Presentation on theme: "Texas Department of State Health Services"— Presentation transcript:
1 Texas Department of State Health Services Tobacco 101Barry Sharp, MSHP, CHESTexas Department of State Health Services
2 Tobacco = ProblemNationally – One person dies every 72 seconds from a tobacco related cause.Texas – One person dies every 22 minutes from a tobacco related cause.1,140 youth take up smoking every day; one third of them will die from their habit.
3 Tobacco = Problem In Comparison, Every two and a half days, tobacco’s death toll on Americans equals the number of deaths from the terrorist attacks on September 11, 2001.In 2006, alcohol-related car wrecks claimed the lives of 1,677 Texans. Tobacco kills more Texans each month.
5 Former U.S. Surgeon General Tobacco use will remain the leading cause of preventable illness and death in this Nation and a growing number of other countries until tobacco prevention and control efforts are commensurate with the harm caused by tobacco use.David Satcher, MD, PhDFormer U.S. Surgeon GeneralReducing Tobacco Use, A ReportOf the Surgeon General
6 Tobacco 101 Prevalence Tobacco – Products & Chemistry The Tobacco IndustryHealth EffectsTobacco LawsPro-Health InitiativesThe Awareness ClassBest Practices for Schools
7 Tobacco’s Human Toll 9.5% middle school students smoke. 24.7% of high school students smoke.18.1% of adults smoke.Deaths in Texas from smoking:24,200 adults each year503,000 youth alive today will die prematurely from smoking2,660 to 4,720 adults, children and babies die from diseases caused by secondhand smoke and pregnancy smoking
8 Tobacco’s Economic Toll Texas Economic costs:$1.6 billion in Medicaid$5.83 billion overall health costs$10.3 million in fire loss$11.7 million in highway trash cleanup$6.44 billion in lost productivityState and federal tax burden from smoking-caused government expenses - $630 per householdEach pack of cigarettes sold costs the United States $10.28 in health care related costs and lost productivity.
9 Big Tobacco’s Spending $13.36 billion – tobacco industry marketing expenditures nationwide in 2005.$884.7 million – estimated portion spent in Texas for marketing in 2005.$37.63 for every Texas resident$28.05 every second$254,500 – political contributions, ‘01-’061 of 2 U.S. Senators from Texas23 of 32 U.S. Representatives from Texas
18 Texas Synar Rates Federal Tobacco Sales Inspection
19 How Youth Get Tobacco Methods used by middle school students: Gave someone else money to purchaseBorrowed from someone willing to shareStole (often from parents)Other (i.e. Internet)Methods used by high school students:BorrowedBought in store & not asked for ID
20 Youth Cessation More than half of youth smokers: Tried to quit in the past 12 monthsWant to completely stop smokingTried to quit at least twiceAbout 8 of 10 current youth smokers:Think they would be able to quit smoking if they wanted.
21 NicotineNaturally occurring addictive substance. Created by nature as an insecticide. (Commercial use banned by EPA.)Enters the blood stream and travels to brain in less than 10 seconds.Affects brain cells responsible for memory and mood control.Stays active for minutes.
22 Nicotine Immediate Effects: Long-term Effects: Increased heart rate Blood vessels constrictLower skin temperature“Head rush”Long-term Effects:High blood pressureBlockage of blood vesselsReduced effectiveness of immune systemWrinkling of skin
23 Effects on the Brain Dopamine – pleasure, appetite suppression Norepinephrine – arousal, appetite suppressionAcetylcholine – arousal, cognitive enhancementVasopressin – memory improvementSerotonin – mood modulation, appetite suppressionBeta-endorphin – reduction of anxiety and tension
24 What do tobacco companies think of kids? Philip Morris: “Today’s teenager is tomorrow’s potential regular customer….”RJ Reynolds: “…the year old group is an increasing segment of the smoking population. RJR-T must soon establish a successful new brand in this market .…”
25 What do tobacco companies think of kids? Brown & Williamson: “Kool’s stake in the 16- to 25-year-old population segment is such that the value of this audience should be accurately weighted and reflected in current media programs all magazines will be reviewed to see how efficiently they reach this group.”Lorillard Tobacco: “The base of our business is the high school student.”U.S. Tobacco: “Cherry Skoal is for somebody who likes the taste of candy, if you know what I’m saying.”
