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
Best practicestobaccocontrol.trc. 10.21.11.final
Best Practices in Tobacco Control Proven strategies to reduce tobacco use, prevent initiation and eliminate exposure to tobacco smokeCover this blue placeholderwith your program logo
Tobacco is still the leading cause ofpreventable 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 .
Tobacco use is costly for everyoneCost to United States economy each year inhealthcare costs and lost productivity: $193 billionCost to Colorado each year in healthcare costs andlost productivity: $2.4 billion*Annual U.S. Medicaid costs due to smoking: $30.9 billionAnnual Colorado Medicaid costs due to smoking: $319 million
US Adult Smoking Prevalence-2010Cover this blue placeholder Source:2010 BRFSSwith your program logo http://www.cdc.gov/vitalsigns/AdultSmoking/index.html
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)Cover this blue placeholderwith your program logo
Adult current smoking by demographic groupCover this blue placeholder Note: * Estimates for education are based on adults aged 20 years and older. Estimates for racial/ethnic groupswith your program logo are based on combined 2009 and 2010 data. Source: CDC Behavioral Risk Factor Surveillance System
Tobacco Use in Medicaid Population~500,000 individuals receive Medicaid each year in CO40%35%30%25%20% 38%15%10% 18% 5% 0% Medicaid Colorado Adults Tobacco Use TABS 2008
Smoking Among Pregnant Women35.0 33.030.0 25.825.0 19.220.015.0 13.310.0 8.5 5.3 5.0 0.0 Medicaid Non-Medicaid Before pregnancy During pregnancy After delivery Colorado PRAMS, 2004-2008
Middle School & High School Students Ever Smoking-Colorado100.0% 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
SOLVING THE TOBACCO PUZZLE:REDUCE OR ELIMINATE CO- CREATE REMINDERSPAYMENTS FOR CESSATION SYSTEMS FOR MEDICALTHERAPY PROFESSIONALS PROVIDE PROHIBIT SMOKING INCREASE THE CESSATION IN INDOOR PUBLIC PRICE OF TOBACCOSUPPORT TO HELP AND PRIVATE PEOPLE QUIT WORKPLACESTARGET SPECIFIC AND HIGH- REDUCE THE AVAILABILITY OFRISK POPULATIONS THROUGH TOBACCO PRODUCTS TO YOUTHMASS MEDIA CAMPAIGNS
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.”Cover this blue placeholderwith your program logo
Evidence Base for Interventions CDC (Community IOM (Tobacco NIH (State of the Guide) Blueprint) Science)Increase the price of tobaccoProhibit smoking in indoor publicand private workplacesReduce the availability of tobaccoproducts to youthProvide cessation servicesTarget specific and high-riskpopulations through mass mediacampaigns
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
“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