-Health Consequences of Smoking, 50 Years of Progress, A Report of the Surgeon General, USDHHS, 2014

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1 Tobacco Prevention A newsletter of the ODH Tobacco Program APRIL, 2015 I N S I D E T H I S I S S U E : Program Update 1-2 Youth E-Cigarette Usage Ohio Partners for Smoke-free Families Subgrantee Thank You We Want To Hear From You Vital Signs Report Tobacco-free Schools 2015 Tobacco Conference Marketing Database Product Order Forms Faith Webinar 9 Contact Us 10 ODH Tobacco Program Update Exposure to secondhand tobacco smoke has been causally linked to cancer, respiratory, and cardiovascular diseases, and to adverse effects on the health of infants and children. -Health Consequences of Smoking, 50 Years of Progress, A Report of the Surgeon General, USDHHS, 2014 In Ohio about one third (34%) of Ohio adults report recently being exposed to secondhand smoke. 1 Over half (59%) of children grades 6-12 report recently being exposed to secondhand smoke either in a vehicle, at school, or in an indoor or outdoor public place. 2 From a public health perspective, we should all be concerned about these statistics. Exposure to secondhand smoke is largely involuntary and causes serious consequences to the health and quality of life of people who have chosen not to smoke or who have no control over their exposure. It was C. Everett Koop, appointed US Surgeon General in 1981, who had the most recent significant impact on this issue and who clearly stated that the right of smokers to smoke ends where their behavior affects the health and well-being of others. The good news is that evidence has shown us that if we are successful at adoption of smoke-free laws and policies we can be successful at reducing the initiation of smoking, reducing or eliminating the amount people smoke, as well as, reducing exposure of people to secondhand smoke. Ohioans took a significant step forward in limiting their exposure to secondhand smoke when they passed the Smoke Free Workplace Act in This law prohibits smoking in all public indoor places and places of employment in Ohio. Ohio should be proud to have one of the most protective laws in the country related to indoor smoking. The Ohio Department of Health (ODH) has enforced the law since it began and continues, with the help of local designees, to strengthen enforcement and increase compliance with this law. We already know that this effort has resulted in improved health. Among other findings, a 2011 report published by ODH, reviewed syndromic surveillance data of chief complaints to emergency departments and urgent care facilities in Ohio and found nearly a 30% reduction in mean total percentage of visits for heart attack/ami post smoking ban when compared to percentages in the year before the ban. Public support for this law has continued to increase over the years and now the interest of Ohioans in other smokefree and tobacco-free environments seems to be increasing. The ODH Tobacco Use Prevention and Cessation Program (TUPCP), along with many other partners, have worked hard to achieve tobacco-free schools in Ohio. There has been a great deal of progress on this front and TUPCP continues to monitor school district policies. While we have only a limited number of 100% tobacco free schools, all have some policy and we are

2 P A G E 2 ODH Tobacco Program Update (Cont.) helping schools to improve and strengthen these policies. Most need to be updated to include prohibition of smoking at school events off campus, elimination of designated smoking areas for staff and inclusion of specific information about how the policy will be enforced. TUPCP maintains the model tobacco-free policy for Ohio schools. An updated toolkit to assist schools in these tobacco-free efforts will be released this summer. Ohio has also seen great progress over the past several years in adoption of tobacco- and smokefree campus policies. Some of Ohio s largest universities and many of the smaller ones have or are in the process of adopting tobacco-free policies. TUPCP convenes a quarterly conference call with campus stakeholders to provide support and technical assistance for these efforts. Another advisory group of college stakeholders has been working on a model campus tobacco-free policy which will likely be released before the end of the year. Smoke-free homes and multi-unit housing are another focus of efforts to reduce exposure to secondhand smoke. TUPCP and other stakeholders, including local communities, have made progress on this issue. Exposure at home is a particular concern for children as there is now evidence to show that exposure of youth is associated with poor birth outcomes, the development of asthma and a higher risk of heart disease later in life. All Ohioans are encouraged to adopt smoke-free policies for their homes and cars. If you live in multi-unit housing or work with housing authorities, TUPCP has tools and can provide support for moving toward smoke-free policies. Because of the way ventilation systems are designed, if smoking is allowed in a multi-unit housing complex, it is likely all many who live there will be exposed to secondhand smoke. TUPCP maintains an ever increasing list of smoke-free public housing for those who are seeking smokefree environments. Finally, we are seeing increasing efforts across the state to put in place smoking and tobacco use restrictions in public parks and recreational areas. TUPCP will continue funding, this year, for local adoption of smoke-free and tobacco-free policies. If you are interested in becoming involved or continuing your involvement in this effort and would like our support, please us that you would like to be notified about these opportunities. Also, if you re interested in additional information about any of the TUPCP efforts discussed here, please contact us at TobaccoPrevention@odh.ohio.gov or browse our online information here. References 1 ODH Vital Statistics, 2012, vitalstatsmainpage.aspx 2 ODH, Ohio Partners for Smoke Free Families, psmok/presmoke1.aspx

