Tobacco Control: How is Michigan Doing? Ron Davis, M.D. Center for Health Promotion & Disease Prevention Henry Ford Health System Tobacco-Free Michigan Membership Meeting July 25, 2003 / East Lansing, Michigan

Henry Ford, 1916 How Employers Feel Toward Cigarette Smokers Here is an Automobile Company’s Attitude “Cigarette smoking is acquiring a hold on a great many boys in our community…. Since it is such a bad practice and is taking such a hold upon so many people, we think it is a disgrace for a grown man to smoke cigarettes, because it is not only injurious to his health, but it is such a bad example to the boys….” Source: Henry Ford, The Case Against the Little White Slaver, (reprinted by the Historical Society of Michigan, 1992)

Henry Ford, 1916 (continued) “Boys who smoke cigarettes we do not care to keep in our employ. In the future we will not hire anyone whom we know to be addicted to this habit. It is our desire to weed it entirely out of the factory just as soon as practicable…. “We have two objects in interesting ourselves in this matter: First, to help men and boys; second, we believe that men who do not smoke cigarettes or frequent the saloon can make better automobiles than those who do.”

MichiganAll States Adult smoking (2000)24.2%23.3% Michigan versus U.S.

MichiganAll States Adult smoking (2000)24.2%23.3% Youth smoking (grades 6-8)*9.3%11.0% * National YTS (2000); Michigan YTS (2001) Michigan versus U.S.

MichiganAll States Adult smoking (2000)24.2%23.3% Youth smoking (grades 6-8)*9.3%11.0% Youth smoking (grades 9-12)*27.6%28.0% * National YTS (2000); Michigan YTS (2001) Michigan versus U.S.

MichiganAll States Adult smoking (2000)24.2%23.3% Youth smoking (grades 6-8)*9.3%11.0% Youth smoking (grades 9-12)*27.6%28.0% Smoking-attributable death rate, 1999 (per 100,000) * National YTS (2000); Michigan YTS (2001) Michigan versus U.S.

Guide to Community Preventive Services: Tobacco Use Prevention and Control Strategies to Reduce Tobacco Use Initiation Increase the unit price for tobacco products: strongly recommended Mass media campaigns: strongly recommended (when combined with other interventions) Source: Amer J Prev Med 2001; 20 (2S): 1-88

Guide to Community Preventive Services: Tobacco Use Prevention and Control Strategies to Increase Tobacco Use Cessation Increase the unit price for tobacco products: strongly recommended Mass media campaigns: strongly recommended (when combined with other interventions) Source: Amer J Prev Med 2001; 20 (2S): 1-88

Guide to Community Preventive Services: Tobacco Use Prevention and Control Strategies to Increase Tobacco Use Cessation Multicomponent patient telephone support: strongly recommended Provider reminder system and a provider education program, with or without patient education: strongly recommended Source: Amer J Prev Med 2001; 20 (2S): 1-88

Guide to Community Preventive Services: Tobacco Use Prevention and Control Strategies to Reduce Exposure to ETS Smoking bans and restrictions: strongly recommended Community education: insufficient evidence Source: Amer J Prev Med 2001; 20 (2S): 1-88

Michigan’s Investment in Tobacco Control CDC’s Best Practices recommends: $ million / year In FY 2002, Michigan spent: –$3.9 million from state sources –$2.4 million from federal/national sources –$6.3 million total (63¢ per capita)

State Cigarette Excise Taxes, 2002 $1.51 Massachusetts $1.51 Connecticut $1.50 New York $1.50 New Jersey $1.50 Rhode Island $1.425 Washington $1.30 Hawaii $1.28 Oregon $1.25 Michigan State average = 70.5¢ Very little earmarked to health in MI

Cigarette Taxes and Prices in Selected Developed Countries, 2002 Percentages represent proportion of retail price devoted to taxes

States with Comprehensive Smoke-free Workplace Laws California – 1994, 1998 (bars) Delaware – 2002 Florida –2002 ballot initiative (71% support) –2003 law Connecticut – 2003 New York – 2003

Municipalities with 100% Smoke-Free Ordinances Source: American Nonsmokers’ Rights Foundation

Michigan Clean Indoor Air Policies Weak Michigan Clean Indoor Air Act –Does not apply to most private worksites –Allows designated smoking areas in public places (no requirement to be physically separated and separately ventilated) Weak state restaurant smoking law > 50% nonsmoking seating (> 50 seats) > 25% nonsmoking seating (< 50 seats) (no special requirements for ventilation)

Michigan Clean Indoor Air Policies (continued) State preemption of local restaurant smoking ordinances State school smoking ban applies only to public schools, and allows smoking on school grounds after school hours Few local jurisdictions have adopted comprehensive smoke-free ordinances (Ingham and Washtenaw Counties, City of Marquette)

Secondhand Smoke

Australia: Aorta

Australia: Stroke

Australia: Eye

Michigan’s Scorecard Adult smoking: C- Youth smoking: C+ Smoking deaths: C- Investment in tobacco control: D Tobacco taxes: B- Clean indoor air: D- Mass media: D- Cessation support (healthcare/quitline): C Organizational commitments: B+ Human capital: A Overall Score =

Omar Paulk Grade 8: “In the neighborhood, the phrase ‘to smoke’ means to kill someone. ‘He got smoked’ means he got killed. When smokers finish a cigarette, they say they are killing the cigarette. My drawing asks the question, Who’s Smoking Who? It means the cigarette is killing the smoker.”

James Robinson Grade 11 Cass Technical High School

Damardre Williams Grade 11 Detroit High School for the Arts

Edwin Andrews Grade 12 Renaissance High School