Tobacco Use: Epidemiology and Determinants Andrea Villanti, PhD, MPH Vermont Center on Behavior and Health University of Vermont November 1, 2017

Transcription

1 Tobacco Use: Epidemiology and Determinants Andrea Villanti, PhD, MPH Vermont Center on Behavior and Health University of Vermont November 1,

2 What is public health? Public health promotes and protects the health of people and the communities where they live, learn, work and play. Prevention and intervention at the population level Public health activities: Scientific research Public education & communication Compliance & enforcement Policymaking & regulation Community engagement & advocacy Careers in public health First responders Restaurant inspectors Health educators Scientists and researchers Nutritionists Community planners Social workers Epidemiologists Public health physicians Public health nurses Occupational health and safety professionals Public policymakers Sanitarians 2

3 5 Areas of focus Young adult tobacco use and cessation How and why do young adults use tobacco products? How can we reduce tobacco use in young adults? How can we change tobacco products through regulation to make them less appealing, addictive, and toxic? Tobacco regulatory science Methods and measures How can we ensure that we conduct the most rigorous science to inform our work in these areas and beyond? 6 3

4 Learning objectives After completion of this session, you will be able to: Describe the global burden of tobacco use and current trends in the tobacco epidemic Explore influences on tobacco use at individual, social, community, and societal/political levels Describe features of recent tobacco education campaigns 8 Recommended reading Executive Summary to the 2014 Surgeon General's Report on the Health Consequences of Smoking rts/50 years of progress/exec summary.pdf 9 4

5 Setting the scene What are the top causes of death in the World? What are the top causes of death in the U.S.? Why does health related behavior matter? Source: CDC 10 Leading causes of death Actual causes of death* 1. Tobacco 2. Poor diet and physical inactivity 3. Alcohol consumption *In U.S.; Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual causes of death in the United States, JAMA, 11291(10), World 1. Ischemic heart disease 2. Stroke 3. Lower respiratory infections 10/en/ U.S. 1. Heart disease 2. Cancer 3. Chronic lower respiratory diseases of death.htm 5

6 12 U.S. Department of Health and Human Services. The Health Consequences of Smoking 50 Years of Progress. A Report of the Surgeon General. January

7 Cigarette smoking is still a major problem The burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products. Smoking accounts for 480,000 deaths annually in the U.S. ~1,300 smokingrelated deaths per day 5.6 million of today s youth expected to die prematurely from smoking Number of deaths annually 600, , , , , ,000 0 Smoking Prescription opiate overdose Heroin overdose Cause of death U.S. Department of Health and Human Services. The Health Consequences of Smoking 50 Years of Progress. A Report of the Surgeon General. January Cigarette smoking is still a major problem Cigarettes have become more lethal over time. More death and disease, despite lower per capita consumption and lower smoking prevalence U.S. Department of Health and Human Services. The Health Consequences of Smoking 50 Years of Progress. A Report of the Surgeon General. January

8 Projected deaths due to tobacco (global) 1 in 10 deaths worldwide due to tobacco use Tobacco use is responsible for ~5M deaths per year Projected to rise to 8M by 2030 An additional 600,000 die from secondhand smoke annually Mathers, C. D., & Loncar, D. (2006). Projections of global mortality and burden 16 of disease from 2002 to PLoS Med, 3(11), e442. Global trends in men and women 17 8

9 Prevalence of current smoking among adults in the US, Prevalence of current smoking (%) Current smoking prevalence among all U.S. Adults, 2015: 15.1% Year National Health Interview Survey cig_smoking/index.htm 9

10 What do we mean by tobacco products? 20 E cigarettes Prevalent products in the U.S. Cigars Hookah 21 10

11 Finishers Past 30 day tobacco use in U.S. high school students, : 20.2% any tobacco use = ~3 million high school students 11

12 PATH: Current tobacco use in young adults vs. adults aged Prevalence (%) Any tobacco Cigarettes Any cigar E cigarettes Hookah years 25+ years Kasza KA, et al. N Engl J Med 2017;376: Smoking uptake by age, 2002 Pierce JP. Am J Prev Med 2007;33:S

13 Smoking onset in young adulthood U.S. Department of Health and Human Services. The Health Consequences of Smoking 50 Years of Progress. A Report of the Surgeon General. January

14 Reducing tobacco use prevalence Initiation Prevalence = (Incidence)*(Duration) Cessation 28 Thought experiment Societal/ political **Identify one influence at each level and describe whether it promotes or discourages tobacco use. Community Social networks Individual 29 14

15 Thought experiment Societal/ political Community Social networks Individual 30 Initiation: Individual level influences Genetics/epigenetics Sensation seeking Perceptions of risk Beliefs regarding the effects of smoking Optimism bias Beliefs regarding addiction and cessation Beliefs regarding certain products Weighing of risks and benefits Underestimate risks Exaggerate benefits Chapter 2: Factors perpetuating the tobacco problem In: Bonnie RJ, Stratton KR, Wallace RB, eds. Ending the tobacco problem: A blueprint for the nation. Washington, D.C.: National Academies Press; 2007:

16 Thought experiment Societal/ political Community Social networks Individual 32 Descriptive norms The perceived prevalence of a particular behavior Injunctive norms The social pressure to conform to that behavior What should you do? Social environment 16

17 Initiation: Social network level influences Parents Parental disapproval Smoking rules at home Parental support Siblings Shared environmental factors Social connectedness Mutual friendships Peers Selection or projection? School Norms Academic achievement Thought experiment Societal/ political Community Social networks Individual 35 17

18 Initiation: community level influences Exposure to pointof sale marketing Exposure to outdoor marketing Access to tobacco products Source: Thought experiment Societal/ political Community Social networks Individual 37 18

19 Key components of marketing appeal Product presentation Size of the package Colors and text Price Placement Product placement in TV, movies, entertainment venues Point of sale displays and advertising Promotion Print, media advertisements Direct to consumer Source: trinketsandtrash.org Prevention: social ecological approach Smoke free indoor air Youth access laws Excise tax Societal/ political Community Social networks Indiv Graphic warning labels Media Marketing restrictions FDA regulation of product 39 19

20 Prevention: Cessation: social ecological approach Smoke free indoor air Youth access laws Excise tax Societal/ political Community Social networks Indiv Graphic warning labels Media Access to cessation treatment Marketing restrictions FDA regulation of product 40 Comprehensive tobacco control State and community interventions Administration and management Health communication interventions Surveillance and evaluation Cessation interventions Centers for Disease Control and Prevention. (2007). Best Practices for Comprehensive Tobacco Control Programs Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 20

21 Tobacco prevention mass media FDA Truth Initiative The Real Cost Fresh Empire This Free Life

22 QUESTIONS? 22