Tobacco: A Critical Element in Addressing Cancer Disparities. Athena Ramos, PhD, MBA, MS, CPM

Transcription

1 Tobacco: A Critical Element in Addressing Cancer Disparities Athena Ramos, PhD, MBA, MS, CPM

2 Learning Objectives 1. To discuss the impact of tobacco in Nebraska 2. To identify potential linkages between state tobacco control and cancer plans 3. To share best practices for tobacco control initiatives

3 Remember When Smoking was glamorous Smoking was allowed in the workplace Smoking was allowed on airplanes You would go to a restaurant and the hostess would ask you Smoking or non-smoking? You would go out to the bar with friends and come home smelling like an ashtray

4 We ve Made a lot of Progress U.S. Surgeon General. (2015). The next 50 years. Available at:

5 Tobacco kills more people every year than AIDS, alcohol, car crashes, illegal drugs, murders, and suicides combined 480,000 people annually Campaign for Tobacco Free Kids. (2017). Toll of Tobacco in the USA. Retrieved from

6 Health Consequences Causally Linked to Smoking Centers for Disease Control and Prevention, 2014

7 Health Consequences Causally Linked to Secondhand Smoke Centers for Disease Control and Prevention, 2014

8 Tobacco s Toll in Nebraska Tobacco use by youth and young adults causes both immediate and long-term damage 17% of adults smoke 13% of high school students smoke, but 22% of high school students use e-cigarettes Nearly 9 out of 10 adult smokers started smoking before 18 years of age and 99% started by age 26 Tobacco Free Nebraska. (2016). Data & trends on tobacco use in Nebraska.

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11 Adult Smoking Rate by Gender and Age (2014) Tobacco Free Nebraska. (2016). Data & trends on tobacco use in Nebraska.

12 Adult Smoking Rate by Race and Ethnicity (2014) Tobacco Free Nebraska. (2016). Data & trends on tobacco use in Nebraska.

13 Adult Smoking Rate by Education and Income (2014) Tobacco Free Nebraska. (2016). Data & trends on tobacco use in Nebraska.

14 Adult Smoking by Veteran Status and Age (2014) Tobacco Free Nebraska. (2016). Data & trends on tobacco use in Nebraska.

15 Adult Smoking Rate by Industry and Occupation Group (2014) Tobacco Free Nebraska. (2016). Data & trends on tobacco use in Nebraska.

16 Smoking Rate by Mental Health and Substance Abuse Consumers (2014) Tobacco Free Nebraska. (2016). Data & trends on tobacco use in Nebraska.

17 Tobacco Use Among Youth by Gender and Grade (2014) Tobacco Free Nebraska. (2016). Data & trends on tobacco use in Nebraska.

18 Had Type of Cancer Other Than Skin Cancer by Age and Smoking Status (2014) Tobacco Free Nebraska. (2016). Data & trends on tobacco use in Nebraska.

19 Saskatoon Health Region. (2014). Better health for all: Health status reporting series 3 advancing health equity in health care. Retrieved from Publications/2014_shr_phase3_advancing_healthequity_healthcare_series.pdf

20 Social Determinants of Health World Health Organization. (2010). A conceptual framework for action on the social determinants of health. Retrieved from

21 Equity-Based Interventions Equity-based interventions seek to improve health outcomes in subgroups that are disadvantaged, while improving the overall situation Interventions that do not have an equity focus may inadvertently exacerbate inequalities, even when national averages indicate overall improvements For example, media campaigns and workplace smoking bans have shown evidence of increasing inequalities World Health Organization. (2013). Health inequality monitoring. Retrieved from

22 Recommendations for Promoting Equity within the Health Sector Recognize that the health sector is part of the problem Prioritize diseases of the poor Deploy or improve services where the poor live Employ appropriate messaging and delivery channels Reduce cultural, linguistic, financial, and logistic barriers to services Set goals and monitor progress through an equity lens World Health Organization. (2013). Health inequality monitoring. Retrieved from Based on unpublished work by Cesar G Victora, Fernando C Barros, Robert W Scherpbier, Abdelmajid Tibouti and Davidson Gwatkin.

