1. 2016 Tobacco-Free Nebraska State Conference Social Determinants of Health: Tobacco Prevention and Control Dwana “Dee” Calhoun, MS-SMHN Director April 21, 2016 Nebraska

2. Mission

3. SMHN Leadership Council Reference: http://www.selfmadehealth.org/about/network-leadership-council/

4. Tobacco-Related Disparities (1) Disparities associated with tobacco-related disease burden, secondhand smoke exposure and initiation behavior among adults exist by income level, industry type and other relevant characteristics:  Lower income cigarette smokers may encounter more barriers, as a result suffer more from diseases caused by smoking compared to smokers with higher incomes.  Blue-collar workers are more likely to start smoking cigarettes at a younger age and to smoke more heavily than white-collar workers.  Populations with low socioeconomic status (SES) characteristics are more likely to suffer the harmful health consequences of exposure to secondhand smoke. Reference: CDC-Cigarette Smoking and Tobacco Use Among People of Low Socioeconomic Status http://www.cdc.gov/tobacco/disparities/low-ses/index.htm

5. Tobacco-Related Disparities (2) Disparities in smoking duration and cessation rates among adults exist by level of income and highest level of education:  Populations living in poverty smoke cigarettes for a duration of nearly twice (2x) as many years compared to populations with a family income of three times the poverty rate.  Adults who live below the poverty level have less success in quitting (34.5%) than those who live at or above the poverty level (57.5%).  Adults with less than a high school education (9–12 years, but no diploma) have less success in quitting (43.5%) than those with a college education or greater (73.9%). Reference: CDC-Cigarette Smoking and Tobacco Use Among People of Low Socioeconomic Status http://www.cdc.gov/tobacco/disparities/low-ses/index.htm

6. Tobacco Disparities Data (1) Reference: CDC-Cigarette Smoking and Tobacco Use Among People of Low Socioeconomic Status http://www.cdc.gov/tobacco/disparities/low-ses/index.htm

7. Tobacco Disparities Data (2) Reference: CDC-Cigarette Smoking and Tobacco Use Among People of Low Socioeconomic Status http://www.cdc.gov/tobacco/disparities/low-ses/index.htm

9. Opportunities “Achieving success in substantially reducing tobacco use will require taking stock of the progress made with current tobacco prevention and control strategies and identifying where potential opportunities exists in response to emerging trends: tobacco use (including smoking) and the characteristics of behaviors of subpopulations of tobacco users (including smokers) with particular vulnerabilities.” Reference: IOM (Institute of Medicine). 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press.

10. Ten Essential Services of Public Health Reference: National Public Health Performance http://www.cdc.gov/nphpsp/essentialservices.html

11. Historical Context: Determinants of Health Reference: Novick, L. F., Morrow, C. B., & Mays, G. P. (2008). Public health administration: Principles for population-based management (2nd ed.)

12. Determinants and Social Determinants of Health (SDoH) Reference: Novick, L. F., Morrow, C. B., & Mays, G. P. (2008). Public health administration: Principles for population-based management (2nd ed.) Determinants of Health  Broad causal or contributing factors involved in influencing health and illness, including social, economic, genetic, perinatal, nutritional, behavioral and environmental characteristics. Social Determinants of Health (SDoH)  complex, integrated, and overlapping social structures and economic systems that are responsible for most health inequities.  include the social environment, physical environment, health services, and structural and societal factors.

13. Socioeconomic Status and Gradient Socioeconomic Status: composite measure that typically incorporates economic, social, and work status.  economic status (income)  social status (level of education)  work status (occupation) Socioeconomic Gradient in Health: the stepwise fashion in which health outcomes improve as socioeconomic position improves.  measured by a person's income, occupation, or the highest level of education he or she has. Reference: CDC http://www.cdc.gov/nchhstp/socialdeterminants/definitions.html

14. Determinants of Health- Healthy People 2020 Determinants of health are located in 5 general categories:  Policymaking  Social Factors  Health Services  Individual Behavior  Biology and Genetics Interventions that target multiple determinants of health are most likely to be effective.