26 Tobacco MarketingTobacco companies spent $13.36 billion on U.S. advertising in 2005.$25,419 per minute$ per secondDSHS marketing budget for 2006$1.5 million for settlement area$730,000 for statewide media$4.24 per minute (total for both campaigns)7 cents per second (total for both campaigns)
27 Tobacco MarketingDuring the 22-minute interval between the deaths of Texans from tobacco-related causes, the tobacco industry will spend more than $37,000 in Texas to make their products appealing in order to replace their dying customers.How’s that as a reward for customer loyalty?
29 U.S. Cigarette Consumption (In billions of individual cigarettes)
30 Does Marketing Work?81.3 percent of youth (12-17) smokers prefer Marlboro, Camel and Newport – three heavily advertised brands.Marlboro, the most heavily advertised brand, constitutes almost 50 percent of the youth market but only about 40 percent of smokers over age 25.Youth recall seeing tobacco ads almost 3:1 over adults.
31 Marlboro Man - AltriaMost successful and longest running campaign in tobacco advertising history. Honored by AdWeek as one of the top campaigns of the past century.Campaign originated in early 1960s.Images of masculinity and rugged individualism appeal to adolescents struggling to define themselves.Originally marketed as a woman’s cigarette.
32 Joe Camel – R.J. ReynoldsIntroduced in Voluntarily removed from market in 1997.During campaign, Camel’s share of the children’s cigarette market increased from less than 1% to more than 32% by 1993.Joe Camel was as familiar to 6-year-olds as Mickey Mouse.
33 Internet MarketingIn 2000, there were 40 web sites selling tobacco. By 2002, the number ballooned to 200 U.S. and 200 foreign web sites.Most sellers fail to pay taxes.Most do not enforce or ignore age requirements.Texas and Maine regulate tobacco sales over the Internet; New York and Connecticut ban it completely.
34 Health Effects – Short Term Shortness of breathSmell in hair and clothesDiscolored teeth and skinAvoided by non-smokersFinancial costs (Pack/day = $1,700+)
35 Health Effects – Long Term Cancers of the lung, larynx, oral cavity, pharynx, esophagus, bladder, pancreas, uterine, cervix and kidneyHeart DiseaseCerebrovascular Accidents (stroke)Chronic BronchitisEmphysema
36 CessationSmoking cessation is more cost effective than other commonly provided clinical preventive services, including mammography, colon cancer screening, PAP tests, treatment of mild to moderate hypertension and treatment of high cholesterol.
37 Benefits of Quitting Begin within 20 minutes of quitting. Within 1 year, risk of heart disease is half that of a smoker.Within 5 years, risk of cancers of lung, mouth and esophagus are half that of a smoker.Within 15 years, risk of heart disease is that of a non-smoker.
38 Withdrawal Symptoms Withdrawal Symptoms can include: Nervousness Irritability, anger and frustrationLack of concentrationDepressionIncreased appetite and weight gainInsomnia, restlessness
39 The Texas Tobacco Players Texas Department of State Health ServicesMental Health & Substance Abuse ServicesTobacco settlement initiativeStatewide programs for prevention & controlSynar inspectionsAlcohol, tobacco and other drugs prevention & treatmentComptroller of Public AccountsCigarette & tobacco retailer permits/taxesEnforcement & criminal investigationGrants to law enforcement agencies
40 Texas Department of State Health Services Tobacco Staff Region 1 – PanhandleSherri Scott, CanyonRegion 2/3 – North TexasBetty Boenisch, ArlingtonRegion 4/5 – East TexasLana Herriman & Dreka Strickland, TylerRegion 6/5 – Southeast TexasDebbie Melecio, HoustonRegion 7 – Central TexasSylvia Barron & Lance Starzyck, TempleRegion 8 – South TexasRick Meza, San AntonioRegion 9/10 – West TexasBecky Zima & Sandra Herrera, El PasoRegion 11 – Rio Grande ValleyMartha Gonzalez, Harlingen
41 Legislative Interventions While prevention is always the best method, and is a key focus of the Texas Department of State Health Services and other anti-tobacco advocates, kids are still using tobacco products.The Texas Legislature in the 1990s passed two major bills aimed at curbing tobacco abuse by minors.