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24 Components of Successful Programs Human & Relational Advocacy & Persuasion Building Sustainability Partnerships Program Capacity Readiness & Support Program Management Fundamentals Technical & Scientific Use of Evidence Implementation Monitoring & Evaluation Stillman, Schmitt, & Rosas. (2012). Opportunity for collaboration: A conceptual model of success in tobacco control and cancer prevention. Preventing Chronic Disease, 9, E02. doi:

25 Cancer Control Plan GOAL: Reduce the percentage of lowincome (less than $35,000/year) adults that currently smoke from 25.5% to 21% by Increased calls to Quitline Increased requests for available resources Increased connection to stakeholder groups Increased quit attempts Decreased smoking rate Tobacco control is identified as a program activity in 10 comprehensive cancer programs including lung cancer, radon, nutrition & physical activity, colorectal cancer, breast cancer, survivorship/quality of life, HPV, and access to care.

26 Strategic Plan The vision of Tobacco Free Nebraska is a healthy, tobacco-free Nebraska, and the mission is to prevent and reduce tobacco use among Nebraskans of all ages through advocacy, education, and collaboration. Goals: 1. Prevent initiation among youth and young adults 2. Promote quitting among tobacco users 3. Eliminate exposure to secondhand smoke 4. Identify and eliminate tobacco-related disparities Reduce the percentage of low-income (less than $35,000 annual income) adults that currently smoke from 25.5% to 21% by

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28 U.S. Preventative Services Task Force Recommendations 1. Providers should ask every patient about tobacco use, advise them to stop using, and provide behavioral interventions. 2. There is insufficient evidence to recommend pharmacotherapy for pregnant women. 3. There is insufficient evidence to recommend electronic nicotine delivery systems as a cessation aid.

29 5A s Brief Intervention ASK about current smoking status ADVISE to quit and provide information on how beneficial is quitting ASSESS willingness to quit ASSIST with finding resources and making a plan to quit ARRANGE for follow-ups to help the patient follow through and QUIT for good! Agency for Healthcare Research and Quality. (2012). Five major steps to intervention (The "5 A's"). Retrieved from

30 Best Practices for Tobacco Control Limit tobacco promoting influences Tobacco marketing and deglamorization Economic Physical environment Global movement Reduce exposure to secondhand smoke, tobacco smoke residue, tobacco waste, and other tobacco products Reduce the availability of tobacco Promote tobacco cessation Cessation services Policy

31 State Smoke-Free Laws Campaign for Tobacco-Free Kids. (2017). Smoke-free states in the United States. Retrieved from

32 Smoke-Free Living 1. Sample lease addendums for landlords of any type of property (smoke-free clause) 2. Technical assistance for property owners/ landlords 3. Supportive materials to educate tenants/ renters Photo credit Omaha World Herald

33 Tobacco-Free Parks 1. Educating community members about importance of tobacco-free parks 2. Obtaining support from various community sectors (e.g., business, law enforcement, youth services, etc.) 3. Providing technical assistance to policy-makers to implement tobaccofree policies

34 Nebraska s Local Tobacco Prevention Coalitions Buffalo Cass Douglas Hall Lancaster Lincoln Panhandle Platte & Colfax Sarpy

35 Consortium of National Networks to Impact Populations Experiencing Tobacco-Related and Cancer Health Disparities National Network Population Awardee Organization Geographic Health Equity Alliance Geographically Defined Community Anti-Drug Coalitions of America LGBT HealthLink Lesbian, Gay, Bisexual, and Transgender CenterLink (LGBT) National African American Tobacco Prevention Network* National Behavioral Health Network for Tobacco and Cancer Control African American Mental and/or substance use disorders National African American Tobacco Prevention Network* National Council for Behavioral Health National Native Network American Indian and Alaska Native Inter-Tribal Council of Michigan Nuestras Voces Network Hispanic National Alliance for Hispanic Health RAISE Network (Reaching Asian Americans Pacific Islanders through Innovative Strategies to Achieve Equity in Tobacco Control and Cancer Prevention) Asian American Native Hawaiian Pacific Islander Asian Pacific Partners for Empowerment, Advocacy, & Leadership SelfMade Health Network Low Socioeconomic Patient Advocate Foundation

36 Questions? Athena Ramos, PhD, MBA, MS, CPM Community Health Program Manager Center for Reducing Health Disparities College of Public Health University of Nebraska Medical Center Omaha, NE (402)

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