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  • The blue bar indicates actual spending in NM, $5 million in State general funds and $1.1 million in CDC funds for staff positions and administrative costs. All of the $ 5 million goes to contractors in NM to deliver services.
    The red bar indicates the CDC recommend minimum of $14.2 million for a comprehensive tobacco control program in NM. NOTE: for substantial reductions
  • Madame Chair and members of the committee. name….program manager.
    Dr. Baum described the health consequences of tobacco use, I am going to give an overview of our program’s activities and the challenges related to commercial tobacco use prevention and control.
    The NMDOH, TUPAC program is a comprehensive program built around CDC/OSH recommended goals,program components, and best practices.
    This is how our program works in NM utilizing the Best Practice recommendations. SHOW SLIDES
    Funds go to Program Component Areas
    Services are delivered by contractors-evaluation built in to every contract
    READ: COMPONENTS
    These guide us toward achieving our program goals
    READ: PROGRAM GOALS
    Goals: destination
    Program Components : vehicle
    Best Practices: roadmap
    Funding : fuel
    Evaluation is built into every contract, it’s like checking the map to make sure we are on course
  • Madame Chair and members of the committee.
    NAME POSITION
    Thank you for this opportunity.
  • Reduced breathing capacity, poor heart functioning, greater susceptibility to lung infections, visual loss due to cataracts, etc.
  • READ SLIDE
    Received 871 calls to quitline last year
    Worked with National Cancer Institute/Cancer Information Service to pilot a pro-active (call back) quitline. Results of pilot project shared with programs nationwide.
    CDC released an RFP for supplemental quitline funding. NM applied and received full funding of $375,000 per year added to our base CDC budget. Cannot be used to supplant existing funding for quitline and quitline media promotion.
    With this funding we will start a new quitline. We are releasing an RFP shopping for pro-active quitline services, expanded hours, healthcare provider referral service, bi-lingual, Medicaid reinbursement and special services for pregnant women, youth and web-based services
  • Successes:
    READ SLIDE
    Challenges:
    We want to see significant declines in youth smoking rates; yet they have remained relatively stable since 2001.
    We should begin seeing the effects of the tobacco tax increase in our next youth survey but Even with tobacco tax increase and clerk assisted sales being passed by the legislature, we face significant challenges NEXT SLIDE
    NOTE Youth RatesYouth smoking has remained relatively stable since 2001, after declining steadily since the late 1990’s (~38%). In 2003, the youth smoking rate was about 29%.2 : We are seeing a year to year percentage variation but the change is not statistically significant. The range is 25% to 29%. Youth smoking is defined as having smoked in the last 30 days.
  • Transcript

    • 1. Securing Tobacco Settlement Funds for Health Care Dona Upson, MD Pulmonary & Critical Care Medicine New Mexico Veterans’ Affairs Health Care Services University of New Mexico American College of Physicians – 4/13/05
    • 2. Master Settlement Agreement  Written by and for tobacco companies  Implemented 1998  States supposed to use payments to support public health and tobacco prevention  Settlement, not a law – Only the parties involved, the tobacco companies and the states, have legal standing to enforce its terms
    • 3. Challenges  Since 1998, tobacco companies have doubled spending on marketing and promotion ($5.7 to $12.7 billion)  States’ economies have declined  Many state anti-tobacco media campaigns reduced or cut since 2002  Funding decreased for Legacy (truth)  Youth smoking rates stable since 2002 (previously in decline)
    • 4. Finances - Fiscal Year 2005  Annual smoking caused health costs – $75+ billion  Prevention spending – $538 million  CDC minimum prevention spending goal – $1.6 billion  Total state revenue from tobacco – $19,966.5 million ($12,911 taxes; $7,055 MSA)  Total prevention spending 2.7% of tobacco revenue (0% DC, MO to 10.1% ME)
    • 5. Tobacco Use Prevention and Control (TUPAC) - New Mexico $37 million from MSA TUPAC Funding:  2001 $2.225 million  2002 $5 million  2003 $5 million  2004 $5 million  CDC recommends $14.2 million annual funding for NM tobacco control  CDC funds TUPAC staff positions & administrative costs ($1.1 million)
    • 6. $5.0 $57.7 $144.0 $0 $20 $40 $60 $80 $100 $120 $140 $160 Currrent TUPAC Program Funding in NM Tobacco Industry Marketing in NM Tobacco-Caused Medicaid Costs in NM AnnualSpending(inmillions)
    • 7. Funds to TUPAC School Programs Community Programs Media Cessation Programs Evaluation Identify and Eliminate Tobacco-related Disparities Promote Quitting Among Youth and Adults Best Practices Eliminate Exposure to Secondhand Smoke Prevent Initiation Among Youth & Young Adults TUPAC PROGRAM COMPONENTS PROGRAM GOALS
    • 8. Partnerships  Oversight group – Planning, coordination & implementation  Voluntaries - ALA, ACS, AHA, etc – Funding, advice, credibility  Legislators – On key committees  Department of Health – Promote each other’s agendas – Provide state-specific data and education  Health care professionals – Credibility, access, personal stories  Grassroots advocates
    • 9. Strategy  Education – Public, legislature, executive branch  Polling  Lobbyist  Media – Advertising, press conferences, editorials
    • 10. Oversight group - NMCAT NMCAT works to create community norms that discourage smoking and spit tobacco use. We believe that through responsible public policy changes New Mexico can become a healthier state and tobacco-related illnesses can be decreased.
