1. Protecting Children and Families from Tobacco: Leadership Advocacy Training Jonathan D. Klein, MD, MPH AAP Associate Executive Director and Director, Julius B. Richmond Center

2. Sponsoring Partners American Academy of Pediatrics American Academy of Pediatrics American Medical Association American Medical Association American Academy of Family Physicians American Academy of Family Physicians American Congress of Obstetrics and Gynecology American Congress of Obstetrics and Gynecology American College of Physicians American College of Physicians

3. Funders Grant support to the American Academy of Pediatrics from: DHHS – National Technical Assistance to the Communities Putting Prevention to Work Program Flight Attendant Medical Research Institute (FAMRI) Legacy Unrestricted donation from: Pfizer, Inc.

5. …dedicated to eliminating children’s exposure to secondhand smoke and tobacco.

6. Global State of Tobacco Control 2011 WHO Report on the Global Tobacco Epidemic: Tobacco use continues to be the leading preventable cause of premature death and disease worldwide 6 million people die each year due to tobacco related illnesses, most of these in low- and middle-income countries This disparity is expected to widen, with deaths expected to increase to > 8 million a year by 2030 700 million children – almost half of the world’s children - are exposed to secondhand smoke

7. US Tobacco Control Tobacco is the leading cause of preventable death and disease in the United States, too Approximately 443,000 die each year 19.3% of adults >18 years smoked in 2010 (45 million)

8. Secondhand Smoke Exposure An estimated 88 million nonsmokers were exposed in the United States in 2007-2008 Children are at particular risk for exposure Only 5.4% of adult nonsmokers live with a smoker Among children: –41.1% exposed to SHS at home –54.9% exposed to SHS in public places Global Youth Tobacco Surveillance, 2000—2007 cdc.gov/preview/mmwrhtml/ss5701a1.htm cdc.gov/preview/mmwrhtml/ss5701a1.htm

9. Secondhand Tobacco Smoke Children exposed to SHTS have greater risk/rates of:Children exposed to SHTS have greater risk/rates of: Decreased lung functionDecreased lung function AsthmaAsthma Sudden Infant Death SyndromeSudden Infant Death Syndrome Upper and lower respiratory track infections; pneumonia and bronchitisUpper and lower respiratory track infections; pneumonia and bronchitis Ear infectionsEar infections Neuro-cognitive delay and behavior problemsNeuro-cognitive delay and behavior problems Increased adult risk of:Increased adult risk of: LLung cancer and leukemias HHeart disease, lipid disorders, and metabolic syndrome Smoking themselvesSmoking themselves

10. Screening Are we asking the right questions?

11. WHO MPOWER Package Monitor tobacco use and prevention policies Protect people from tobacco smoke Offer help to quit tobacco use Warn about the dangers of tobacco Enforce bans on tobacco advertising, promotion and sponsorship Raise taxes on tobacco.

12. HHS Strategic Plan Ending the Tobacco Epidemic Accelerate progress for four Healthy People 2020 goals: Reduce tobacco use by adults and adolescents Reduce initiation of tobacco use among children, adolescents, and young adults Increase successful cessation by smokers Reduce nonsmokers exposure to secondhand smoke Support FDA regulation of manufacture, marketing, and distribution of tobacco products

13. Conference Goals To improve the spread and effectiveness of clinical services for tobacco cessation To engage health care organizations in state, county and local community policy advocacy for better access to tobacco control services.

14. Tobacco Control “Champions” Identify at least two qualities physicians bring to advocacy. Describe trends in tobacco use and secondhand smoke prevention. Identify risk factors for initiation and barriers to cessation. Advocate for coverage of tobacco cessation and pharmacotherapy. Educate private and public leaders about tobacco control policiess, cessation and pharmacotherapy. Articulate at least two policy changes to improve tobacco control. Identify opportunities for tobacco advocacy in states and communities. Develop a commitment to change, advocacy goals and strategies.

18. Tobacco Advocacy and Policy Issues

20. Adolescent and Adult Smokers Know they are addicted and want to quitKnow they are addicted and want to quit Many have tried to quit without successMany have tried to quit without success Younger smokers less likely to think there are resources to helpYounger smokers less likely to think there are resources to help Many clinicians feel unprepared to helpMany clinicians feel unprepared to help With advice, most parents say they would be able to set strict smoking policies

21. Evidence-based best practices Increase price/taxation of tobacco Smoking bans and restrictions Counseling – reframe expectations of successCounseling – reframe expectations of success –5A’s - Ask, Advise, Assess, Assist and Arrange –Strict No Smoking Rules - Smoke-free homes and cars Availability of treatment –Reduced cost for pharmacotherapy treatment –Provider reminder systems –Telephone/web counseling and support Mass media counter-marketing campaigns

22. Community and public health Make tobacco control for children and youth a priority –Include secondhand smoke –Headstart, schools, housing, etc. Age of sale restrictions and enforcement Advertising limitations Smokefree Movies Public smoke exposure reduction Do not allow preemptive efforts by tobacco industry Reduce social acceptability of smoking

23. Exposure to Tobacco Use in Movies and Smoking Among 5th-8th grader Adapted from Sargent, DiFranza, 2003 8 th Grade 7 th Grade 6 th Grade 5 th Grade

24. Smoke Free Movies Rate new smoking movies "R" Certify no pay-offs Require strong anti-smoking ads Stop identifying tobacco brands