15. SDoH: Healthy People 2020 Reference: Healthy People 2020 Objectives https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

16. Social Determinants of Health- Healthy People 2020 Five key areas of Social Determinants of Health (SDoH)  Economic Stability  Education  Social and Community Context  Health and Healthcare  Neighborhood and Built Environment

17. Social Determinants of Health- Economic Stability Examples Economic Stability  Poverty  Employment  Food Security  Housing Stability Education  High School Graduation  Enrollment in Higher Education  Language and Literacy  Early Childhood Education and Development Goals for Comprehensive Tobacco Control Programs:  Prevent initiation among youth/young adults  Promote quitting among adults and youth.  Eliminate secondhand smoke exposure.  Identify/eliminate tobacco-related disparities among population groups.

18. Cumulative Tobacco Use: Adolescent and Young Adult Period Reference: Institute of Medicine (IOM) Report-Growing Up Tobacco Free: Preventing Nicotine Addition in Children and Youth (1994)

19. Social Determinants of Health Inclusion: Potential Areas Impacted (Part 1) Opportunities Planning: Prevention and Control DataPartnershipsFundingPolicy Sustainable Outcomes

20. Social Determinants of Health- Health and Environmental Examples Health and Health Care  Access to Health Care  Access to Primary Care  Health Literacy Neighborhood and Built Environment  Access to Healthy Foods  Quality of Housing  Crime and Violence  Environmental Conditions Goals for Comprehensive Tobacco Control Programs:  Prevent initiation among youth/young adults  Promote quitting among adults and youth.  Eliminate secondhand smoke exposure.  Identify/eliminate tobacco-related disparities among population groups.

21. Development of Nicotine Addition Reference: Institute of Medicine (IOM) Report-Growing Up Tobacco Free: Preventing Nicotine Addition in Children and Youth (1994) Nicotine AddictionRegular UseExperimentationInitial AttemptPreparatory

22. Social Determinants of Health Inclusion: Potential Areas Impacted (Part 2) Opportunities Planning: Prevention and Control DataPartnershipsFundingPolicy Sustainable Outcomes

23. Social Determinants of Health- Social and Community Context Social and Community Context Social Cohesion Civic Participation Discrimination Incarceration Goals for Comprehensive Tobacco Control Programs:  Prevent initiation among youth/young adults  Promote quitting among adults and youth.  Eliminate secondhand smoke exposure.  Identify/eliminate tobacco-related disparities among population groups.

24. Social Determinants of Health Inclusion: Potential Areas Impacted (Part 3) Opportunities Planning: Prevention and Control DataPartnershipsFundingPolicy Sustainable Outcomes

25. Resources CDC-Social Determinants of Health: Know What Affects Health -includes tools, programs and policy option resources Reference: http://www.cdc.gov/socialdeterminants/http://www.cdc.gov/socialdeterminants/ CDC-Community Health Status Indicators (CHSI 2015) Reference: http://wwwn.cdc.gov/communityhealthhttp://wwwn.cdc.gov/communityhealth Please stay tuned for a listing of additional resources to be posted on the SelfMade Health Network (SMHN) website: http://www.selfmadehealth.org/http://www.selfmadehealth.org/

26. Contact Information Dwana “Dee” Calhoun, MS Director, SelfMade Health Network (SMHN) Patient Advocate Foundation (PAF)-Parent Organization 421 Butler Farm Road Hampton, Virginia 23666 Telephone # 757-509-0227 E-mail address: d.calhoun@selfmadehealth.orgd.calhoun@selfmadehealth.org Twitter: @SelfMadeHealth and @DeeCalhounSMHN Website: http://www.selfmadehealth.org/http://www.selfmadehealth.org/ Send questions or contact us at anytime via shared SMHN mailbox: info@selfmadehealth.org info@selfmadehealth.org