    • 11. NMCAT Background Established in 1997  Initially funded by ACS, AHA, ALA & Campaign for Tobacco Free Kids  Staffed entirely by contractors  Primary Focus: Legislative campaign for settlement dollars & other tobacco issues  900+ members on email/ fax/ phone lists  Currently have grassroots network of 2,000
    • 12. Report to the Tobacco Settlement Revenue Oversight Committee Susan Baum, Physician/Epidemiologist Larry Elmore, Program Manager Tobacco Use Prevention and Control Program September 29, 2004
    • 13. Data-driven  Program planning – Baselines and future directions  Measuring performance  Measuring outcomes – short-, intermediate- and long-term  Counter marketing  Justify continued/ increased funding
    • 14. Smoking & Lower Quality of Life  CDC 2003 estimate – For every premature death caused each year by smoking, there are at least 20 smokers suffering with at least one serious illness from smoking.  NM estimate – 42,000 New Mexicans living with serious smoking-related diseases.
    • 15. FY04 Highlights - Adults Quitting  Best Practices as of FY04: All UNM Hospital patients are now screened for tobacco use.  Over 37,000 adults were screened for tobacco use, and over 2,700 adults received cessation services  1,500 healthcare providers trained in brief interventions “Of all the classes I’ve ever attended, this class was the most effective because you inspired my self- confidence.” --Freedom from Smoking Graduate
    • 16. FY04 Highlights - Youth & Schools  CDC Guidelines implemented in over 150 schools, reaching 45,000 students statewide  Nearly 1,000 youth trained as peer educators & coalition members “My students became better communicators, especially after they participated in the National Smoke-free Movies Campaign. They became empowered!” --Alameda Middle School SQUADS Facilitator
    • 17.  30% of smokers were advised to quit smoking by their dental providers  20% of working adults report that their employer has offered some type of stop smoking program or assistance in the past year Sources: 2003 NM Adult Tobacco Survey & 2001 BRFSS Smoking Cessation Assistance 49 68 0 20 40 60 80 Percent(%)of Smokers 2001 2003 Percent of NM Smokers Advised to Quit Smoking by a Health Care Provider in the Past Year
    • 18. Smoking Cessation among Adults in New Mexico Smokers who tried to Quit Smoking in Past Year  More than half of smokers have made a quit attempt during the past 12 months. Source: BRFSS, 2001-2003
    • 19. Polling - Secondhand Smoke: Attitudes  91% of New Mexicans believe that secondhand smoke is harmful to their health (up from 84% in 2001) Sources: 2001 & 2003 NM Adult Tobacco Survey Place Percent of New Mexicans who believe place should be completely smoke-free Day Care Centers 97% Indoor Work Areas 76% Public Buildings 73% Indoor Shopping Malls 71% Indoor Sporting Events 71% Indoor Dining Area of Restaurants 65%
    • 20. Health & Economic Impact of Tobacco New Mexico and United States Updated March 2005
    • 21. Total Annual Smoking-Attributable Costs in NM (2002) Direct Medical Costs $425 million Lost Productivity Costs $428 million Total Costs Annually $853 million Annual Per Capita $460 per person Sources: Campaign for Tobacco Free Kids, “The Toll of Tobacco in New Mexico” Fact sheet (2002 dollars), Full list of references available at http://tobaccofreekids.org/reports/settlements/toll.php?StateID=NM. Per capita calculation based on 2002 NM population.
