Tobacco 101 Reducing the Problem of Tobacco Use
Our Learning Environment
Training Topics Credible Tobacco Control Resources Public Health Approach Comprehensive Programs Strategies for Success
Learning Objectives Find resources and data to help with planning and communication. Understand the benefits of using credible resources. Credible Tobacco Control Resources
Public Health Approach Learning Objectives Understand the public health approach to tobacco prevention and control. Know of effective policy interventions to reduce tobacco use.
Learning Objectives Define the components of a comprehensive tobacco prevention and control program. Understand the elements of science- based tobacco control programs. Comprehensive Programs
Strategies for Success Learning Objectives Understand how to implement strategies to reduce tobacco use in your community. Understand how to sustain your tobacco control programs long term.
Credible Tobacco Control Resources
Credible Resources 1998 Master Settlement Agreement (MSA) Tobacco Control and Prevention Attorneys general of 46 states and the four largest U.S. tobacco companies settled lawsuits against the tobacco industry for recovery of their tobacco- related healthcare costs. Tobacco companies agreed to cease certain marketing practices.
Credible Resources Provides information on the history of tobacco control. Discusses prevention and treatment interventions. Contains a set of tobacco control policies for federal and state governments. Tobacco Control and Prevention
Credible Resources Explains — Which laws are effective in reducing tobacco use. Which interventions work or do not work. Cost of interventions. How to find funds, set priorities, build community support, influence legislators, and more. Source: The Task Force on Community Preventive Services
Credible Resources Evidence-based guide developed to help states plan and establish effective tobacco control programs. October, 2007 CDC, Office on Smoking and Health Tobacco Control and Prevention
State Tobacco Activities Tracking and Evaluation (STATE) System Tobacco Control and Prevention Credible Resources CDC, Office on Smoking and Health
Credible Resources: Activity
Partners in Tobacco Control
Organizations representing populations with higher than average rates of tobacco use Not-for-profit organizations State and local governments Federal agencies Tobacco Control and Prevention
National Networks National African American Tobacco Prevention Network The National Latino Tobacco Control Network Asian Pacific Partners for Empowerment, Advocacy and Leadership The National LGBT Tobacco Control Network Break Free Alliance Ending the cycle of tobacco and poverty National Native Commercial Tobacco Abuse Prevention Network Partners in Tobacco Control Tobacco Control and Prevention Source: National Networks for Tobacco Control and Prevention
Selecting Partners: Activity Selecting Partners: Activity
Taking a Public Health Approach to Tobacco Control
The Public Health Approach Global tobacco control models: what works in the U.S. and around the world CDC recommendations for comprehensive programs Policy interventions Strategies for success
Comprehensive Programs Public health approach to tobacco control uses environmental approaches to increase the wellbeing of individuals within a community and decrease the rate of mortality and morbidity related to tobacco use.
Global Tobacco Control Model
MPOWER Six effective policies that reduce tobacco use and foster social change WHO Framework Convention
MPOWER M Monitor tobacco use and prevention policies. P Protect people from tobacco smoke. O Offer help to quit tobacco use. W Warn about the dangers of tobacco. E Enforce bans on tobacco advertising, promotion, and sponsorship. R Raise taxes on tobacco.
M POWER Monitoring — Measures the extent of tobacco use. Ensures the success of the other five policies. Helps when allocating tobacco control resources. Shows the effectiveness of tobacco control policies. Monitor tobacco use and prevention policies WHO Framework Convention
M P OWER Protect everyone from secondhand smoke. Prompt more smokers to quit. Increase the number of successful quit attempts. Reduce the number of cigarettes smoked. Discourage kids from starting to smoke. Protect people from tobacco smoke WHO Framework Convention
Smoke-Free Environments are Popular WHO Framework Convention
MP O WER Incorporate stop-smoking programs into primary care Set up quit lines Provide pharmacological treatment Look for government support for treatment of tobacco dependence Offer help to quit tobacco use WHO Framework Convention
MPO W ER Warn about the dangers of tobacco Educate everyone about the risks of tobacco use. Change the image of tobacco use (not “cool”). Print warnings with graphic pictures of the results of tobacco use on cigarette packs. WHO Framework Convention
Graphic Warnings on Cigarette Packs WHO Framework Convention