3 P A G E 3 E-Cigarette Use Triples Among Middle and High School Youth In Just One Year Current e-cigarette use among middle and high school students tripled from 2013 to 2014, according to data published by the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration s Center for Tobacco Products (CTP) in the April 16th Morbidity and Mortality Weekly Report (MMWR). Findings from the 2014 National Youth Tobacco Survey show that current e-cigarette use (use on at least 1 day in the past 30 days) among high school students increased from 4.5 percent in 2013 to 13.4 percent in 2014, rising from approximately 660,000 to 2 million students. Among middle school students, current e-cigarette use more than tripled from 1.1 percent in 2013 to 3.9 percent in 2014 an increase from approximately 120,000 to 450,000 students. This is the first time since the survey started collecting data on e-cigarettes in 2011 that current e-cigarette use has surpassed current use of every other tobacco product overall, including conventional cigarettes. E-cigarettes were the most used tobacco product for non-hispanic whites, Hispanics, and non-hispanic other race while cigars were the most commonly used product among non-hispanic blacks. among high school students and remained unchanged for middle school students. Among high school students, current hookah use rose from 5.2 percent in 2013 (about 770,000 students) to 9.4 percent in 2014 (about 1.3 million students). Among middle school students, current hookah use rose from 1.1 percent in 2013 (120,000 students) to 2.5 percent in 2014 (280,000 students). The increases in e-cigarette and hookah use offset declines in use of more traditional products such as cigarettes and cigars. There was no decline in overall tobacco use between 2011 and Overall rates of any tobacco product use were 24.6 percent for high school students and 7.7 percent for middle school students in The National Youth Tobacco Survey (NYTS) is a school-based, self-administered questionnaire given annually to middle and high-school students in both public and private schools. NYTS, which surveyed 22,000 students in 2014, is a nationally representative survey. We want parents to know that nicotine is dangerous for kids at any age, whether it s an e- cigarette, hookah, cigarette or cigar, said CDC Director Tom Frieden, M.D., M.P.H. Adolescence is a critical time for brain development. Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction, and lead to sustained tobacco use. Hookah use roughly doubled for middle and high school students, while cigarette use declined

4 P A G E 4 Ohio Partners for Smoke-free Families By Sherry M. Sexton Smoking during pregnancy remains one of the most common preventable causes of infant mortality. Among Ohio women giving birth, 17.8% 1 smoke during the 3rd trimester, a rate that is 2x that of the nation as a whole. Rates are highest among low-income women, including those on Medicaid, with 1 in 3 smoking throughout pregnancy. 2 Smoking cigarettes during pregnancy has been identified as one of the most significant factors contributing to poor pregnancy outcomes including miscarriage, prematurity, stillbirth and low birth weight. Women who quit before or during pregnancy can reduce or eliminate these risks. 2 The Ohio Partners for Smoke Free Families (OPSFF) is the culmination of many years of planning that includes partners throughout the State of Ohio, including the Ohio Department of Health (ODH). This project aims to decrease the tobacco-smoking rate among women before, during and after pregnancy. The project includes four major components: the expansion of 5As evidence-based smoking cessation program (Ask, Advise, Assess, Assist, and Arrange) within ODH funded local programs; conduct a fourcounty saturation project with the 5As smoking cessation program; a marketing saturation in these same four-counties; and quality improvement project. 2 ODH joined with the Ohio Chapter of the American Academy of Pediatrics and the Ohio University Heritage College of Osteopathic Medicine to provide a lectureship program to support local providers in addressing the 5As for smoking cessation and second hand smoke exposure reduction. OPSFF has partnered with the Ohio University Voinovich School of Leadership and Public Affairs to train providers in four southeast Ohio Appalachian counties (Gallia, Lawrence, Ross and Scioto) to implement the 5As. OPSFF is implementing a media campaign in those four southeast Ohio counties receiving 5As saturation. OPSFF has partnered with the Ohio Colleges of Medicine Government Resource Center (GRC) to implement a quality improvement project within the local clinics in Child and Family Health Services, Women, Infants and Children, Reproductive Health and Wellness Program and Ohio Infant Mortality Reduction Initiative home visiting programs and Help Me Grow. This project ensures the implementation of the 5As brief counseling intervention for smoking cessation to fidelity. GRC is subcontracting with the Health Services Advisory Group (HSAG) to develop and test a patient and provider toolkit in these projects. Future funding is dependent upon grant application and availability of funds. (References on next page)