    • 22. Annual Smoking-Attributable Direct Medical Costs in NM Ambulatory (outpatient) $135 million Hospital $103 million Nursing Home $58 million Prescription Drugs $29 million Other medical $35 million Annual Total $360 million Annual Per Capita $208 per person Source: Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Economic Costs—United States, 1995-1999, MMWR (CDC), April 12, 2002/51(14); 300-303
    • 23. Smoking-Attributable Neonatal Costs Annual Neonatal Costs in New Mexico $92 million Smoking-Attributable Neonatal Costs $1.6 million Percent of Total Neonatal Costs Related to Maternal Smoking 1.75% Annual Smoking-Attributable Costs per Maternal Smoker by Insurance Status $635 (Medicaid or Uninsured) $583 (Private or Other Insurance) Source: State Estimates of Neonatal Health-Care Costs Associated with Maternal Smoking, United States, 1996, MMWR (CDC), October 8, 2004/53(39); 915-917.
    • 24. Smoking-Attributable Deaths in NM & US, Disease-Specific Disease NM (Deaths per 100,000) US (Deaths per 100,000) Smoking-Related Cancers (Lung cancer accounts for about 75% of the smoking- related cancer deaths in NM) 80.1 111.0 Cardiovascular Diseases 80.4 90.4 Respiratory Diseases 76.2 71.1 Source: 2001 Annual Smoking-Attributable Mortality calculated using Smoking-Attributable Mortality, Morbidity, and Economic Cost (SAMMEC) software. Available at www.cdc.gov/tobacco/sammec. Does not include burn or secondhand smoke deaths.
    • 25. NM and US Per Capita Taxable Cigarette Sales among Adults, 1992-2001 0 20 40 60 80 100 120 140 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 PacksperCapita(Adults) New Mexico United States Per capita sales in NM have historically been lower than in the U.S. Per capita sales have been decreasing from 1992 through 2001. Sources: NM Taxation & Revenue Dept. and Orzechowski, W & Walker, RC, Tax Burden on Tobacco, 2001
    • 26. 68 50 45 55 63 62 59 60 54 53 64 64 0 20 40 60 80 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 Year PacksofCigarettes Tobacco Control begins in NM MSA Funding 70-cent tax increase NM Per Capita Taxable Cigarette Sales 1992-2003 Per capita cigarette sales decreased by one-third between 1992 and 2003. Source: NM Taxation & Revenue Department, 1992-2003
    • 27. True Cost of a Pack of Cigarettes in New Mexico Retail Price Per Pack $3.35 Smoking-Attributable Medical & Lost Productivity Costs Per Pack $8.94 Smoking-Attributable Medicaid Costs Per Pack $1.78 Source: Sustaining State Programs for Tobacco Control: Data Highlights, 2004, CDC. Direct medical expenses are updated from 1998 to 2002 dollars, and lost productivity costs are updated from 1999 to 2002 dollars, using the Medical Consumer Price Index and the Wage Consumer Price Index.
    • 28. Tobacco Industry Marketing Expenditures Annual tobacco industry marketing expenditures, U.S. $12.7 billion Estimated annual tobacco industry marketing expenditures, New Mexico $57.7 million Estimated annual tobacco industry marketing expenditures per New Mexican $30.77 Annual expenditures on tobacco prevention and control per New Mexican $3.25 Sources: Campaign for Tobacco Free Kids “The Toll of Tobacco in New Mexico” fact sheet. Original source: U.S. Federal Trade Commission (FTC), Cigarette Report for 2000, 2002; FTC, Federal Trade Commission Smokeless Tobacco Report for the Years 2000 and 2001. State total a prorated estimate based on its population. Tobacco prevention and control expenditures data from TUPAC Program.
    • 29.  Tobacco companies spend $23 to market their products for every $1 states spend on tobacco prevention.  States have cut funding for tobacco prevention programs by 28% in the past three years, resulting in overall funding which is only one-third of CDC minimum recommendations.  In NM, the amount spent by tobacco companies on marketing their products is about ten times the amount spent by the State on tobacco prevention and control programs. Source: National Cancer Institute, Smoking and Tobacco Control Monograph No. 10 NIH Pub. #99-4645, 1999; NM estimate derived from NCI monograph, assuming a similar ratio between smoking deaths and secondhand smoking deaths in NM as in the US. Tobacco Industry vs. Tobacco Prevention & Control Spending
    • 30. Securitization
    • 31. Securitization  Sale of future state tobacco settlement receipts for smaller lump-sum payment today  25-40 cents on the dollar  Credit or bond ratings downgraded due to lower future revenue stream
    • 32. Benefits of Dedicated Trust Fund  Improve health  Moral obligation to use funds as intended  Political capital - popular use of funds  Reduces future state expenditures  Strengthens bond and credit ratings