MPOW E R Regulate tobacco industry (no advertising, marketing, promoting, or sponsoring). Enforce bans on marketing tobacco. Enforce bans on tobacco companies’ sponsoring events. Enforce bans on tobacco advertising, promotion, and sponsorship WHO Framework Convention
MPOWE R Taxation is the best way to cut tobacco use. Higher taxes increase government revenue. Higher taxes help the young and the poor. Excise taxes are most effective at reducing tobacco use. Raise taxes on tobacco WHO Framework Convention
Global Tobacco Control Tobacco prevention and control is a health priority worldwide. MPOWER, when implemented and enforced, will Prevent young people from smoking. Help current smokers quit. Protect nonsmokers from secondhand smoke WHO Framework Convention
CDC Recommendations for Comprehensive Programs
Comprehensive Programs CDC, Office on Smoking and Health
Comprehensive Programs CDC Best Practices CDC, Office on Smoking and Health
Comprehensive Programs 1.Prevent the initiation of tobacco use among young people. 2.Promote quitting among young people and adults. 3.Eliminate nonsmokers’ exposure to secondhand smoke. 4.Identify and eliminate the disparities related to tobacco use and its effects among different population groups. CDC Best Practices: Four Goals
Comprehensive Programs 1.State and community interventions 2.Interventions through health communications 3.Cessation programs 4.Surveillance and evaluation 5.Administration and management CDC, Office on Smoking and Health CDC Best Practices
Comprehensive Programs CDC Recommended Annual Investment13.9 million Deaths in Delaware Caused by Smoking Annual average smoking attributable deaths1,200 Youth ages 0-17 projected to die from smoking18,000 Annual Costs incurred in Delaware from Smoking Total medical$284 million Medicaid medical$79 million Lost productivity from premature death$304 million State revenue from Tobacco Excise Taxes and Settlement FY 2006 tobacco tax revenue$86.1 million FY 2006 tobacco settlement payment$23.1 million Total state revenue from tobacco excise taxes and Settlement$109.2 million Percent revenue to fund at CDC recommended level13% CDC Best Practices
Comprehensive Programs Year CDC: National Center for Chronic Disease Prevention & Health Promotion, BRFSS Massachusetts - Percentage Current Adult Smokers Percentages
Percentages CDC: National Center for Chronic Disease Prevention & Health Promotion, BRFSS. Missouri - Percentage Current Adult Smokers Comprehensive Programs Year
Funding of State Tobacco Control Programs (2008) A Decade of Broken Promises: The 1998 State Tobacco Settlement Ten Years Later
Tobacco is now the world’s leading killer. We have the proven means to reduce tobacco use, but policy-makers are not yet applying these interventions. Michael R. Bloomberg, Mayor of New York City
Effective Policy Interventions Increase excise taxes. Enact smoke-free laws. Offer quit services.
I NCREASE E XCISE T AXES
Trends in sale of cigarettes and price of cigarettes (U.S ) Source: Robert Wood Johnson ImpactTeen Tobacco Chart Book
Trends in Smoking by Young People and Price of Cigarettes (U.S ) Source: Robert Wood Johnson ImpactTeen Tobacco Chart Book
Effect of Federal Tobacco Tax Increase Source: Free and Clear, Inc. Tax increased from 62 cents to $1.01 per pack on April 1, 2009 National Jewish Health quit lineCalls tripled Arkansas (number of calls per week) Jan 2009: 550 Mar 2009: >2000 calls Free and Clear (operator of quit lines in 17 states) 3250 calls on April 1, 2009 (date of tax increase) 369% increase in calls on Apr 1, 2009 over April 1, 2008
Source: Robert Wood Johnson ImpactTeen Tobacco Chart Book
E NACT S MOKE -F REE L AWS
Effects of Smoke-free Laws Smoke-free laws do NOT hurt business. They — Protect everyone from secondhand smoke. Prompt many smokers to quit. Increase the number of successful quit attempts. Reduce the number of cigarettes smoked. Discourage kids from starting to smoke.
O FFER Q UIT S ERVICES
Comprehensive Programs Help Adult Smokers Quit Massachusetts: Cut adult smoking by 21% from 1993 to 2000 California: Cut adult smoking by 35% from 1988 to 2007 Maine: Cut adult smoking by 12.5% from 2001 to 2004 Washington: Cut adult smoking by 30% from 1999 to 2008 New York: Cut adult smoking by 22.6% from 2000 to 2008 Source: Campaign for Tobacco-Free Kids
Comprehensive Programs Reduce Youth Smoking Ohio: Cut high school smoking by 45% from 1999 to 2003 Washington: Cut youth smoking by 50% from 2000 to 2006 Maine: Cut high school smoking by 64% from 1997 to 2007 Mississippi: Cut smoking among public middle school students by 48% in 5 years Indiana: Cut high school smoking by 42% from 2000 to 2008 Source: Campaign for Tobacco-Free Kids
We Know What Works New York’s combined comprehensive approach Excise tax increases: State: 55¢ in March 2000 and 39¢ in April 2002 State: 55¢ in March 2000 and 39¢ in April 2002 City: $1.42 in July 2002 City: $1.42 in July 2002 Smoke-free workplace laws enacted: City on March 20, 2003 City on March 20, 2003 State on July 24, 2003 State on July 24, 2003 With the help of quit services, smoking in NYC declined substantially.
