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Best practicestobaccocontrol.trc. 10.21.11.final
1. Best Practices in Tobacco Control
Proven strategies to reduce tobacco use,
prevent initiation and eliminate exposure
to tobacco smoke
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2. Tobacco is still the leading cause of
preventable death in the US and in Colorado
• In Colorado, nearly
4,390 deaths each
year due to tobacco
use.*
• Smoking causes
more deaths than
HIV, illegal drug
use, alcohol use,
motor vehicle
injuries, suicides,
and murders
COMBINED.†
* MMWR (2009), 58 (02); 29-33.
†MMWR (2008), 57 (45): 1226 – 1228; CDC (2009), Health, United States, 2008; Mokdad AH,
Marks JS, Stroup DF, Gerberding JL. Actual Causes of Death in the United States. JAMA: Journal
of the American Medical Association 2004;291(10):1238–1245 .
3. Tobacco use is costly for everyone
Cost to United States economy each year in
healthcare costs and lost productivity:
$193 billion
Cost to Colorado each year in healthcare costs and
lost productivity:
$2.4 billion*
Annual U.S. Medicaid costs due to smoking:
$30.9 billion
Annual Colorado Medicaid costs due to smoking:
$319 million
4.
5. US Adult Smoking Prevalence-2010
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Source:2010 BRFSS
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http://www.cdc.gov/vitalsigns/AdultSmoking/index.html
6. Adult Cigarette Use-Gender - 2010
21.5
17.4 18
17.3
16
14
CO Overall All States (median) CO Male US Male CO Female US Female
Source: Behavioral Risk Factor Surveillance System (BRFSS)
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7. Adult current smoking by demographic group
Cover this blue placeholder Note: * Estimates for education are based on adults aged 20 years and older. Estimates for racial/ethnic groups
with your program logo are based on combined 2009 and 2010 data. Source: CDC Behavioral Risk Factor Surveillance System
9. Tobacco Use in Medicaid Population
~500,000 individuals receive Medicaid each year in CO
40%
35%
30%
25%
20% 38%
15%
10% 18%
5%
0%
Medicaid Colorado Adults
Tobacco Use TABS 2008
10. Smoking Among Pregnant Women
35.0 33.0
30.0
25.8
25.0
19.2
20.0
15.0 13.3
10.0 8.5
5.3
5.0
0.0
Medicaid Non-Medicaid
Before pregnancy During pregnancy After delivery
Colorado PRAMS, 2004-2008
11. Middle School & High School Students Ever Smoking-Colorado
100.0%
80.0%
60.0%
2001
2006
40.0%
2008
54.2%
20.0% 43.2%
36.8%
25.7%
16.7% 14.4%
0.0%
Middle School High School
Source: Colorado Healthy Kids Colorado Survey on Tobacco and Health, 2001, 2006, and 2008
12. SOLVING THE TOBACCO PUZZLE:
REDUCE OR ELIMINATE CO- CREATE REMINDERS
PAYMENTS FOR CESSATION SYSTEMS FOR MEDICAL
THERAPY PROFESSIONALS
PROVIDE PROHIBIT SMOKING INCREASE THE
CESSATION IN INDOOR PUBLIC PRICE OF TOBACCO
SUPPORT TO HELP AND PRIVATE
PEOPLE QUIT WORKPLACES
TARGET SPECIFIC AND HIGH- REDUCE THE AVAILABILITY OF
RISK POPULATIONS THROUGH TOBACCO PRODUCTS TO YOUTH
MASS MEDIA CAMPAIGNS
13. CDC reports “statewide tobacco control
programs that are evidence-
based, comprehensive, sustained and
accountable are shown to reduce
smoking rates, tobacco related deaths
and diseases caused by smoking.”
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14.
15. Evidence Base for Interventions
CDC (Community IOM (Tobacco NIH (State of the
Guide) Blueprint) Science)
Increase the price of tobacco
Prohibit smoking in indoor public
and private workplaces
Reduce the availability of tobacco
products to youth
Provide cessation services
Target specific and high-risk
populations through mass media
campaigns
18. Moving Forward: Work to be done
• Decrease the cessation disparity affecting low
SES smokers
• Decrease smoking prevalence and initiation
among young adults who are not in college
• Place constraints on the tobacco industry
based on new FDA law
• Reduce initiation among low SES youth
• Recognize and treat tobacco addiction as a
chronic disease
• Increase the price of tobacco products
19. “It is unreasonable to expect that people
will change their behavior easily when
so many forces in the social, cultural,
and physical environment conspire
against such change.”
- Institute of Medicine
Notas del editor
Cultural shift away from smoking acceptance, rates are down – can be lulled into a sense that the battle is won. Except – still a major killer and declines have stalled. Surgeon General Report There is no safe level of exposure to tobacco smoke – even an occasional cigarette or exposure to SHS can be harmful.SHS kills 50,000 US Deaths and 660 Colorado Deaths annually.It is a cause and/or contributor to lung cancer, numerous other cancers, stroke, COPD, and heart disease. It contributes to low infant birth weight.In the US, smoking causes more deaths than HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined.
