Take Control Before Tobacco Takes Its Toll. Sean Niciejewski, Ron Stowers, and Mari Martinez

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1 Take Control Before Tobacco Takes Its Toll Sean Niciejewski, Ron Stowers, and Mari Martinez

2 Healthy People 2020's Goals and Objectives Goal: Reduce illness, disability, and death related to tobacco use and secondhand smoke exposure. (Healthy People 2020) Key areas of focus: Tobacco Use Prevalence: Implementing policies to reduce tobacco use and initiation among youth and adults. (Healthy People 2020) Health System Changes: Adopting policies and strategies to increase access, affordability, and use of smoking cessation services and treatments. (Healthy People 2020) Social and Environmental Changes: Establishing policies to reduce exposure to secondhand smoke, increase the cost of tobacco, restrict tobacco advertising, and reduce illegal sales to minors. (Healthy People 2020)

3 Why is Tobacco Cessation so Important??? DEATH!!! Illness. CANCER BAD BREATH Premature birth, still birth, infant DEATH The CDC estimates that smoking is estimated to cause more than 480,000 deaths per year. (Centers for disease control and prevention)

4 NEGATIVE EFFECTS LUNGS HEART CANCER OTHERS

5 Smoking can cause lung disease by damaging your airways and the small air sacs (alveoli) found in your lungs ( COPD). Smokers are12-13 times more likely to die from COPD (CDC.GOV) Smoking damages blood vessels and can make them thicken and grow narrower. This makes your heart beat faster and your blood pressure go up. Clots can also form. A clot in the brain is a stroke and a clot in the heart is a heart attack, both DEADLY! (CDC.GOV) Watch this video! Normal Lungs vs. A Smokers Lungs

6 Smoking, cancer and the ones you love Smoking causes cancer EVERYWHERE: Bladder, Blood, Cervix, Colon, Rectal, Esophagus, Kidneys, Uterus, Larynx, Liver, Throat, Mouth, Pancreas, Stomach, Lung Smoking affects more than just you: Causes preterm, still birth, and sudden death in your children Second hand smoke can cause cancer in the ones you love.

7 How much is your life worth? More than 10 times as many U.S. citizens have died prematurely from cigarette smoking than have died in all the wars fought by the United States during its history. 1 (CDC.GOV)

8 WE ALL NEED A HAND Nicotine Anonymous Meetings and online support Promedica Tobacco Cessation Weekly meetings, multiple locations Ohio quitline QUIT-NOW A resourec available to those of limited income

9 Smoking cessation methods Electronic Cigarette Medications Nicotine Replacement Please consult a physician to discuss what smoking cessation options would be best for you.

The 5 As and 5 Rs Approach Provide smokers with appropriate tools based on their willingness to quit.

quitting using the 5 R s Intervention: Ask about tobacco use and their smoking pattern Advise and

helpful resources Arrange follow up contact after their quit attempt Relevance is reviewed to determine

Rewards are reviewed on the benefits of quitting Roadblocks to quitting are identified Repetition of

active with a regular exercise routine and make healthy food selections.

10 The 5 As and 5 Rs Approach Provide smokers with appropriate tools based on their willingness to quit. The 5 major steps to intervention are the 5 A s: Smokers, that are not ready to quit, may consider quitting using the 5 R s Intervention: Ask about tobacco use and their smoking pattern Advise and encourage smokers to quit Assess readiness to quit Assist those willing to attempt quitting with helpful resources Arrange follow up contact after their quit attempt Relevance is reviewed to determine what personally motivates them to quit Risks are discussed on the negative effects of tobacco use Rewards are reviewed on the benefits of quitting Roadblocks to quitting are identified Repetition of these methods are continually used with every quit attempt Healthy Lifestyle Diet/ Exercise: stay active with a regular exercise routine and make healthy food selections. Click on the link below for helpful resources from the United States Department of Agriculture website. Stress Reductions: keep yourself distracted with Complementary and Alternative Medicine (CAM) such as meditation, yoga, and massage therapy. Click on link below for helpful CAM resources

11 Lets Recap! Healthy People 2020 objective ("Reduce illness, disability, and death related to tobacco use and secondhand smoke exposure") Tobacco has MANY Negative Health Effects There are multiple Smoking Cessation Methods you can try such as Medications, Nicotine Replacement Therapy, 5 As and Rs Approach, and Healthy Living Alternatives You CAN get help from Relapse and Support Groups

12 THE FUTURE OF TOBACCO Push Towards Public Policies: The Healthy People 2020 Tobacco Use objectives are organized into 3 key areas: 1. Tobacco Use Prevalence: Create policies that will reduce tobacco use and initiation among our youth and adults. 2. Health System Changes: Implement policies and strategies to make it easier to access, afford, and use smoking cessation services/treatments. 3. Social and Environmental Changes: Provide policies that reduce our exposure to secondhand smoke, increase the cost of tobacco, restrict tobacco advertising, and reduce illegal sales to minors. The Food & Drug Administration (FDA) is also working to reduce illnesses and Death caused by tobacco use through public regulations and reviewing national studies. Click on the Links below for more Information from FDA and Healthy People

13 References CDC: Center for Disease Control and Prevention. (2014, February 6). Smoking and Tobacco Use. Retrieved from Center of Disease Control and Prevention, CDC 24/7: Saving Lives, Protecting People: /data_statistics/fact_sheets/health_effects/effects.cig_smoking/#estimates Five Major Steps to Intervention (The "5 A's"). December Agency for Healthcare Research and Quality, Rockville, MD. Retrieved from recommendations/tobacco/5steps.html Patients Not Ready To Make A Quit Attempt Now (The "5 R's"). December Agency for Healthcare Research and Quality, Rockville, MD. Retrieved from recommendations/tobacco/5rs.html U.S. Department of Health and Human Services. (2014, June12). Healthy People.gov., Tobacco Use. Retrieved from topicid=41

Case 1:99-cv GK Document Filed 01/10/14 Page 1 of 11. Exhibit D. Online newspaper exemplars

Case 1:99-cv GK Document Filed 01/10/14 Page 1 of 11. Exhibit D. Online newspaper exemplars Case 1:99-cv-02496-GK Document 6021-4 Filed 01/10/14 Page 1 of 11 Exhibit D Online newspaper exemplars Case 1:99-cv-02496-GK Document 6021-4 Filed 01/10/14 Page 2 of 11 Philip Morris USA Corrective Statements