City and State Combined Comprehensive Approach Adult smokers in NYC declined by 15% in just 2 years. That’s 188,000 fewer smokers.
Increase to $1.11 per pack on 3/1/00 State smoke-free law went into effect on 7/24/03 City cigarette tax increase to $1.50 per pack on 7/2/02 State cigarette tax increase to $1.50 per pack on 4/3/02 City smoke-free law went into effect on 3/30/03 NY Youth Smoking Rates City and State Combined Comprehensive Approach
We must become the change we want to see. Mahatma Gandhi
Strategies for Success
Implementing tobacco control programs locally is a process that requires community members’ time and effort. 1.Engage stakeholders. 2.Develop a strategic plan. 3.Implement the program. 4.Evaluate the program. 5.Sustain programs.
Strategies for Success Engaging Stakeholders
Strategies for Success Community mobilization “is the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the wellbeing of those people.” Engaging Stakeholders Fawcett et al., 1995
Strategies for Success Parent Organizations Parent Organizations Business Community Business Community Tribal Councils Tribal Councils Faith-Based Organizations Faith-Based Organizations Neighborhood Associations Neighborhood Associations Teachers and Other Education Professionals Teachers and Other Education Professionals Community Mobilization (State and Local) Concerned Citizens Concerned Citizens Community Leaders Community Leaders Youth Groups Youth Groups Local Boards of Health Local Boards of Health Local Health Departments Local Health Departments Professional Associations Professional Associations Medical Community Medical Community Engaging Stakeholders
Strategies for Success Engaging Stakeholders
Strategies for Success
Strategic plans are roadmaps to your organization’s destination. Strategic plans include (among other items)— Set of goals and objectives. Strategies for achieving the goals. Funding sources. Evaluation methods. Developing a Strategic Plan
Strategies for Success Implementing the Program
Strategies for Success Evaluating the Program
Comprehensive Programs Sustaining State Programs for Tobacco Control: Sustaining the Program
Comprehensive Programs COLORADO Sustaining the Program: A Success Story
Sustaining the Program Examples of Hindrances to Adequate Funding: Lobbying by tobacco companies. Political climate of “hands-off” approach to government. State budget deficits. Comprehensive Programs
Overcoming Funding Difficulties Have a well-written strategic plan that partners and politicians can easily buy into. Always look out for new sources of funding. Follow procedures in Best Practices. Have diverse, skilled, and active leaders. Evaluate your program, so you have evidence of success. Sustaining the Program Comprehensive Programs
Strategies for Success CDC’s Best Practices for Comprehensive Tobacco Control Programs Centers for Disease Control and Prevention, Office on Smoking and Health
Strategies for Success Preventing Initiation among Youth and Young Adults
Strategies for Success Preventing Initiation among Youth and Young Adults
Preventing Initiation among Youth and Young Adults Strategies for Success
Promoting Quitting Among Adults and Youth
Strategies for Success Each Year: 70% of U.S. smokers report a desire to quit. Almost 50% of people who have ever smoked have quit. Quitting often requires several attempts over a span of a few years. Promoting Quitting Among Adults and Youth CDC, Office on Smoking and Health
Smoke-free policies motivate smokers to quit. Strategies for Success Promoting Quitting Among Adults and Youth
The Health Consequences of Smoking, Surgeon General’s Report, 2006 Strategies for Success Quitting smoking has immediate and long-term benefits, reducing risks for diseases caused by smoking and improving health in general. Promoting Quitting Among Adults and Youth
Comprehensive approaches use a combination of these options and are systems-based: ♦ Brief clinical interventions ♦ Counseling ♦ Nicotine replacement therapy (NRT) ♦ Prescription NRT and medication Science-Based Treatment Options Strategies for Success Promoting Quitting Among Adults and Youth
Effective cessation outreach should include — Payment by a third party (Managed care organization or health insurance). Communication through multiple means. Training for health care providers. Worksite and health center programs. Strategies for Success Promoting Quitting Among Adults and Youth
Strategies for Success Successful strategies: Increasing the unit price for tobacco products. Organizing mass media campaigns in combination with other interventions. Reducing smokers’ out-of-pocket costs for cessation therapies. Multi-component interventions that include telephone support. Promoting Quitting Among Adults and Youth
Strategies for Success Clinical Practice Guideline “Treating Tobacco Use and Dependence” Provides recommendations for brief and intensive clinical interventions and implementing effective treatment programs. Promoting Quitting Among Adults and Youth
Strategies for Success Eliminating Exposure to Secondhand Smoke
What are the benefits of a smoke-free environment? Strategies for Success: Smoke-free Air
Strategies for Success Regulatory Efforts Mandated by ordinance Legal consequences for noncompliance Consistent and permanent for locality Precedent set by other localities Campaign target: city councils and mayors Voluntary Efforts Not mandated No consequences for noncompliance Useful as educational campaign Can be used against passing regulations Campaign target: restaurants and businesses Americans for Nonsmokers’ Rights Eliminating Exposure to Secondhand Smoke
Strategies for Success: Smoke-free Air What has been successful or unsuccessful in your community?
