering our message.

24 Gas Station TV November February 2016 Ads running at 25 gas stations on 245 screens statewide.

25 In FFY15, 14 jurisdictions had violation rates over 20% In FFY16, 4 jurisdictions had violation rates over 20%

26 Retailer Non-Compliance Rate State Retailer Non-Compliance Rates: High, Low, Avg., and MD Highest State Rate Lowest State Rate Weighted National Avg. Maryland 80% 72.7% 70% 60% 58.8% 55.8% 50% 46.9% 41.9% 40% 30% 36.0% 33.7% 30.2% 38.0% 31.4% 20% 19.2% 22.7% 17.0% 18.8% 16.8% 19.3% 17.9% 22.5% 24.1% 10% 0% 7.2% 5.5% 6.3% 6.0% 4.1% 4.5% 5.4% 3.9% 0.9% 2.2% 3.2% 4.1% 1.6% 2.2% 1.1% 1.8% 1.0% % Federal Fiscal Year Synar Report

27

28 35% 30% 25% 20% 15% 10% 5% 29.4% Changes in Underage Use of Tobacco Products: (Underage Less than 18 Years of Age) 17.7% 14.9% 23.0% Fall 2000 Spring 2013 Fall % 11.0% 11.5% 9.9% 8.2% In 2014, 19.7% of Maryland underage high school youth used an electronic vaping device. 4.7% 6.9% 5.5% 0% Any Tobacco Cigarettes Cigars Smokeless Tobacco

29 Current Adolescent Product Use Status Current Use of Electronic Vapor Product Smokes Cigarettes 70.2% Uses Smokeless Tobacco 67.4% Smokes Cigars 63.5% Smokes Marijuana 53.8% Drinks Alcohol 46.7% Not Using Tobacco 12.0% Not Smoking Marijuana 11.0% Not Drinking Alcohol 8.2%

30 Nearly 5% of Maryland adults (203,982) use an ENDS product either every day or on some days. Almost 20% of current adult Maryland ENDS users have never been cigarette smokers. An additional 35% of adult ENDS users report that they are using ENDS while at the same time continuing to smoke cigarettes every day. Almost one-fourth of current adult Maryland ENDS users are former cigarette smokers.

31 Quitline began asking about use in 2013 QL Registrants Reporting ENDS use Over 700 reports of ENDS use to QL in % using to quit or cut down on traditional tobacco 90% also want to quit e-cigarettes

32 7,000 6,000 5,000 4,000 3,000 2,000 1, ,342 Tobacco Tobacco HIV/AIDS Homicide ,286 Other Selected Causes Accidental - All Causes Suicide

33 CDC launched first-ever paid national tobacco education campaign Tips From Former Smokers (Tips) in March Profiles real people who are living with serious long-term health effects from smoking and secondhand smoke exposure In 2012, the Tips campaign motivated 1.6 million smokers to make a quit attempt. In 2013, the average weekly number of calls to the QUIT-NOW Quitline increased by 75%. Expanded 20 week run launching January 25, 2016

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