1. Louisiana and Tobacco Jennifer Burris Director of Health and Wellness Programs Southwest Louisiana Area Health Education Center

2. Tobacco 438,000 deaths – the number of American deaths-per-year caused by smoking. In Louisiana, an estimated 6,400 adults die each year from smoking. Another 650-1,150 people die each year from the effects of exposure to secondhand smoke. Tobacco use is the single most preventable cause of death in Louisiana and the United States. * Secondhand smoke is the third leading cause of preventable death in the U.S. * * Centers for Disease Control and Prevention MMWR — Annual Smoking– Attributable Mortality, Years of Potential Life Lost, and Productivity Losses — United States, 1995–1999. 2002 / Vol. 51

3. Health Care Cost In Louisiana Smoking costs more than $1.15 billion each year in direct medical costs. Louisiana spends $518 million each year in Medicaid funds to treat tobacco related illnesses. An additional $1.66 billion in lost productivity For a total of $2.8 billion in direct and indirect medical costs annually

4. Louisiana Laws

5. Act 815 – Smoking is no longer allowed in Restaurants, school campuses, work places and other public buildings. Gave local control back to the local government. Act 838 – No smoking in a car if a child 13 and under is present, even if the window is down FDA Regulation - A piece of legislation that would give the U.S. Food and Drug Administration (FDA) authority over manufactured tobacco products.

6. What does the New FDA regulation include The Family Smoking Prevention Tobacco Control Act No health Claims (low tar, light, reduced) Outlaws most tobacco flavoring Ingredients made public Advertising and marketing strictly regulated(1000ft) Black and White warning labels 50%of cigarette packs 30% of smokeless tobacco cans Black and white print

7. Components of a Comprehensive Tobacco Approach According to the Centers for Disease Control Best Practices 1.Enact meaningful legislation and policy Limit access, availability Clear stance on health concerns Clean indoor air

8. Components of a Comprehensive Tobacco Approach 2. Taxation Associated with prevention, cessation, and reduction in use 3. Prevention and Counter Advertising Minimize the replacement of tobacco users who die with new users Accurate portrayal of tobacco and its health-damaging and other effects 4. Cessation Programs Intensity of the treatment Delivery systems

9. Why is all of this necessary?

10. Who The Tobacco Industry Target? Heavily Targeted Louisianans African Americans & Asian Americans Hispanics and Latinos & Native Americans Low Socio-economic status Lesbian, Gay, Bisexual and Transgender community Disabled/Mentally Ill and Veterans Youth 11-17 Blue Collar Workers and Rural Citizens Young Adults 18 – 24 (straight to work and college)

11. Marketing $13 billion – the amount Big Tobacco spends on promotions and advertising. The tobacco industry spends 285 million dollars annually in Louisiana to attract new smokers and ensure that current smokers keep smoking.

12. RJ Reynolds At R.J. Reynolds Tobacco Company we operate our business in a responsible manner that best balances the desires of our many stakeholders. Our Guiding Principles and Beliefs seek to reflect the interests of shareholders, consumers, employees, and other stakeholders. In particular, R.J. Reynolds is committed to addressing the issues regarding the use of and harm associated with tobacco products in an open and objective manner. ….we are principled, creative, dynamic and passionate

13. Other Industry Quotes We don’t smoke the Sh**, we just sell it. We reserve that for the young, the black, the poor and the stupid.” -RJ Reynolds Executive “We are more interested to learn how you plan to target the emerging young adult female smokers rather than the older female smokers” - Phillip Morris 1989

16. According to the Campaign for Tobacco-Free Kids, in the last two years, the industry has launched its most aggressive marketing campaigns aimed at women and girls in over a decade.

