Ending the Tobacco Epidemic RADM Patrick O Carroll, MD, MPH Senior Advisor, Assistant Secretary for Health, US DHSS Tim McAfee, MD, MPH Senior Medical Officer, Office on Smoking and Health, CDC www.nwcphp.org/hot-topics Polling Question Do you feel that we can eliminate new addictions to tobacco smoking in our lifetime? Yes No Maybe 1
Consider Our Collective History Lead exposure in paint banned in household paints in US since 1979 in gasoline phased out, 1976-95 Child labor laws Steady progress throughout 20 th C, ending full-time child labor Building codes safeguard the health, safety and welfare of building occupants. The Health Consequences of Smoking: 50 Years of Progress A Report of the Surgeon General 1964 2014 2
The Grim Statistics Smoking is still the leading cause of preventable disease and death in the United States. Over 20 million deaths 2.5 million nonsmokers 100,000 babies US deaths from smoking, 1964-2014 US deaths from 1918 flu pandemic US deaths in combat in WWII Smoking Today The Persistent Epidemic Caused nearly half a million premature deaths Caused 61% of all pulmonary deaths Caused 32% of all coronary deaths Caused more than 87% of all lung cancer deaths 3
Smoking and Children Each day over 3,200 kids try their first cigarette and 2,100 youth and young adults become daily smokers. About half of children 3-18 are exposed regularly to cigarette smoke. Every adult who dies early because of smoking is replaced by two new young smokers. If they keep smoking, at least one of the two will also die early from smoking. Nearly 9 out of 10 smokers started before age 18. The Costs of Smoking $289 billion each year Spent in yearly medical care for adult smokers $132 billion Lost in yearly productivity costs when smokers get sick and die early $157 billion 4
Adult Cigarette Use in Region X 30.0% 28.0% 26.0% 24.0% 22.0% 20.0% 18.0% 16.0% 14.0% 12.0% 1992 1997 2001 2005 2009 2013 Alaska Idaho Oregon Washington Source: Behavioral Risk Factor Surveillance System (BRFSS), 2013 5
Proven Strategies for Success: Increase Price Tobacco taxes are the single most effective component of a comprehensive tobacco control program Price increases reduce rates of smoking among both adults and youth Tax adjustments are needed to offset inflation and tobacco industry attempts to control retail prices Proven Strategies for Success: Aggressive Media Campaigns Reduce youth initiation Encourage cessation Increase negative attitudes toward dltobacco use Increase support for policy changes 6
Proven Strategies for Success: Smoke-Free Policies Prevent heart attacks Help motivate smokers to quit Worker safety issue not personal nuisance Smoke-free workplaces don t hurt business No trade-off between health and economics Comprehensive Smoke-Free Laws United States 2000-2014 No State Law/Exemptions/ Ventilation/Separation Partial Law (One Location) Partial Law (Two Locations) Comprehensive Law (Worksites, Bars & Restaurants) Source: CDC STATE System 7
Quitting Smoking 70 percent of U.S. smokers want to quit 50 percent try to quit each year 4-6 percent succeed How do we get from here to 0? 8
End Game Strategies & Emerging Products Timothy McAfee, MD, MPH It is my sincere hope that 50 years from now we won t need another Surgeon General s report on smoking and health, because tobacco-related disease and death will be a thing of the past. Working together, we can make that vision a reality. Boris D. Lushniak, MD, MPH Acting Surgeon General, January 2014 9
Polling Question Who in the United States has the authority to stop the sale of cigarettes in retail outlets? Food and Drug Administration States Municipalities Retail outlets Tobacco companies No one End Game Strategies: Sales Restrictions Product restrictions at local and state levels Why now? Less than 1 in 5 smoke Keep heat on! Industry commitment to smokeless/ecigs Complements and backstops FDA How restrictive? Product types Location characteristics Who can buy? 10
