Presentation on theme: "Building a Legacy of Tobacco-Free Communities"— Presentation transcript:
3The Bad News: Smoking Kills 443,000 Americans Each Year Average annual number of deaths,Source: Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses – United States, MMWR 2008;57(45):
4U.S. Adult Per-Capita Cigarette Consumption, 1900-2010 Source: USDA Tobacco & Situation Outlook report until 2002; Office on Smoking & Health Data
5U.S. Adult Per-Capita Cigarette Consumption Projected through 2035 Tobacco use is a minor public health nuisanceSource: USDA Tobacco & Situation Outlook report until 2002; Office on Smoking & Health DataProjection: Calculations from Gary Giovino, University of Buffalo
6Trends in Current Cigarette Smoking by High School Students and Adults—U.S., 1965-2010 *High school students who smoked on 1 >/ of the 30 days preceding the survey--United States, CDC. Youth Risk Behavior Survey,** Total population adults who were current cigarette smokers, National Health Interview Surveys,
7Surgeon General’s Report: Preventing Tobacco Use Among Youth and Young Adults
8Current High School Cigarette Smoking and Projected Rates if Decline Had Continued—U.S., 1991-2009 3 million fewer youth and young adults would be smokers8%Source: YRBS: Centers for Disease Control and Prevention, Division of Adolescent and School Health, Office on Smoking and Health (unpublished data).
9FDA Granted Authority to Regulate Tobacco Adult Per Capita Cigarette Consumption and Major Smoking-and-Health Events—U.S.,1st SurgeonGeneral’s ReportEnd of WW IIMasterSettlementAgreementFairness DoctrineMessages on TVand RadioFDA Granted Authority to Regulate Tobacco1st Smoking-Cancer ConcernFederal CigaretteTax More Than DoublesGreat DepressionSource: USDA Tobacco & Situation Outlook report until 2002; Office on Smoking & Health Data
10Lung Cancer Incidence, US Men, 1998 U.S. Cancer Statistics: 1998–2007 Incidence and Mortality.
11Lung Cancer Incidence, US Men, 2007 U.S. Cancer Statistics: 1998–2007 Incidence and Mortality.11
12Adult Smoking Prevalence by StateBehavioral Risk Factor Surveillance System, 2010
13Percent of Adults Who Smoke by SexNational Health Interview Survey, 2010
14Percent of Adults Who Smoke by Racial/Ethnic Group National Health Interview Survey, 2010
15Percent of Adults Who Smoke by Poverty LevelNational Health Interview Survey, 2010
16Percent of Adults Who Smoke By Education LevelNational Health Interview Survey, 2010
17We Know What Works: Evidence-Based Interventions
18CDC’s Recommendations for Prioritizing Policies Phase IComprehensive Smoke-Free PoliciesPrice IncreasesHard-Hitting Media CampaignsSustained/Increased Program FundingPhase IIPolicy-Based CessationExpanded Smoke-Free EnvironmentsReduce Retailer Density, Location, TypeProduct Display BansGraphic Retail Health Warnings
19Factors that Affect Health LargestImpactSmallestExamplesEat healthy, be physically activeCounseling& EducationRx for high blood pressure, high cholesterol, diabetesClinicalInterventionsImmunizations, brief intervention, cessation treatment, colonoscopyLong-lasting Protective InterventionsFluoridation, 0g trans fat, iodization, smoke-free laws, tobacco taxChanging the Contextto make individuals’ defaultdecisions healthyPoverty, education, housing, inequalitySocioeconomic Factors19
20Changing the Cost-Benefit Calculus Tobacco easily accessibleSmoking in public legalUnfettered advertising, no counter-advertisingHard to access quitting resourcesCigarettes designed to addictIndividual
21Changing the Cost-Benefit Calculus Tobacco more expensive, less accessibleSmoke-free policiesCounter-marketing, promotion restrictionsEasy access to helpCigarettes made less addictiveIndividual
22Phase I Priorities Comprehensive Smoke-Free Policies Price Increases Hard-Hitting Media CampaignsSustained/Increased Program Funding