*(2nd Row)$579 per Colorado Household Smoking harms others and costs everyone money. Tobacco addiction results in chronic disease that is expensive to treat and contributes to the ever-increasing medical costs that healthcare reform can’t fully solve. And exposure to second-hand smoke kills others. In fact, it has been shown to contribute to infant SIDS deaths.$193 billion – MMWR (2008) 57(45);1226-1228.$2306 million – CDC (2007) Best Practices…Medicare and Medicaid fed stat: Campaign for Tobacco Free KidsState Medicaid _ 2007 CDC Best Practices2nd-hand smoke stat: 2006 Surgeon General’s report on 2nd hand smoke – pg. 5-6.
Items for the Notes section:Past 20 year prevalence trend – peaked over 24% in 1994 currently at 16% an all time low in Colorado.1.5 billion fewer cigarettes smoked per year in the past decadeProgress has been made, but more to be done.Nationally and in Colo data show that there is a stall in the decrease for both youth and adults
2010 BRFSS data, Colorado adult smoking prevalence is 16%, Colorado is in the middle. (ranked 19th in the nation).
Adult prevalence has declinedCan see disparities among certain groups ethnicity, age and education (why?)Smoking rate is inversely proportional to educational atainment
Looking more closely at 18-24, highlighting the education disparity.
Women with Medicaid coverage for prenatal care and deliver were more than twice as likely to be smokers before pregnancy than women without Medicaid coverage (who were typically covered by private health insurance). One-third of women with Medicaid coverage reported smoking before pregnancy, compared to 13.3 percent of women not on Medicaid. Smoking prevalence rates during pregnancy were almost four times as high for women with Medicaid coverage as compared to women without Medicaid coverage.
As you can see from this figure, the rate of ever smoking among both middle and high school students has decreased since 2001. The prevalence of high school ever smokers is twice that of middle school students. While we don’t have income data on youth smoking (don’t ask for it), we know based on other research that kids who smoke are more likely to be low-income, based in part on what we infer from other data about low-income smokers.We know that kids who have friends or family who smoke, who don’t have a trusted adult tell them not to use tobacco, and that are exposed to higher levels of advertising, which is more prominent in low-income neighborhoods, are more likely to try tobacco.
Strategies are evidence-based, we also know that a comprehensive approach utilizing all strategies works best to reduce tobacco use prevalence.3 cessation strategies focus on current tobacco users. Smoke-free laws protect non-smokers, especially employees, contribute to social norming to make tobacco use less popular, and encourages cessation. Increasing price encourages current users to quit – especially youth, low-income and pregnant smokers, discourages susceptible youth from starting, and funds other intervention strategies, increasing their effectiveness.Mass-media campaigns support other interventions and contribute to social norming making tobacco use less popular.Reducing availability of tobacco products to minors typically means stricter enforcement to reduce illegal tobacco sales, and restrictions on tobacco advertising. Evidence shows that stronger laws also need strong enforcement to be effective.
According to CDC to implement a comprehensive Tobacco Control Program Colorado needs $54.4 million.The tobacco industry spends nearly $140 million to market tobacco products in Colorado.
This chart from Dr. Friedan at the CDC shows the rationale behind focusing on policy and environmental change initiatives. We know that the most significant impacts on health are socioeconomic factors – the Social Determinants of Health. The next level of the pyramid encompasses the kinds of change we have been focused on. Data shows that changing the context to make the healthy choice the easy choice has a larger impact on population-level health outcomes than more targeted, individual interventions. In an era of limited funding, it is a more cost-effective strategy for improving population outcomes.
The evidence base for these interventions is solid. Three leading sources for evidence-based tobacco interventions – CDC’s community guide, the Tobacco Blueprint from the Institute of Medicine, and the National Institutes of Health State of the Science report all recommend the strategies we have highlighted (the three cessation-related interventions are combined into one in this chart).
This slide shows program interventions and economic variables that coincide with changes in smoking prevalence and cigarette consumption in Colorado.The largest change in consumption was at the time of the state excise tax, voted in to law in Nov 2004 and effective January 1, 2005.The tobacco control program budget was at it’s peak in 2005. Colorado did meet the CDC recommended funding that year.The Colorado Clean Indoor Air Act was implemented July 1, 2006, casinos became smoke-free January 1, 2008.Items of historical significance were:1986 state tobacco tax - $0.201991 ASSIST grant awarded – 1992 eight community coalition grants, 1996 13 community coalition grants1994 Tobacco Free Schools law passed1994 Ballot initiative to raise tax from $0.20 to $0.70 fails due to heavy advertising by the industry2003 reduction to MSA program (show up tick)Reduced price and significant program funding to show decrease
New Mexico, Arizona, Utah of the corner states we are low