42 Tobacco at Schools Education Code, Section 38.006 (passed 1995) The board of trustees of a school district shall:Prohibit smoking or using tobacco products at a school-related or school-sanctioned activity on or off school property;Prohibit students from possession of tobacco products at a school-related or school-sanctioned activity on or off school property.Ensure that school personnel enforce the policies on school property.
43 Selling Tobacco Health & Safety Code, Section 161. 081-161 Selling Tobacco Health & Safety Code, Section Tax Code, Sections , , , , – ( Passed 1899, Modified 1989, 1997)Maintains existing penalty for store clerks who sell tobacco to a minor.Photo identification to verify anyone under the age of 27.Specified signage to include language that it is both illegal to sell to a minor and for minors to purchase tobacco.
44 Selling Tobacco (cont’d.) Restricts vending machines and self service sales to places not open to those under the age of 18.Prohibits the giveaway of free samples and coupons to anyone under 18.Prohibits the sales of cigarettes of less than 20 per package.Requires a fee for a retail permit to sell tobacco. Penalty for violations is $500 to $1,000, suspension or revocation of permit.Requires employers to train employees on tobacco laws.
45 Advertising Tobacco Health & Safety Code, Section 161 Advertising Tobacco Health & Safety Code, Section (Passed 1997)Outdoor advertising is prohibited within 1,000 feet of a church or school. (Measured along roadways/property lines from sign.)Cigarette advertising is in limbo due to Supreme Court ruling in Lorrilard Tobacco Co. et al v. Reilly, Attorney General of Massachusetts, et al.Texas Tobacco Settlement prohibits tobacco billboards since June 24, 1998.
46 Minor Possession Health & Safety Code, Section 161-252-161 Minor Possession Health & Safety Code, Section (Passed 1997)Possession and consumption of tobacco products is Class C misdemeanor.Consequences:Fine of up to $250;8-hour tobacco awareness class;8-12 hours of community service;6 month loss or delay of driver’s license.
47 Additional Efforts Texas Tobacco Settlement Initiative Comprehensive tobacco prevention and control effort in Southeast TexasCommunity coalition building and technical assistanceTDH regional staff throughout the stateState level partnerships with other stakeholders agencies seeking synergistic outcomes through collaborative efforts
48 Recent DevelopmentsIncrease in the state cigarette tax to $1.41 per packIncreased compliance with youth tobacco laws (7.2% Synar buy rate for 2006)Increased number of local secondhand smoke ordinances across stateStatewide smoking ban proposed (but not passed)2006 U.S. Surgeon General’s report on involuntary exposure to secondhand smoke
49 New Direction From the 80th Legislature Create competitive statewide grant program allowing health departments and school districts in communities statewide to apply for funds.Dedicate $3 million in tobacco settlement funds to the Texas Education Agency for tobacco education in schools statewide.Dedicate $1 million for smokeless tobacco prevention in rural communities.Produce resource list identifying best practice and evidence-based interventions for use by organizations receiving state appropriated funds.
50 New DirectionDSHS and grantees must use only best practice or evidence-based tobacco prevention, cessation, and enforcement interventions.DSHS or its contractor must notify Comptroller’s tobacco law enforcement grantees and local sheriff’s departments in writing when Synar violations occur during the annual survey.DSHS must prepare a report on the progress of the program to the legislature.
51 Texas Youth Tobacco Awareness Program Goal is behavior modification, not punishmentIntended for year oldsProgram delivered in 8 hours in four two-hour sessions over two weeksSmall Class size, 20 participants maximum (10-12 ideal)Sessions are activity oriented
52 Risk Reduction Secondary prevention Gain knowledge and skill with each sessionAwareness and behavioral disruptionChallenges participants to make changes in tobacco use behaviorsMeets mandate of Senate Bill 55Focus is on long-term cessation
53 TYTAP StudentsAbout 20% of the youth say their primary supplier of tobacco is their parents. They also state that parents can be a big help in quitting.Social support is essential for youth desiring to quit. They need encouragement and understanding from a variety of social sources.
54 TYTAP StudentsMany youth are engaging in a variety of risky behaviors, not just tobacco use. Drawings and writings in the workbooks indicate a substantial number are involved in poly-drug use, including alcohol & illegal drugs.Some have indicated suicide fantasies and evidence of depression.
55 How does enforcement affect your community? A study of tobacco enforcement in Illinois showed:Enforcing tobacco laws led to a decrease in youth tobacco abuse and retail sales.Enforcing tobacco laws led to a decrease in other drug offenses.Enforcing tobacco laws led to a decrease in overall juvenile crime.
56 Guidelines for School Health Programs CDC’s Guidelines for School Health Programs to Prevent Tobacco Use and Addiction.Prohibit tobacco use at all school facilities and events.Encourage and help students and staff to quit using tobacco.Provide developmentally appropriate instruction in grade K-12 that address social and psychological causes of tobacco use.
57 Guidelines for School Health Programs CDC’s Guidelines continued:Provide developmentally appropriate instruction in grade K-12 that address social and psychological causes of tobacco use.Part of a coordinated school health program.Reinforced by community efforts.
58 Guidelines for School Health Programs Policy: Develop and enforce school policy developed in collaboration with all stakeholders.Prohibit tobacco useProhibit tobacco advertisingStudents receive instructionAccess to cessation programsHelp violators quit rather than punish
59 Guidelines for School Health Programs Instruction: Short & long term negative physiologic and social consequences, social influences, peer norms and refusal skills.Decrease social acceptabilityUnderstand why people start and identify more positive activitiesDeveloped skills in assertiveness, goal setting, problem solving and resisting pressure from media and peers.
60 Guidelines for School Health Programs Curriculum: Provide prevention education in grade K-12Instruction should begin in elementary and intensify in middle/junior high when exposure to older students increases initiation rates.Reinforce throughout high school years.
61 Guidelines for School Health Programs Training: Provide program-specific training on tobacco use prevention for teachers. The training should include reviewing curriculum, modeling instructional activities, and providing opportunities to practice implementing lessons. Well trained peer leaders can be an important adjunct to teacher-led instruction.
62 Guidelines for School Health Programs Family Involvement: Involve parents or families in supporting school-based programs to prevent tobacco use.Promote discussions at home about tobacco use by assigning homework and projects that involve families.Encourage parents to participate in community efforts to prevent tobacco use and addiction.
63 Guidelines for School Health Programs Tobacco-Use Cessation Efforts: Support cessation efforts among students and school staff who use tobacco. Schools should provide access to cessation programs that help students and staff stop using tobacco rather than punishing them for violating tobacco use policies.
64 Guidelines for School Health Programs Evaluation: Assess the tobacco use prevention program at regular intervals. Schools can use CDC’s Guidelines for School Health Programs to Prevent Tobacco Use and Addiction to assess whether they are providing effective policies, curricula, training, family involvement and cessation.
65 SummaryTobacco by itself is a dangerous, addictive and deadly substance.Youth tobacco use is tied to a number of major short and long term health hazards, including substance abuse.Enforcement can lead to getting youth help with tobacco abuse and other health threats.Solutions involve all community partners and institutions coming together in a collaborative and comprehensive approach.