5 P A G E 5 Smoke-free Families Continued... References 1 ODH Vital Statistics, 2012, 2 ODH, Ohio Partners for Smoke Free Families, presmoke1.aspx Subgrantee Thank You! As the Tobacco Use Prevention Policy, Systems & Environmental Change grant year comes to a close March 28, 2015, the ODH Tobacco Use & Cessation Program would like to extend a sincere thank you to our nine (9) subgrantees. Through their hard work and dedication they helped inform and educate their local populations about the dangers of second hand smoke and engaged local youth groups to educate their peers about the dangers of tobacco and to curb youth initiation. From March 29, 2014 to March 28, 2015, subgrantees played a significant role in: Achieving 22 new smoke-free policies in multi-unit housing complexes (21 of which were in Lucas County) Collecting 2,367 smoke-free home pledges Establishing more than 20 stand groups and reaching more than 8,150 youth with anti-tobacco messages Again, thank you and great job! We Want To Hear From You! The ODH Tobacco Program wants to learn about your experiences with and opinions about tobacco-related information and reports. The information you provide will help us understand what data and data report formats are useful, and what data would be useful that are not currently available. To that end, we invite you to participate in the Tobacco Information Survey, conducted for ODH by Strategic Research Group. The survey takes around minutes to complete. Please be assured that your answers are completely confidential, and results will not be shared in any way that is personally identifiable. All results will be reported at the aggregate level. The following link will take you to the survey: odhtis You should receive an from Tina Kassebaum at Strategic Research Group with a unique passcode. This enables you to complete the survey in multiple sittings, if necessary. If you didn t receive the from Tina or need it to be resent, please contact SRG at or odhtis@websrg.com. Thank you for your participation!

6 P A G E 6 Vital Signs - Disparities in Nonsmokers' Exposure to Secondhand Smoke A new report released last month reiterated the fact that exposure to secondhand smoke (SHS) from burning tobacco causes disease and death in nonsmoking children and adults. No risk-free level of SHS exposure exists. Methods: National Health and Nutrition Examination Survey (NHANES) data from were used to examine SHS exposure among the nonsmoking population aged 3 years. SHS exposure among nonsmokers was defined as a serum cotinine level (a metabolite of nicotine) of ng/ml. SHS exposure was assessed overall and by age, sex, race/ethnicity, poverty level, education, and whether the respondent owned or rented their housing. Results: Prevalence of SHS exposure in nonsmokers declined from 52.5% during to 25.3% during During this period, declines were observed for all population subgroups, but disparities still exist. During , SHS was highest among: Children aged 3 11 years (40.6%) Non-Hispanic blacks (46.8%) Persons living below the poverty level (43.2%) And persons living in rental housing (36.8%). Among children aged 3 11 years, 67.9% of non-hispanic blacks were exposed to SHS compared to 37.2% of non-hispanic whites and 29.9% of Mexican Americans. Conclusion: Overall, SHS exposure in the United States has been reduced by half since However, 58 million persons were still exposed to SHS during , and exposure remains higher among children, non-hispanic blacks, those living in poverty, and those who rent their housing. Implications for Public Health Practice: Eliminating smoking in indoor spaces fully protects nonsmokers from SHS exposure; separating smokers from nonsmokers, cleaning the air and ventilating buildings cannot completely eliminate exposure. Continued efforts to promote implementation of comprehensive statewide laws prohibiting smoking in workplaces and public places, smoke-free policies in multi-unit housing, and voluntary smoke-free home and vehicle rules are critical to protect nonsmokers from this preventable health hazard in the places they live, work, and gather. For the full report, click here. For more information on smoke-free multi-unit housing, contact sfhousing@odh.ohio.gov.

7 P A G E 7 Tobacco-free Schools and Secondhand Smoke Children are one of secondhand smoke s most vulnerable victims. Children often have no control over when and where adults are smoking. They may be stuck in a car with a smoking parent or around relatives who smoke on the weekends. One environment in which children spend much of their time is school. Ohio has 637 school districts, most of which have some sort of tobacco-free policy. Some policies simply say staff cannot smoke on school grounds, which leaves staff to smoke in their car or across the street. Some policies regulate visitors and any activities on school grounds even when school is not in session think Friday night football games and weekend plays, concerts, or other sporting events. What kind of role model are we being if we allow children to see adults smoking at their school, the one place they go where they should always feel safe? Out of Ohio s 637 school districts, only 38 have a 100 percent tobacco-free policy. We want to increase that number. If you want to help, please see the toolkit we created last year to help you approach school administrators to develop, strengthen, and implement a tobacco-free school policy. We will be updating this toolkit over the next few months. Please send any recommendations to tobaccoprevention@odh.ohio.gov with subject: tobacco-free schools toolkit revisions Tobacco Conference It s time to begin looking forward to our 2015 Tobacco Conference. Please save the date for November 5, Quest Conference Center will once again be our host. A lot of great feedback was received when ODH recently fielded a survey of conference participants. This information will be used to inform our planning to the coming year. Thank you to those who provided feedback. Due to the high demand of the cessation track last year, and the fact that there are more and more TTS in Ohio, this year s event will be entirely cessation focused. If you have an interest in being part of the planning committee, please contact Amy Gorenflo at amy.gorenflo@odh.ohio.gov or

8 P A G E 8 Marketing Database Is Live! The Tobacco Use Prevention and Cessation Program marketing resources database is now online. Browse through our collection of tobacco counter-advertisements including print (newspaper, magazine), digital (online), out of home (billboards, buses), radio, and television media materials. The resources on the site can be altered to fit your campaign s needs. All resources in the database are available at no cost and will be continually updated as new ODH campaigns are released. This is a great opportunity for you to receive posters, videos, and other media at no cost. To request a resource, contact tobaccoprevention@odh.ohio.gov. If you will need a resource resized, altered (this includes adding localized text/your logo), or in a certain format, please include that information in your . Please allow at least two weeks to receive altered materials. You can access the database here. Product Order Forms The Ohio Department of Health offers products and materials to help market tobacco prevention and cessation. All materials are free and subject to availability. Please allow at least one week for ODH to process and ship orders. To receive an order form, place an order, or for any additional questions, please tobaccoprevention@odh.ohio.gov. Secondhand Smoke and Housing Product Order Form Quit Line and Healthcare Provider Product Order Form stand Product Order Form Disability Product Order Form

9 P A G E 9 Join Us For a Webinar... It Takes Faith: Addressing Tobacco Use Within the Faith Community Date: May 13, 2015 Time: 1 pm Eastern Time & 7 pm Eastern Time Hosted by: Faiths United Against Tobacco and the Centers for Disease Control Faiths United Against Tobacco and the Centers for Disease Control Office on Smoking and Health invite you to a webinar on the importance of addressing tobacco use with your members. The webinar will feature the CDC national tobacco education campaign Tips From Former Smokers. You will learn about the campaign and new resources especially designed for faith leaders and their communities. You will also hear how Faiths United Against Tobacco engaged and motivated their communities to adopt healthier lifestyles. It Takes Faith Addressing Tobacco Use within the Faith Community occurs twice on May 13, Please register for the time that works best for you: After registering, you will receive a confirmation containing information about joining the webinar.

10 A N E W S L E T T E R O F T H E O D H T O B A C C O P R O G R A M P A G E 10 About TFOA The Tobacco Free Ohio Alliance (TFOA) is an association of Ohio agencies, organizations, groups and individuals who work to prevent the use of tobacco products and to educate Ohioans about the harmful effects of tobacco use and second-hand smoke exposure. TFOA meetings are held in Columbus at the State Library of Ohio and are open to the public. TFOA Meetings in 2015 will be held from 10 a.m. to noon on: July 14 and October 13 Tobacco prevention & cessation resources Ohioans who are uninsured, have a Medicaid fee for service plan, are pregnant, or are covered through the Ohio Tobacco Collaborative qualify for Quit Line telephone counseling. All Ohioans qualify for the QuitLogix online tobacco cessation program. ODH Tobacco Programs contact information ODH Tobacco Program: Program Phone Line: Ohio Tobacco Quit Line: TobaccoPrevention@odh.ohio.gov The ODH Tobacco Use Prevention and Cessation Program is supported by Cooperative Agreement number 1O58DP from the Centers for Disease Control and Prevention (CDC). The contents of the newsletter are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. Ohio Smoke Free Workplace Program: To report a smoke-free violation: OHIO NoSmoke@odh.ohio.gov For information about the Smoke Free Workplace Program:

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