1. Tobacco Control Integration Project (TCIP) Addressing the Burden of Tobacco Use in Populations with Fewer Resources

2. Why TCIP?

4. By SES: What Percent Smoke? Oregon BRFSS Low SES Not Low SES 44% 34% 19% 13%

5. Defining Low Socio-Economic Status Low SES if: Did not graduate high school Did not graduate high school HH income is less than $25K HH income is less than $25K On Oregon Health Plan On Oregon Health Plan Uninsured Uninsured

8. By Low-SES: What about Secondhand Smoke? Smoking Ban In the Home Low SES Not Low SES Oregon BRFSS

9. What about Secondhand Smoke? Smoking In Homes with Kids Low SES Not Low SES Oregon BRFSS

10. Medicaid Burden In 2007, adult smoking prevalence: In 2007, adult smoking prevalence: 37% - Medicaid recipients - adults 37% - Medicaid recipients - adults 19% - Oregon adults 19% - Oregon adults

11. Financial costs to Medicaid in Oregon Medicaid costs for smoking related disease: Medicaid costs for smoking related disease: $287 million per year

12. E xposure to Smoking in the Womb Oregon Birth Files Births paid by Medicaid All births

13. Intention to Quit Smoking by SES, Oregon, 2007 Oregon BRFSS 2007 Do not want to quit Plan to quit in 6 months Plan to quit in 30 days

14. RJ Reynolds, chew addict, died from pancreatic cancer (according to the WWW which is always accurate)

16. What is TCIP? What the Tobacco Prevention and Education Program knows about What the Tobacco Prevention and Education Program knows about tobacco control + tobacco control + What DHS/OHA Divisions know about their clients and workforce = What DHS/OHA Divisions know about their clients and workforce = TCIP! TCIP!

17. Tobacco Control Integration Project DHS/OHA touches 1 million Oregonians yearly DHS/OHA touches 1 million Oregonians yearly Weaving Tobacco Prevention and Education throughout DHS/OHA Weaving Tobacco Prevention and Education throughout DHS/OHA Policy and procedure changes Policy and procedure changes Projects in each Division of DHS/OHA Projects in each Division of DHS/OHA

18. Temporary Assistance to Needy Families In April ‘09, TANF served 25,178 one and two parent families. The current maximum benefit for a family of three is $528. In April ‘09, TANF served 25,178 one and two parent families. The current maximum benefit for a family of three is $528. Over a third of the adults in those families smoke. Over a third of the adults in those families smoke.

19. TANF, Cont. At $4.00 per pack, a two pack per day smoker spends $240 per month on cigarettes At $4.00 per pack, a two pack per day smoker spends $240 per month on cigarettes If both adults smoke, they may easily spend more on cigarettes than they receive through TANF If both adults smoke, they may easily spend more on cigarettes than they receive through TANF

20. Food Stamps In April ’09, over 300,000 households and almost 600,000 persons received food stamps. In April ’09, over 300,000 households and almost 600,000 persons received food stamps. This is more than a tenth of our population This is more than a tenth of our population Over a third of these Oregonians smoke Over a third of these Oregonians smoke

21. Food stamps In 2007, the average family food stamp benefit was $127 per month. In 2007, the average family food stamp benefit was $127 per month. A one-pack per day smoker spends about $120 per month on cigarettes. A one-pack per day smoker spends about $120 per month on cigarettes.

22. Food Insecurity Archives of Pediatric and Adolescent Medicine, 2008: Archives of Pediatric and Adolescent Medicine, 2008: Living with adult smokers doubles the rate of adult and child food insecurity and triples the rate of severe food insecurity. Living with adult smokers doubles the rate of adult and child food insecurity and triples the rate of severe food insecurity.

23. Vs.

24. Divisions of the Department of Human Services (DHS) and the Oregon Health Authority (OHA) include: Public Health Division Public Health Division Addictions and Mental Health Division Addictions and Mental Health Division Division of Medical Assistance Programs Division of Medical Assistance Programs Children, Adults and Families Division Children, Adults and Families Division Seniors and People with Disabilities Seniors and People with Disabilities Administrative Services Division Administrative Services Division

25. What is TCIP doing now? Projects include: Contract language Contract language Website buttons Website buttons Targeted mailings Targeted mailings Quit Line promotion Quit Line promotion Home Care workers Home Care workers

28. But what is TCIP REALLY doing?? Changing systems, policies and procedures to create sustainable environmental support for becoming and remaining tobacco-free. Changing systems, policies and procedures to create sustainable environmental support for becoming and remaining tobacco-free.

30. ARRA Goals To increase 100% tobacco-free or smokefree policies in facilities serving DHS/OHA clients To increase 100% tobacco-free or smokefree policies in facilities serving DHS/OHA clients To increase policies requiring promotion of, access to and delivery of cessation resources to DHS/OHA clients and employees To increase policies requiring promotion of, access to and delivery of cessation resources to DHS/OHA clients and employees

31. ARRA Goals, Cont. To implement a hard hitting counter- advertising campaign targeted to people with fewer resources To implement a hard hitting counter- advertising campaign targeted to people with fewer resources To raise the price of tobacco by 10% To raise the price of tobacco by 10%

32. Vision Clients and employees of DHS have improved health and quality of life due to the elimination of tobacco use and exposure to secondhand smoke. Mission Tobacco use reduction is an integral part of work in each division of DHS.