End Game Strategies: Sales Restrictions Product restrictions at local and state levels Scenario? Sale limited to adult only stores Store can only sell tobacco Only sell to 21 and over Limited point of sale advertising 75% tax Severe zoning limits on store location and number What is it? Virtual prohibition? Draconian governmental over-reach? OR Legalization? Communities with Sales Restrictions Sales in certain retailers Sales within a certain distance of venues Sales of certain products Sales age 21 and over Chicago, IL Boston, MA San Francisco, CA Providence, RI New York, NY Hawaii 11
Sales Restrictions: Raising Age to 21 Prevent or delay initiation of tobacco use by adolescents and young adults Nonsmokers and smokers favor raising the minimum age 223,000 fewer premature deaths End Game Strategies: Hard-Hitting Media Campaigns Tips from Former Smokers 12
Tips 2012 Effective Saw at Least One Ad Quit Attempts Quit at End of Campaign Likely to Quit Permanently 80% smokers 75% nonsmokers 1.6 million additional (12%) more More than 200,000 100,000 Cost Effective Total investment Time for tobacco industry to spend $54 million on marketing $54 million Less than 3 days Years of life saved 300,000-500,000 Cost per year of life Less than $200 Number of calls (in thousands) Weekly Calls to 1-800-QUIT-NOW Before, during, and after CDC's 2013 Tips from Former Smokers campaign Off week 30 25 20 15 10 5 0 On week Talk with your doctor week 2/4 2/112/182/25 3/4 3/113/183/25 4/1 4/8 4/154/224/29 5/6 5/135/205/27 6/3 6/106/176/24 7/1 7/8 7/15 Pre-campaign Campaign Post-campaign 13
Emerging Products 25 High School Students Tobacco Use by Product 20 2011 2012 2013 2014 Percentage 15 10 5 0 Tobacco* 2 Tobacco + E-Cigarettes Hookahs Cigarettes Cigars Smokeless Tobacco * Defined as preceding 30-day use of cigarettes, cigars, smokeless tobacco, e-cigarettes, hookahs, tobacco pipes, snus, dissolvable tobacco, and/or bidis + Defined as preceding 30-day use of two or more of cigarettes, cigars, smokeless tobacco, e-cigarettes, hookahs, tobacco pipes, snus, dissolvable tobacco, and/or bidis 14
Electronic Nicotine Delivery Systems (e-cigarettes) Potential for Benefit Complete long-term substitution by established smokers Short-term use if shown to produce successful and permanent cessation of burned products Assist in rapid transition to a society with little or no use of burned products E-Cigarettes Potential for Harm May increase youth exposure to nicotine May re-glamorize tobacco use for adolescents Increased nicotine poisoning in children Long-term health effects May delay quitting in some adults due to dual use May lead former smokers to relapse to nicotine 15
Electronic Nicotine Delivery Systems: Policy Approaches Not tolerated: Marketing or sales that result in youth use Prohibited: Eliminate: In places where smoking is Use of combusted tobacco FDA regulation is fundamental to minimizing harms States and communities can also take action State and Local Action on Electronic Nicotine Delivery Systems No sales to minors (40 states) No use where smoking is not allowed (4 states) No use where smoking is not allowed (4 states) Additional strategies may include public education, retailer licensing, marketing restrictions, some flavor restrictions, and some form of taxation CDC will soon track e-cigarette legislation on http://www.cdc.gov/tobacco/state_system/ 16
Tobacco-Related Revenue and Tobacco Control Allocation, 1998-2010 $6,000,000,000 $5,000,000,000 Tobacco Control Spending Tobacco-Related Revenue Ratio = 23:1 $6.0 B $4,000,000,000 Ratio = 36:1 $3,000,000,000 $3.5 B $2,000,000,000 $1,000,000,000 $0 Ratio = 13:1 Ratio = 28:1 $920.5 M $68.1 M $739.3 M $26.8 M $97.5 M $258.0 M Alaska Idaho Oregon Washington Source: CDC. Morbidity and Mortality Weekly Report, May, 2012. 61(20); 370-374 We Can Be Tobacco-Free The time is NOW to begin a tobacco-free future. Let s end the tragic epidemic of sickness, disability and death caused by tobacco use, once and for all. 17
Questions? 18