Tobacco 101 Reducing the Problem of Tobacco Use. Our Learning Environment

Tobacco 101Reducing the Problem of Tobacco Use

Our Learning Environment

Training TopicsCredible 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


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.



Learning Objectives

Understand how to implement strategies to reduce tobacco use in your community.

Understand how to sustain your tobacco control programs long term.


http://www.lungusa.org/press/tobacco/slati.lungusa.org

http://www.cdc.gov/mmwr/index.html

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.


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


State Tobacco Activities Tracking and Evaluation (STATE) System

Tobacco Control and PreventionCredible Resources


Credible Resources: Activity

Partners in Tobacco Control

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


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 ControlTobacco Control and Prevention

Source: National Networks for Tobacco Control and Prevention

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


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.

MPOWER

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


MPOWER

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


Smoke-Free Environments are Popular


MPOWER

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


MPOWERWarn 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.


Graphic Warnings on Cigarette Packs


MPOWER

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


MPOWER

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


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


CDC Recommendations for Comprehensive Programs

A comprehensive approach is one that optimizes synergy from applying a mix

of educational, clinical, regulatory, economic, and social strategies.

Best Practices, 2007



Comprehensive ProgramsCDC Best Practices



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


1. State and community interventions

2. Interventions through health communications

3. Cessation programs

4. Surveillance and evaluation

5. Administration and management


CDC Best Practices


CDC Recommended Annual Investment 13.9 millionDeaths in Delaware Caused by Smoking Annual average smoking attributable deaths 1,200 Youth ages 0-17 projected to die from smoking 18,000Annual Costs incurred in Delaware from Smoking Total medical $284 million Medicaid medical $79 million Lost productivity from premature death $304 millionState revenue from Tobacco Excise Taxes and Settlement FY 2006 tobacco tax revenue $86.1 million FY 2006 tobacco settlement payment $23.1 millionTotal state revenue from tobacco excise taxes and Settlement $109.2 millionPercent revenue to fund at CDC recommended level 13%

CDC Best Practices


0

5

10

15

20

25

30

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Year

CDC: National Center for Chronic Disease Prevention & Health Promotion, BRFSS

Massachusetts - Percentage Current Adult Smokers

Perc

enta

ges

0

5

10

15

20

25

30

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Perc

enta

ges

CDC: National Center for Chronic Disease Prevention & Health Promotion, BRFSS.

Missouri - Percentage Current Adult SmokersComprehensive 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.

INCREASE EXCISE TAXES

Trends in sale of cigarettes and price of cigarettes (U.S. 1970-2005)

Source: Robert Wood Johnson ImpactTeen Tobacco Chart Book

Trends in Smoking by Young People and Price of Cigarettes (U.S. 1991-2007)

27.5%

30.5%

34.8% 36.4%34.8%

28.5%

21.9% 23.0%20.0%

$2.33

$2.64$2.39 $2.39

$2.71

$3.65

$4.19$3.97 $3.93

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

$3.00

$3.50

$4.00

$4.50

0%

5%

10%

15%

20%

25%

30%

35%

40%

1991 1993 1995 1997 1999 2001 2003 2005 2007

Youth Smoking Prevalence Cigarette Pack Price (in 2007 dollars)


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 line Calls tripled

Arkansas(number of calls per week)

Jan 2009: 550Mar 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


ENACT SMOKE-FREE LAWS

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.

OFFER QUIT SERVICES

Comprehensive ProgramsHelp Adult Smokers Quit

Massachusetts: Cut adult smoking by 21% from 1993 to 2000

California: Cut adult smoking by

35% from1988 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 ProgramsReduce 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

• City: $1.42 in July 2002

Smoke-free workplace laws enacted: • City on March 20, 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.

0

5

10

15

20

25

30

35

1997 1999 2001 2003 2005

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



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 SuccessEngaging Stakeholders


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


Parent Organizations Business Community Tribal Councils Faith-Based Organizations Neighborhood Associations Teachers and Other

Education Professionals

Community Mobilization (State and Local) Concerned Citizens Community Leaders Youth Groups Local Boards of Health Local Health Departments Professional Associations Medical Community

Engaging Stakeholders

Strategies for SuccessEngaging Stakeholders



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 SuccessImplementing the Program

Strategies for SuccessEvaluating the Program

http://www.cdc.gov/tobacco/basic_information/secondhand_smoke/evaluation_toolkit/pdfs/evaluation_toolkit.pdf

http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/key_outcome/pdfs/key_Indicators.pdf

http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/process_evaluation/pdfs/tobaccousemanual_updated04182008.pdf

http://www.cdc.gov/tobacco/tobacco_control_programs/surveillance_evaluation/evaluation_manual/pdfs/evaluation.pdf


Sustaining State Programs for Tobacco Control:

Sustaining the Program


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.


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 ProgramComprehensive Programs

Strategies for SuccessCDC’s Best Practices for Comprehensive

Tobacco Control Programs

Centers for Disease Control and Prevention, Office on Smoking and Health


Preventing Initiation among Youth and Young Adults

Strategies for SuccessPreventing Initiation among Youth and Young Adults

www.thetruth.com

Preventing Initiation among Youth and Young AdultsStrategies for Success

http://www.thetruth.com/

http://www.keepkidssmokefree.org/youth_involvement.htm

http://healthymissouri.net/showmesmokefree


Strategies for SuccessPromoting Quitting Among Adults and Youth


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


Smoke-free policies motivate smokers to quit.


The Health Consequences of Smoking , Surgeon General’s Report, 2006


Quitting smoking has immediate and long-term benefits, reducing risks for diseases caused by smoking and improving health in general.


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


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.



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.



Clinical Practice Guideline “Treating Tobacco Use and Dependence”

Provides recommendations for brief and intensive clinical interventions and implementing effective

treatment programs.


Strategies for SuccessEliminating Exposure to Secondhand Smoke

What are the benefits of a smoke-free environment?

Strategies for Success: Smoke-free Air


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?


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



Tobacco Technical Assistance Consortium


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.


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.



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.


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.




PreemptionWhen 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.



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 SmokeStrategies 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.”


http://www.no-smoke.org/pdf/preemptionmap.pdf

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.



Strategies for SuccessIdentifying and Eliminating Disparities


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 ExcellenceRestrictions 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

ConclusionWe 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


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




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 ConsortiumRollins School of Public Health

Emory UniversityAtlanta, Georgia

To Contact: [email protected]: 404-712-8474

Documents

Tobacco 101 Reducing the Problem of Tobacco Use. Our Learning Environment