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Jeff McKenna, MS Associate Director for Communication Science Centers for Disease Control and Prevention National Center for Chronic Disease Prevention.

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Presentation on theme: "Jeff McKenna, MS Associate Director for Communication Science Centers for Disease Control and Prevention National Center for Chronic Disease Prevention."— Presentation transcript:

1 Jeff McKenna, MS Associate Director for Communication Science Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Building a Legacy of Tobacco-Free Communities ACHIEVE Action Institute April 25, 2012

2 The Good News: We Have Recast Social Norms

3 The 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):

4 U.S. Adult Per-Capita Cigarette Consumption, Source: USDA Tobacco & Situation Outlook report until 2002; Office on Smoking & Health Data

5 U.S. Adult Per-Capita Cigarette Consumption Projected through 2035 Source: USDA Tobacco & Situation Outlook report until 2002; Office on Smoking & Health Data Projection: Calculations from Gary Giovino, University of Buffalo Tobacco use is a minor public health nuisance

6 Trends in Current Cigarette Smoking by High School Students and Adults—U.S., *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, High school students* Adults**

7 Surgeon General’s Report: Preventing Tobacco Use Among Youth and Young Adults

8 8% Current High School Cigarette Smoking and Projected Rates if Decline Had Continued—U.S., million fewer youth and young adults would be smokers Source: YRBS: Centers for Disease Control and Prevention, Division of Adolescent and School Health, Office on Smoking and Health (unpublished data).

9 Adult Per Capita Cigarette Consumption and Major Smoking-and-Health Events—U.S., Source: USDA Tobacco & Situation Outlook report until 2002; Office on Smoking & Health Data Great Depression 1st Surgeon General’s Report Fairness Doctrine Messages on TV and Radio Federal Cigarette Tax More Than Doubles Master Settlement Agreement 1st Smoking- Cancer Concern End of WW II FDA Granted Authority to Regulate Tobacco

10 Lung Cancer Incidence, US Men, 1998 U.S. Cancer Statistics: 1998–2007 Incidence and Mortality.

11 11 Lung Cancer Incidence, US Men, 2007 U.S. Cancer Statistics: 1998–2007 Incidence and Mortality.

12 Behavioral Risk Factor Surveillance System, 2010 Adult Smoking Prevalence by State

13 National Health Interview Survey, 2010 Percent of Adults Who Smoke by Sex

14 National Health Interview Survey, 2010 Percent of Adults Who Smoke by Racial/Ethnic Group

15 National Health Interview Survey, 2010 Percent of Adults Who Smoke by Poverty Level

16 National Health Interview Survey, 2010 Percent of Adults Who Smoke By Education Level

17 We Know What Works: Evidence-Based Interventions

18 CDC’s Recommendations for Prioritizing Policies Phase I  Comprehensive Smoke-Free Policies  Price Increases  Hard-Hitting Media Campaigns  Sustained/Increased Program Funding Phase II  Policy-Based Cessation  Expanded Smoke-Free Environments  Reduce Retailer Density, Location, Type  Product Display Bans  Graphic Retail Health Warnings

19 Largest Impact Smallest Impact Examples Eat healthy, be physically active Rx for high blood pressure, high cholesterol, diabetes Poverty, education, housing, inequality Immunizations, brief intervention, cessation treatment, colonoscopy Fluoridation, 0g trans fat, iodization, smoke- free laws, tobacco tax Socioeconomic Factors Changing the Context to make individuals’ default decisions healthy Long-lasting Protective Interventions Clinical Interventions Counseling & Education Factors that Affect Health

20 Changing the Cost-Benefit Calculus Tobacco easily accessible Smoking in public legal Unfettered advertising, no counter-advertising Hard to access quitting resources Cigarettes designed to addict Individual

21 Changing the Cost-Benefit Calculus Tobacco more expensive, less accessible Smoke-free policies Counter-marketing, promotion restrictions Easy access to help Cigarettes made less addictive Individual

22 Phase I Priorities  Comprehensive Smoke-Free Policies  Price Increases  Hard-Hitting Media Campaigns  Sustained/Increased Program Funding

23 AZ WY OR ID MT UT NV WA CA TX AR OK ND LA KS IA NE SD CO NM MO MN TN AL KY OH MS MI IN GA FL PA ME NY WV VA NC SC VT CT D.C. RI NJ MD DE NH MA IL WI AK HI Ban in worksites, restaurants, and bars (n=3) Ban in two of three locations (n=1) Laws in effect as of Dec 31, 2004 N=51 Source: Centers for Disease Control and Prevention. State Tobacco Activities Tracking and Evaluation (STATE) System. Available at: No Ban in all these locations (n=47) State Smoke-Free Indoor Air Laws for Private Worksites, Restaurants, and Bars

24 AZ WY OR ID MT UT NV WA CA TX AR OK ND LA KS IA NE SD CO NM MO MN TN AL KY OH MS MI IN GA FL PA ME NY WV VA NC SC VT CT D.C. RI NJ MD DE NH MA IL WI AK HI Ban in worksites, restaurants, and bars (n=26) Ban in two of three Locations (n=5) Laws in effect as of April* 2012 N=51 Source: Centers for Disease Control and Prevention. State Tobacco Activities Tracking and Evaluation (STATE) System. Available at: No Ban in all these locations (n=20) State Smoke-Free Indoor Air Laws for Private Worksites, Restaurants, and Bars *Note Indiana is effective in July 2012