Strategies for Success Start on the local level. Work on a traditional council-based campaign. Develop a written campaign plan. Agree on a bottom line. Reach out. No law is better than a weak or ineffective one. American for Nonsmokers Rights and Tobacco Control Partners Eliminating Exposure to Secondhand Smoke
Strategies for Success Eliminating Exposure to Secondhand Smoke Tobacco Technical Assistance Consortium
Americans for Nonsmokers’ Rights Smoke-free environments Avoid the “minors only” trap... ♦ Secondhand smoke is dangerous to everyone. ♦ Smoke-free policies are to protect the public and employees. ♦ “Minors only” is difficult to enforce. Strategies for Success Eliminating Exposure to Secondhand Smoke
Smoke-free environments Avoid the “ventilation” trap... ♦ No ventilation system can remove the dangers of secondhand smoke. ♦ All employees deserve smoke-free workplace. ♦ Businesses have to make large capital investment. ♦ It will be more difficult to pass stronger legislation in the future. Americans for Nonsmokers’ Rights Strategies for Success Eliminating Exposure to Secondhand Smoke
Smoke-Free Environments Avoid the “smoke-free hours” trap... Employees deserve consistent protection. Mixed messages lead to confusion and low compliance. Enforcement becomes difficult and taxing. Strategies for Success Eliminating Exposure to Secondhand Smoke
Smoke-Free Environments Avoid the “hardship” trap... ♦ Don’t allow permits, licenses, and tax incentives – they imply financial losses will accompany smoke-free policy. ♦ Smoke-free laws have been shown to increase sales tax income. Strategies for Success Eliminating Exposure to Secondhand Smoke Americans for Nonsmokers’ Rights
Strategies for Success Preemption When a state law conflicts with federal law, the federal law preempts — or trumps — the state law. When a state law conflicts with a local ordinance, state law preempts the local ordinance. Americans for Nonsmokers’ Rights Eliminating Exposure to Secondhand Smoke
Preemption in Tobacco Control Local ordinances (laws) — Are easier to enact. Have better compliance and enforcement. Contribute to societal rejection of tobacco. Are more difficult for big tobacco to combat. Americans for Nonsmokers’ Rights and National Cancer Network Eliminating Exposure to Secondhand Smoke Strategies for Success
“...At the town meeting, we’re almost always killed. At the board of health level, we do better. At the city council level, we do very well. And at the state level we do great.” Eliminating Exposure to Secondhand Smoke
Tobacco industry tactics against preemption are REAL. “We introduce legislation of our own to scatter the resources of antis.” From memo by Tina Walls, Vice President, State Government Affairs, Philip Morris. Americans for Nonsmokers’ Rights Strategies for Success Eliminating Exposure to Secondhand Smoke
Strategies for Success Identifying and Eliminating Disparities
Strategies for Success Questions to ask yourselves: How do we plan to reach out to populations with tobacco-related disparities? Who from those populations can serve as spokespersons? What activities and program strategies are effective with each of these populations? Identifying and Eliminating Disparities
To make a difference is not a matter of accident, a matter of casual occurrence of the tides. People choose to make a difference. Maya Angelou
Communities of Excellence Restrictions on tobacco ads Identifiable tobacco control funds/staff High taxes on tobacco No sales of tobacco to minors Public education campaigns Cessation services Tobacco-free public places and worksites Detailed plan of action Monitor & counter tobacco influence Tobacco-free school campuses Communities of Excellence Plus in Tobacco Control
Conclusion We know what works... What works are comprehensive programs that use a public health approach: Increase excise taxes on tobacco. Enact and enforce smoke-free air laws. Provide systems-based cessation services. When we apply what we know works...we can realize our own potential.
Review
Public Health Approach Locate resources and data to help with planning and communication. Understand the benefits of using credible resources. Understand the public health approach to reducing tobacco use. Know of effective policy interventions. Review Credible Tobacco Control Resources
Comprehensive Programs Strategies for Success Define the components of a comprehensive tobacco prevention and control program. Understand elements of science-based tobacco control programs. Review Understand how to implement strategies at the community level for successful outcomes. Understand how to sustain your tobacco control programs.
Tobacco Technical Assistance Consortium Rollins School of Public Health Emory University Atlanta, Georgia To Contact: Phone: