Where We Are: State of Tobacco Control and Prevention

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1 Where We Are: State of Tobacco Control and Prevention Corinne Husten, MD, MPH Acting Director CDC Office on Smoking and Health Nova Scotia, Canada October 2006

2 Tobacco Impact Background Tobacco is leading cause of preventable death In U.S.440,000 die each year In Canada, over 45,000 die prematurely each year

3 Health Effects Multiple cancers Heart disease and stroke Lung disease, including COPD Reproductive diseases And others Smoking harms nearly every organ of the body. The Health Consequences of Smoking: A Report of the Surgeon General, 2004

4 Secondhand Smoke Health Effects Known human carcinogen Causes lung cancer and heart disease in adults In children: Causes SIDS, respiratory infections, ear problems, more severe asthma,

5 Secondhand Smoke No risk-free level of exposure Ventilation does not work Only 100% smoke-free policies fully protect from exposure

6 Cost of Smoking Substantial costs Smoking costs Nova Scotia economy more than half a billion per year from premature death, absenteeism, medical costs

7 Effective Intervention.

8 OSH Goal Areas Prevent tobacco use initiation among youth and young adults Promote tobacco use cessation Eliminate exposure to secondhand smoke Identify and eliminate tobacco-related disparities

9 Funding Recommendation Estimates Small states (populations under 3 million) From $7 to $20 per person Large states (population over 7 million) From $5 to $16 per person Nova Scotia projection: $10 million at lower level and $21.9 million at upper level

10 Best Practices Update Based on new science and programmatic experience Seven intervention categories collapsed into four.

11 Community Guide Recommendations: Reducing Initiation Increase price of tobacco products Mass media education campaigns Community mobilization combined with other interventions to decrease minors access

12 Community Guide Recommendations: Increasing Cessation Increase price of tobacco products Mass media campaigns Telephone quitlines Reduce out-of-pocket costs of treatment Health care system changes

13 Community Guide Recommendations: Reducing Exposure to Secondhand Smoke Smoking bans and restrictions

14 Other Interventions Canada Prohibited tobacco promotional giveaways and in-store displays Improved warning labels Regulatory policies

15 Comprehensive Programs Increasing Price When tobacco prices increase, prevalence rates and number of cigarettes decrease Increasing excise taxes may be most effective single intervention Canada leader in high tobacco excise taxes

16 Comprehensive Programs Counter-marketing campaigns Evidence that mass media campaigns reduce youth and adult smoking rates

17 Comprehensive Programs Counter-marketing campaigns Between 1998 and 1999, Florida appropriated $70 million for prevention program that included countermarking campaign After first 4 years, youth smoking rates reduced by 50% in middle school students; 35% among high school students

18 Comprehensive Programs Telephone Quitlines Every state, all ten provinces have quitlines California: when coordinated with other interventions, cessation rates doubles New York: quitline calls, cessation rates increased with free nicotine replacement therapy

19 1-800-QUIT-NOW Single portal number Since Nov 2004: over 420,000 calls QUITNOW

20 Comprehensive Programs Cessation Coverage Reducing out-of-pocket costs Increases the number of people who attempt to quit Increases the use of proven cessation therapies Increases the number of people who successfully quit

21 Comprehensive Programs Secondhand Smoke Smoking bans and restrictions are effective in reducing exposure Smoke-free policies can change attitudes and behaviors of smokers May also improve success rate for each quit attempt Smoke-free policies might reduce tobacco initiation

22 Smoke-free Nova Scotia Ninth province to require smoke-free workplaces Smoking permitted in ventilated rooms in restaurants, as well as throughout bars after 9pm

23 The Impact of Tobacco Control Program Expenditures on Aggregate Cigarette Sales: Longer sustained investment: bigger and faster impact Cigarette sales fell 43% in AZ, CA, MA, and OR compared to 20% for rest of country Source: Farrelly MC, Pechacek TP and Chaloupka FJ. The Impact of Tobacco Control Program Expenditures on Aggregate Cigarette Sales: Journal of Health Economics, 2003;22(5):

24 Comprehensive Tobacco Control Program Investment Equals Impact Youth prevalence and consumption decreases more Prevalence of youth smoking could have been between 3% and 13% lower Source: Tauras JA, Chaloupka FJ, Farrelly MC, et al. State Tobacco Control Spending and Youth Smoking. Am J Public Health :

25 Estimated Annual Change in Lung and Bronchus Cancer, Percentage Male Female Total California Cancer Registry (CCR) Surveillance, Epidemiology, and End Results (SEER)

26 Challenges Sustaining funding for tobacco control programs New products including smokeless tobacco products Stalled progress in decreasing prevalence Need to counteract discounting policies Continued disparities in tobacco use Smuggling Global tobacco marketing and use

27 Sustained Funding Perception problem is solved Tobacco branded as old news Competing priorities

28 Sustained Funding Nova Scotia funding at $2.50 per capita In U.S., funding reduced and programs cut Recommendation: ensure tobacco control budgets are sustained and increased

29 New Smokeless Products

30 Smokeless Tobacco Major Impact It could: Lead to foregoing cessation to switch to smokeless Lead to relapse among former smokers. Encourage initiation Lead to concurrent tobacco use

31 Smokeless Tobacco Concerns Known human carcinogen Don t know true smokeless risks Have a proven harm reduction strategy: comprehensive tobacco control programs

32 Stalled Progress United States Youth starting in 2002 Adults starting in 2004

33 Factors Slowing Decline in Youth Rate Reductions in funds for tobacco-use prevention and control Tobacco industry advertising increase Smoking still glamorized in films

34 Need to Counteract Discounting Strategies In 2003, tobacco industry spent nearly $11 billion on price discounts in U.S. Despite state tax increases, real price of cigarettes barely increased

35 Disparities in Tobacco Use

36 Smuggling Tax increases led to rise in smuggling In 1998, RJ Reynolds pleaded guilty to smuggling, paid $15 million fine

37 Global Tobacco Use Global action needed Shared responsibility

38 Where We Are: State of Tobacco Control and Prevention Corinne Husten, MD, MPH Acting Director CDC Office on Smoking and Health Nova Scotia, Canada October 2006

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