23State Smoke-Free Indoor Air Laws for Private Worksites, Restaurants, and Bars Laws in effect as of Dec 31, 2004WAVTMTNDMEORMNNHIDWISDNYMAWYMIRIIAPANVNECTNJILUTINOHDECACOWVVAKSMOKYMDNCD.C.TNAZOKComprehensive smoke-free policies are not new…Over the past decade, we’ve seen great progress in policies from coast to coast.Here’s a look at 2004 – when we had 3 states with comprehensive laws:MassachusettsDelawareNew YorkSCNMARBan in worksites,restaurants, and bars (n=3)MSALGALABan in two of threelocations (n=1)TXAKFLNo Ban in all theselocations (n=47)HIN=51Source: Centers for Disease Control and Prevention. State Tobacco Activities Tracking and Evaluation (STATE) System. Available at:
24State Smoke-Free Indoor Air Laws for Private Worksites, Restaurants, and Bars Laws in effect as of April* 2012WAVTMTNDMEORMNNHIDWISDNYMAWYMIRIIAPANVNECTNJILUTINOHDECACOWVVAKSMOKYMDNCD.C.TNAZOKSCNMARBan in worksites,restaurants, and bars (n=26)MSALGALABan in two of threeLocations (n=5)TXAKFLNo Ban in all theselocations (n=20)HIN=51Source: Centers for Disease Control and Prevention. State Tobacco Activities Tracking and Evaluation (STATE) System. Available at:*Note Indiana is effective in July 2012
25Almost 50% of U.S. population is covered by comprehensive state or local smoke-free laws Population figures are as of December 31 of each given year; July for All population figures are from the United States Census. Source: American Nonsmokers’ Rights Foundation,
26Benefits of Smoke-free Policies Reductions in exposure amongnonsmoking hospitality workersgeneral population of nonsmokersHealth improvements among nonsmoking hospitality workersReductions in sensory and respiratory symptomsImproved lung functionReductions in hospital heart attack admissions among the general publicIncreased cessation, reduced smoking rates among workersSmoke-free policies reduce secondhand smoke exposure among smokers and nonsmokers and lead to improvements in lung function. They also lead to substantial reductions in heart attack admissions immediately following implementation of a smoke-free policy.
27There is Also a Good Business Case for Going Smoke-Free
28Groups Disproportionately Exposed to Secondhand Smoke Children and adolescentsAfrican AmericansBlue-collar, service, and hospitality workersLow-income AmericansExamples of exposed populations include:Children, who are primarily exposed in homes or cars; orblue collar and service industry workers, since voluntary smoke-free policies tend to trend to favor white-collar office jobs.Employees who report working in a smoke-free workplace are:83% of white collar workers72% of food- service workers63% of blue collar workers(Based on 2008 State Law MMWR)
29Phase I Priorities Price Increases Comprehensive Smoke-Free Policies Hard-Hitting Media CampaignsSustained/Increased Program Funding
30State Cigarette Excise Tax Rates Laws in effect as of Jan 1, 2011WAChicago $3.66(state + local)VTMTNDMEORMNNHIDWISDNYMAWYMIRIIAPANVNECTNJILINOHNYC $5.85 (state + local)UTDECACOWVVAKSMOKYMDNCD.C.TNAZOKSCNMAR≥ $3.00 per packMSALGALA$2.00-$2.99 per packTXAK$1.50-$1.99 per packFL$1.00-$1.49 per packAnchorage $3.45(state + local)HI50-99 cents per pack<50 cents per packCDC, Office on Smoking and Health. State Tobacco Activities Tracking and Evaluation (STATE) System.303030
31Phase I Priorities Hard-Hitting Media Campaigns Comprehensive Smoke-Free PoliciesPrice IncreasesHard-Hitting Media CampaignsSustained/Increased Program Funding
32Florida Truth Campaign: Dramatic Impact on Youth Smoking Over 2 years, cigarette use plunged 40% among middle-school students and 18% among high-school students
33National truth® Campaign Research finding: more truth® ad exposure, less risk of beginning to smoke among teensAnnual media buy down from $100 million in 2000 to $30 million todayFarrelly et al. The Influence of the National truth Campaign on Smoking Initiation. AJPM 2009.
