Tobacco Control: Big Fast Benefits. Stanton A. Glantz, PhD Professor of Medicine University of California San Francisco
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1 Tobacco Control: Big Fast Benefits Stanton A. Glantz, PhD Professor of Medicine University of California San Francisco
2 Australia (December 2012)
3 Australian Government, Department of Health 2015
4 The California Situation Low taxes (33 rd in US) Few ad restrictions Weak, obsolete warning labels
5 Accelerated prevalence decline
6 Accelerated consumption decline
7 Lower youth smoking
8 The California Model Social norm change
9
10
11 The California Model Key messages Secondhand smoke kills Nicotine is addictive The tobacco industry lies Industry Spokesman
12
13 Deaths from Secondhand Smoke Heart disease 37,000 Lung cancer 3,000 Other cancers 13,000 Source: Wells,1998
14 Heart Disease: Epidemiology About 30% increase in risk if married to smoker or work in smoking workplace
15 Nonlinear Dose-Response Pope et al, Circulation, 2009
16 Helena, Montana Population of city: 28,306 Population of Helena Zip Codes: 46,943 Total Population of Study area: 65,913 Geographically isolated population Next nearest cardiologist: 60 miles
17 AMI Admissions Significant Drop in AMI Admissions while Ordinance in Effect Helena Outside Helena Ordinance Year
18 Literature continued to build 43 studies of 33 laws As of July 2012 Many endpoints Acute myocardial infarction Angina, other heart disease Stroke Asthma COPD Other pulmonary
19 Risk of Hospital Admission Stronger laws Bigger effects 1,2 1 0,8 0,6 0,4 0, Coronary events (AMI, ACS, ACE, IHD) Other heart disease (angina, CHD, SCD) Cerebrovascular accidents Respiratory disease Workplaces Workplaces and restaurants Workplaces and restaurants and bars
20 Also reduces Complications of pregnancy Neonatal complications
21 0 Ambulance Calls (Casinos) Ambulance calls Year
22 Age-Adjusted Heart Disease Mortality (deaths/100,000) Heart Disease Mortality United States - California California Prop 99 Tax increase Year
23 Age-Adjusted Heart Disease Mortality (deaths/100,000) Effect on Mortality ,000 fewer deaths (9%) ,500 unnecessary deaths Year 1994
24 Age adjusted incidence (cases/100,000/year) Effect on Lung Cancer Incidence San Francisco Bay Area Anti-tobacco program 14% reduction
25 Health Care Savings Attributable to CA Tobacco Control
26 1989 through 2008 Tobacco Control Program cost $2.4 billion Save $243 billion in health costs 12% of total health costs in 2008 Reduced cigarette sales by 6.8 billion packs Worth $28.5 billion in to tobacco industry
27 The View from Afar A California Phenomenon Health fanatics Puritans Foreign to European (and other) traditions and sensibilities
28
29 1989
30 1989
31 1989
32 Philip Morris 1993
33
34 1993
35 1993
36 1993
37 E-cigarettes
38
39 Ecigs to quit
40 E-cigarettes = less quitting
41 What about the hard core? People who can not or will not quit Expect as prevalence drops Quitting drops Cigs/day stays same or increases
42 US: More quitting United States Smoking Prevalence (%)
43 EU: More quitting
44 US: Lower consumption United States Smoking Prevalence (%)
45 EU: Lower consumption
46 So softening not hardening
47 What about kids?
48 Current smoking/e-cigarette use (NYTS) Current Cigarette only Current Dual Use
49 E-cig use predicts smoking Nonsmokers at baseline 1 year longitudinal follow-up Smoking at follow-up Study Place Age Odds of Smoking Wills Hawaii ( ) Primack US ( ) Leventhal Southern California ( ) Gmel Switzerland 20 (male) 6.02 ( ) OVERALL 3.21 ( )
50 E-cigs likely to prolong tobacco epidemic Restoring social acceptability Depressing quitting among smokers Attracting kids to nicotine Likely to progress to smoking Even if they don t it s a bad thing
51 The bottom line Possible to get large rapid drops in smoking Immediate and substantial health benefits Immediate and substantial economic benefits
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