25 Almost 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,

26  Reductions in exposure among –nonsmoking hospitality workers –general population of nonsmokers  Health improvements among nonsmoking hospitality workers –Reductions in sensory and respiratory symptoms –Improved lung function  Reductions in hospital heart attack admissions among the general public  Increased cessation, reduced smoking rates among workers Benefits of Smoke-free Policies

27 There is Also a Good Business Case for Going Smoke-Free

28  Children and adolescents  African Americans  Blue-collar, service, and hospitality workers  Low-income Americans Groups Disproportionately Exposed to Secondhand Smoke

29 Phase I Priorities  Comprehensive Smoke-Free Policies  Price Increases  Hard-Hitting Media Campaigns  Sustained/Increased Program Funding

30 30 AZ WY OR ID MT UT NV WA CA TX AR OK ND LA KS IA NE SD CO NM MO MN TN AL KY OH MS MI IN GA FL PA ME NY WV VA NC SC VT D.C. NJ MD DE NH MA IL WI AK HI cents per pack $1.00-$1.49 per pack $1.50-$1.99 per pack $2.00-$2.99 per pack CDC, Office on Smoking and Health. State Tobacco Activities Tracking and Evaluation (STATE) System. <50 cents per pack Chicago $3.66 (state + local) NYC $5.85 (state + local) CT RI State Cigarette Excise Tax Rates ≥ $3.00 per pack Anchorage $3.45 (state + local) Laws in effect as of Jan 1, 2011

31 Phase I Priorities  Comprehensive Smoke-Free Policies  Price Increases  Hard-Hitting Media Campaigns  Sustained/Increased Program Funding

32 Florida Truth Campaign: Dramatic Impact on Youth Smoking Over 2 years, cigarette use plunged 40% among middle- school students and 18% among high-school students

33 Farrelly et al. The Influence of the National truth Campaign on Smoking Initiation. AJPM Research finding: more truth® ad exposure, less risk of beginning to smoke among teens Annual media buy down from $100 million in 2000 to $30 million today National truth® Campaign

34 CDC’s National Tobacco Education Campaign “Tips from Former Smokers” National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health

35

36 Week 1 Metrics  Campaign website : 230,000 page views  Terrie ad: viewed over 240,000 times  Quitline calls doubled U.S. Total Quitline Calls: March 1-26 Campaign Launch

37 Phase I Priorities  Comprehensive Smoke-Free Policies  Price Increases  Hard-Hitting Media Campaigns  Sustained/Increased Program Funding

38 Immediate Impact of a Comprehensive Approach: Youth and Adult Smoking Rates in NYC Source: BRFSS 1993 – 2001; NYC Community Health Survey 2002 – 2010; and NYC YRBS Percent 3-yr. average 21.6%21.5% 21.7% 21.5% 19.2% 18.3% 18.9% 17.5% 16.9% 15.8% City and State tax increases Smoke-free policy Media campaign 17.6% 14.8% 11.2% 8.5% 8.4% 15.8% State and Federal Tax increases 7% 14%

39 Long-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 billion Rates 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,

40 State Tobacco Revenue (taxes and settlement funds) State Tobacco Program Budgets $0.45 billion Total CDC- Recommended Spending Level Tobacco Industry Marketing & Promotion Spending (2008) $25.3 billion $3.7 billion Federal Cigarette Tax Revenues $15 billion Tobacco Industry is Outspending Prevention Efforts  23:1 Source: Campaign for Tobacco Free Kids, Federal Trade Commission, CDC Office on Smoking and Health $10.5 billion

41  The average state cigarette excise tax increased from $1.11 at the end of 2007 to $1.46 today  Total state spending on tobacco control decreased from $717 million in FY2008 to $457 million in FY2012 State Taxes vs. State Spending + 32% - 36%

42 Key CDC Tobacco Prevention Activities  National Tobacco Control Program  Funding and support to 50 states, D.C., U.S. territories, tribes, national organizations.  Community Transformation Grants  Community-level efforts in 61 states and communities  Funded by Affordable Care Act’s Prevention and Public Health Fund  “Next Generation” of Communities Putting Prevention to Work  National Tobacco Education Campaign  TV, radio, print, billboards, theater, bus shelters, and digital ads  Funded by the Prevention and Public Health Fund

43  FDA given authority to regulate sales, advertising, and ingredient content of tobacco  Prohibits candy flavoring and misleading terms  introduces new youth access provisions  Requires new warnings for cigarettes, smokeless tobacco Family Smoking Prevention and Tobacco Control Act of 2009

44  Federal lawsuit challenging FDA’s regulatory authority  Federal lawsuit challenging graphic warning labels Injunction has placed new warnings on hold for now  Continued lawsuits in states and communities against smoke-free, point of sale policies Legal Challenges

45 A Self-Fulfilling Prophecy? Let’s Help!

46 Thank You! Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Building a Legacy of Tobacco-Free Communities


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