34CDC’s National Tobacco Education Campaign “Tips from Former Smokers” National Center for Chronic Disease Prevention and Health PromotionOffice on Smoking and Health
35The Office of Smoking and Health took an evidence based approach to ad development. First, we reviewed our experience running a pilot campaign in HHS Region 6 in the Spring of 2011 where we ran 3 hard-hitting TV ads for 12 weeks.After the 12 weeks, a significant increase in ad awareness was seen and for every dollar we spent, we earned two and a half dollars in free placement.We received very little negative feedback, from only a handful of individuals, and received strong, consistently positive and appreciative feedback from state and local health departments, including State Health Officers.At the same time the pilot campaign was running, we began developing new ads for the national campaign. With message platform testing.We found that messages that were clear, simple, believable and emotional were most well-received, and people responded very well to the “immediacy of health dangers” theme.Next, we developed three campaign concepts and tested them via in-person focus groups. Of the three, the "Tips" concept was strongly preferred by almost all participants, and was rated the most powerful of the campaign concepts.
36U.S. Total Quitline Calls: March 1-26 Week 1 MetricsWeek 1 MetricsCampaign website : 230,000 page viewsTerrie ad: viewed over 240,000 timesQuitline calls doubledU.S. Total Quitline Calls: March 1-26Campaign LaunchThe metrics from the first week of the campaign are encouraging.Our new campaign website had almost 230,000 page views during the first week.The most often viewed ad was the Terrie ad, which was viewed more than 240,000 times.There was about a 114% increase in QUIT-NOW call volume on 3/22 when compared to the previous week’s call volume, prior to the start of the paid campaign.We also received some initial encouraging feedback from one of our states. Arkansas is reporting that their quitline volume increased from 442 calls (the week before the campaign launched) to 563, which was the highest number of calls they’ve ever had.
37Phase I Priorities Sustained/Increased Program Funding Comprehensive Smoke-Free PoliciesPrice IncreasesHard-Hitting Media CampaignsSustained/Increased Program Funding
38Immediate Impact of a Comprehensive Approach: Youth and Adult Smoking Rates in NYC3-yr. average21.6%21.5%21.7%19.2%18.3%18.9%17.5%16.9%15.8%City and State tax increasesSmoke-freepolicyMediacampaign17.6%14.8%11.2%8.5%State and Federal Tax increases15.8%14%Percent8.4%7%Source: BRFSS 1993 – 2001; NYC Community Health Survey – 2010; and NYC YRBS
39Long-term Impact of a Comprehensive Approach: Lung Cancer Incidence Rates in CA California: A 15 year investment of $1.8 billion in tobacco control reduced health care costs by $86 billionRates are per 100,000 and age-adjusted to the 2000 U.S. standard (19 age groups).* The annual percent change is significantly different from zero (p<0.05).Source: Cancer Surveillance Section. Prepared by: California Department of Public Health, California Tobacco Control Program,
40Tobacco Industry is Outspending Prevention Efforts >23:1 State TobaccoRevenue(taxes and settlementfunds)$25.3 billionFederalCigaretteTax RevenuesTobacco Industry Marketing & PromotionSpending (2008)$15billionTotal CDC-Recommended Spending Level$10.5billionState Tobacco Program Budgets$0.45 billion$3.7 billionSource: Campaign for Tobacco Free Kids, Federal Trade Commission, CDC Office on Smoking and Health
41State Taxes vs. State Spending The average state cigarette excise tax increased from $1.11 at the end of 2007 to $1.46 todayTotal state spending on tobacco control decreased from $717 million in FY2008 to $457 million in FY2012+ 32%- 36%
42Key CDC Tobacco Prevention Activities National Tobacco Control ProgramFunding and support to 50 states, D.C., U.S. territories, tribes, national organizations.Community Transformation GrantsCommunity-level efforts in 61 states and communitiesFunded by Affordable Care Act’s Prevention and Public Health Fund“Next Generation” of Communities Putting Prevention to WorkNational Tobacco Education CampaignTV, radio, print, billboards, theater, bus shelters, and digital adsFunded by the Prevention and Public Health Fund
43Family Smoking Prevention and Tobacco Control Act of 2009 FDA given authority to regulate sales, advertising, and ingredient content of tobaccoProhibits candy flavoring and misleading termsintroduces new youth access provisionsRequires new warnings for cigarettes, smokeless tobacco
44Legal ChallengesFederal lawsuit challenging FDA’s regulatory authorityFederal lawsuit challenging graphic warning labelsInjunction has placed new warnings on hold for nowContinued lawsuits in states and communities against smoke-free, point of sale policies
46Building a Legacy of Tobacco-Free Communities Key messages· Need to tell your story throughout· How you can tell your story—model activity· Prepare for pushbackThank You!Centers for Disease Control and PreventionNational Center for Chronic Disease Prevention and Health Promotion