17. Where Do we go from here?

18. What Works? PHS (2008) Recommendations 1. Tobacco Dependence is a chronic condition Often requires repeated interventions, multiple attempts to quit 2. Consistency is Key 3. Treatments are effective across populations 4. Brief tobacco dependence treatment is effective 5. Individual, group, and telephone counseling are effective Effectiveness increase with treatment intensity 2 components are particularly effective: practical counseling (problem solving/skills training); social support delivered as part of the treatment U.S.Department of Health and Human Services, Public Health Service

19. What Works? Continued 6. Medications work, and their use should be encouraged 7. Counseling and medications are effective, but the combination is more effective than either alone 8.Quitline counseling is effective and has broad reach

20. Symptoms of Withdrawl Know what to expect

21. Primary Symptoms of Nicotine Withdraw o Insomnia o Evident 1 st day of quitting o Primarily sleep fragment o Some report decrease in sleep latency o Peaks within 1-3 days o Lasts 3-4 weeks o Irritability/ frustration/anger o can last> 1 month o 80% of quitters endorse this o Anxiety o Often evident prior to quit attempt o Peaks within days o Lasts 3-4 weeks

22. Primary symptoms of Nicotine Withdraw Dysphoric/depressed mood Can last > 1 month Difficulty Concentrating Evident 1 st day of quitting Peaks within 1-3 days Lasts 3-4 weeks Generally mild Restlessness Lasts < 1 month Perceived as highly aversive

23. Primary Symptoms of Nicotine Withdraw Increased Appetite/Weight gain Appetite change lasts 10 weeks Expect 5-7 pounds of weight gain Will loose when metabolism stabilizes Decreased Heart Rate Average decrease is 10 bpm

24. Nicotine Replacement Therapies NRT Therapeutic effect Primarily reduces withdrawal symptoms May provide some positive effects reduce negative mood returns concentration to normal suppression of weight gain associated with cessation May replace oral and handling aspects of the habit (gum, inhaler, lozenge)

25. Nicotine Replacement Therapies Nicotine Transdermal Patch (nicoderm,nicotrol,habitrol) Nicotine Polacrilex Gum (Nicorette) Nicotine Inhaler (nicotrol) px only Nicotine Nasal Spray (nicotrol NS) px only Nicotine Lozenge (commit)

26. Pharmacologic Options Non-nicotine products (FDA approved) zyban/wellbutrin (Bupropion) Chantix (varenicline) Please ask you health care provider what works best for you

27. Resources To Quit www.quitwithusla.org www.BecomeAnEx.org www.ffsonline.com 1.800.Quit Now M.D. Anderson www.latobaccocontrol.com www.tobaccofreeliving.org www.tobaccofreekids.org www.cdc.gov/tobacco/osh Additional Tobacco Resources

28. More Resources How to quit smoking: QuitNet Committed Quitters Online The Quit Smoking Company Try to Stop You Can Quit Smoking Smokefree.gov (U.S. Government) Smokefree.gov No Smoke (anti-smoking software) No Smoke

29. More Resources Products to help smokers quit: NicoDerm CQ (nicotine patch) NicoDerm CQ Nicorette (nicotine chewing gum) Nicorette Nicotrol (nicotine inhaler, spray, and patch) Nicotrol Zyban (a nicotine-free prescription pill) Zyban Chantix ( a nicotine-free prescription pill) Chantix

30. More Resources Books on smoking cessation: Seven Steps to a Smoke-Free Life Quit Smoking for Good The Stop Smoking Workbook Dying to Quit You Can Stop Smoking Freshstart: 21 Days to Stop Smoking Keep Quit! A Motivational Guide Out of the Ashes: Help for People Who Have Stopped Smoking Out of the Ashes: Help for People Who Have Stopped Smoking

31. More Resources Research organizations: American Cancer Society American Lung Association Centers for Disease Control National Cancer Institute Society for Research on Nicotine and Tobacco Society for Research on Nicotine and Tobacco

32. More Resources Research reports: U.S. Surgeon General Reports U.S. Centers for Disease Control Reports World Health Organization Reports Morbidity and Mortality Weekly Reports Social Climate of Tobacco Control Cigarettes: What the Warning Label Doesn't Tell You Research teams: Center for Tobacco Control Research Tobacco-Related Disease Research Program Center for Tobacco Research and Intervention Michigan Nicotine Research Laboratory Ontario Tobacco Research Unit Tobacco Use Behavior Research Research for International Tobacco Control Research Network on the Etiology of Tobacco Dependence

33. Jennifer Burris Director of Health and Wellness Programs SWLA AHEC 103 Independence Blvd. Lafayette, LA 70506 337.989.0001 –office 337.989.1401 – fax advocacy@swlahec.com www.swlahec.com