Presentation on theme: "Changing Public Policy to Reduce Tobacco Use Andrew Hyland, PhD Roswell Park Cancer Institute Stanton Glantz, PhD University."— Presentation transcript:
Changing Public Policy to Reduce Tobacco Use Andrew Hyland, PhD Roswell Park Cancer Institute Andrew.firstname.lastname@example.org Stanton Glantz, PhD University of California San Francisco email@example.com June 2, 2010
Key Messages from Today’s Talk Tobacco is the number one preventable health problem that faces our nation today We know what works! Broad-based policy change Programs and public education $$$ Policy change political will BUT…be careful…the financial viability of a massive oligopy is at stake They will undermine your efforts and be creative to continue to maximize their profits BUT…science tells us that broad-based policy change saves lives and money
What about cessation? Quitlines and direct services are fine But most people quit unaided Goal should be to promote and support unaided quit attempts Smokefree workplaces and homes Reduce social acceptability of smoking Smokefree policies are 10 times more cost effective per new nonsmoker than direct services
What About Youth Smoking? The policies that impact adult smoking impact youth smoking Little evidence school-based education by itself is effective Little evidence youth access policies are effective Why spend lots of money to target a sliver of the smoking population when other policies are less expensive and work for everyone?
Localities can now restrict tobacco marketing Limit number of outlets Limit where ads are placed in retail setting Eliminate buy-one-get-one-free offers These actions may be challenged based on 1 st Amendment Do after clean indoor air
Change Social Acceptability Similar effect to price increases Estimate 15% consumption drop if US was raised to the level in California in 1999 = $1.17 per pack price increase SOURCE: Alamar and Glantz. AJPH 2006
Generated Media on Air Monitoring Studies U.S.A.
"Common Sense" - Tobacco Institute, 1982 (ti53100003)
Clean air policies can be done locally to change social norms… In large part because the data are on our side
Introducing Stan Glantz Pioneer in the clean air and social change movement in California to share his perspective
US Surgeon General (1986) Involuntary smoking is a cause of disease, including lung cancer, in in healthy non- smokers. The children of parents who smoke compared with the children of nonsmoking parents have an increased frequency of respiratory infections, increased respiratory symptoms, and slightly smaller rates of lung function as the lung matures. The simple separation of smokers and nonsmokers within the same airspace may reduce, but will not eliminate, exposure to environmental tobacco smoke.
Secondhand Smoke Causes (Cal EPA/NCI, 1997) Fetal growth retardation SIDS Respiratory problems in kids Asthma in kids Eye and nasal irritation Middle ear infections in kids Lung cancer Nasal sinus cancer Heart disease mortality and morbidity About 53,000 deaths
Secondhand Smoke Causes (Cal EPA, 2006) Pre-term delivery Asthma induction in adults Breast cancer in younger (primarily premenopausal) women Acute and chronic heart disease morbidity Altered vascular properties About 50,000 deaths (not including breast cancer)
Annual deaths due to SHS Source: Wells,1998 37,000 13,000 3,000
InjuryRepair Maintenance of Vascular Endothelium lumen intima media EPCsEndothelial microparticles balance NO
Physical evidence for endothelial damage * p<0.05 vs baseline # p<0.05 vs respective time point on control day * CD31 + /CD41 - (PECAM/Gp IIb) CD144 + (VE-Cadherin) CD62e + (E-Selectin) “Activation” “Structural damage” Endothelial microparticles
Endothelial function is acutely decreased to smokers levels * p<0.05 vs baseline # p<0.05 vs respective time point on control day VEGF
Increased EPC number in blood * p<0.05 vs baseline # p<0.05 vs respective time point on control day
Sustained inhibition of EPC chemotaxis to VEGF * p<0.05 vs baseline, # p<0.05 vs respective time point on control day
Disturbed Maintenance of Vascular Endothelium lumen intima media EPCs Endothelial microparticles balance NO InjuryRepair
Institute of Medicine … secondhand-smoke exposure increases the risk of coronary heart disease and heart attacks and that smoking bans reduce this risk. … smoking bans can have a substantial impact on public health.
Human evidence Increases in risks for smoking and passive smoking among younger women 70% increased risk in younger women Exposure between puberty and lactation probably most dangerous Susceptible women probably get the cancers young
Source: Piazza K, Hyland A. Unpublished analysis. % Women With Smokefree Home AND Workplace By State, 1992/1993 CPS TUS, All Ages STATES WITH MORE 100% SMOKEFREE RULES HAVE LOWER BREAST CANCER MORTALITY
Effect on Industry Sales 2.9 billion packs not smoked ($4 billion) 1 billion extra packs ($1.4 billion)
Large Scale Tobacco Control Programs Work Over the first 15 years the California program cost $1.4 billion It saved $86 billion These savings started appearing quickly and grew with time By 2004, the program was saving $11 billion in health costs 7.3% of all health costs
Large Scale Tobacco Control Programs Work Prevented 3.6 billion packs of cigarettes from being smoked Worth $9.2 billion in lost sales The tobacco industry is motivated to stop you
How do you make change? Identify local champions Health department has to its public policy job Public education Policy maker education Creating positive environment through media Private agencies need to do their job Aggressive Close the deal
The industry will oppose you They have a lot to lose They are highly motivated Work through third parties Public records act requests “Illegal lobbying” Lawsuits