Burden ppt final for stakeholder group


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  • Our goal in next 15-20 minutes is to provide some baseline information. Not time to provide comprehensive, in-depth information – instead, we are providing some basic information to guide the policy discussion today. I’ll cover 3 topics – the problem with smoking, the role of the tobacco industry, and why we are looking at policy for some of the solutions.
  • Cultural shift away from smoking acceptance, rates are down – feels like the battle is won. Except – still a major killer.Exercise: Stand up if you have lost a loved one – close friend or family member, and you think smoking contributed to their death.Raise your hand if you have lost 2 or more loved ones and smoking was a factor.(sit down)Raise your hand if you have a friend or family member who smokes and you worry about the effects on their health.You’re right to be concerned... In the US, smoking causes more deaths than HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined.
  • How many teens are smoking in Colorado? This data is from the Healthy Kids Colorado survey, where we ask teenagers across the state a number of questions about their health and behaviors. The good news is, smoking rates among youth have decreased in the past 9-10 years. 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. The bad news, the rate of decrease has started to level out. A different youth survey, conducted at the national level, shows that Colorado is consistent with national trends in that the rate of decrease is leveling out. We are not seeing the same successes in reducing youth smoking that we saw a decade ago.
  • And – a key reason we are all here today – according to the Healthy Kids Colorado survey, 60% of the smokers under 18 who tried to buy tobacco illegally, tell us that the were successful in their attempt. 60 percent!Furthermore, the rate of successful attempts INCREASED 24% between 2006 and 2008.In addition, 53% of youth in grades 6 – 12 said it would be “very easy” or “pretty easy” to get cigarettes if they wanted.*We conducted key informant interviews with several parents. It doesn’t have the statistical validity of the youth survey, but gave us some insights on what parents might think. Most of the parents agreed that it is not hard for underage youth to get cigarettes, and most felt that the current laws are not adequately enforced.When we met with the Youth Partnership for Health, a youth advisory board to the Health Dept, and asked for their opinions, they mirrored the parents. Youth and parents overwhelmingly stated that current laws prohibiting sales to kids under 18 are meaningless if they are not effectively enforced. The retailers – to a lesser extent – agreed that enforcing current laws would make them more effective.
  • This slide shows where youth are buying tobacco by county. The darkest counties have the highest rate of sales of tobacco to teenagers. (We don’t have a large enough sample size in the white counties to get an accurate estimate.) Colorado law – clerks must examine a government-issued photo identification when tobacco customers look 30 or younger. Pink 3% (0 – 5.9%). Red: 11.9% (8.9 – 14.9%). Dark red/maroon: 22.4% (12.6 – 32.1%).Colorado counties with high rates of underage (<18 years old) cigarette purchases among high school smokers (dark red): Baca, Bent, Crowley, Kiowa, Otero, Huerfano, Las Animas, Prowers, Denver, Eagle, Grand, Garfield, Pitkin, Summit (Data Source: Colorado Youth Tobacco, Attitudes, and Behavior Survey, 2008)
  • Now that I’ve reminded everyone about the continued health impacts of smoking and the consequences of youth smoking, let’s focus for a moment on the industry.
  • Research suggests that children and teens are THREE TIMES more sensitive to tobacco advertising than adults. The tobacco industry pays retailers to place their products in highly visible locations. These pictures were taken in Colorado retail locations.
  • The tobacco industry depends on hooking new smokers, and they spend a lot of money to do so – to the tune of $12.5 BILLION per year. Due in part to restrictions placed on companies by the Master Settlement Agreement, the vast majority of their advertising focuses on the point of sale. And most of the money is spent on price discounts and promotions to decrease the price of cigarettes.
  • Just for comparison, this slide shows the discrepancy between the amount of money spent by the tobacco industry on advertising – the green bar in this slide, and the amount spent in tobacco control efforts to reduce the rate of smoking – the blue bar.
  • Did anyone see the recent 9New story on e-cigarettes? Notice the flavors – strawberry, cherry, and apple.
  • How about some cinnamon ice cream flavored hookah?
  • So, we’ve talked about health impacts and the consequences of youth smoking, and we’ve seen how hard the industry works to hook new smokers, and why they might target youth. Let’s talk for a moment about why we are exploring policy as part of the solution.
  • This illustrates where policy fits in our overall efforts – near the base of the pyramid, meaning it can have significant impact. Essentially, this slide, borrowed from the CDC, shows the level of impact of potential health interventions. The largest impact on health comes from socio-economic factors: education, where people live, and so on. Interventions at the next level can influence or mitigate some of those socioeconomic factors to create significant health improvements for large numbers of people.For example, we know that policy strategies such as higher taxes and clean indoor air laws have had a significant impact on smoking rates. In an era of tight budgets, policy solutions to discourage smoking can provide significant “bang for the buck.” It can lead to significant behavioral change and improved health outcomes for relatively few dollars. How? Policy changes can support the kinds of cultural shifts away from smoking as the norm in our society. It provides support to parents and families who are trying to teach their kids how to make healthy decisions, by helping create a larger culture that does not undermine the positive messages that parents, teachers, churches, and others are trying to provide for our youth.
  • Insert Forward Arrows & Elaborate the Policies in the ActivitiesThis logic model demonstrates our ultimate goal. We start with policy creation and enforcement, which should lead to short-term outcomes of increasing restrictions of tobacco sales to minors, increasing enforcement, and reducing tobacco industry influence. That in turn, should lead to a reduction in youth illegally purchasing cigarettes, and reduced youth susceptibility to smoking. Ultimately, our goals are to prevent tobacco initiation, reduce tobacco prevalence, and reduce tobacco-related illness and death.
  • In Colorado, a study in Ft. Morgan demonstrated that increased retailer enforcement significantly reduced sales to minors, and also reduced the “social supply” of cigarettes to minors.
  • To summarize briefly, I have shown this afternoon how most smokers become addicted to tobacco in their teens, and I’ve described the public health impact of tobacco use and addiction.Then, we covered how the tobacco industry puts substantial resources into marketing, and in spite of limitations, how the industry continues to create advertising and products designed to appeal to young people.Finally, I described why focusing on policy solutions to combat youth smoking makes sense given limited resources. When we interviewed parents, they indicated overwhelmingly that they would like support in their efforts to teach their kids not to smoke, and that stronger enforcement of laws prohibiting youth from buying tobacco would help in preventing kids from smoking. My intent with this presentation was to set the stage for delving into a discussion of policy options to reduce youth smoking.Before that, we’ll take a short break and then Arnold and Celeste will give us a quick overview of current federal and state laws and regulations regarding youth smoking.
  • We have put together a list of 8 potential policy options for discussion today. These were informed by the work of TARP on a model law, and modified slightly to reflect the new FDA law.
  • We conducted key informant interviews via telephone with a small group of retailers and parents. A number of the retailers thought they already had a license requirement to sell tobacco. Many agreed that licensing would probably increase compliance with existing laws prohibiting sales to minors because they “would have more to lose.” There was no consensus, among the small number of retailers we contacted, that licensing was a good or bad idea.The parents we interviewed overwhelmingly supported the idea of licensing tobacco retailers.
  • (go thru slide)This policy will work best with strong local partnerships for implementation and enforcement.
  • 50% of Colorado schools tell us that no one at their school actively enforces the tobacco free schools law (CDC 2008 School Health Profile survey – middle and high schools).
  • Passing similar provisions to the FDA law, like banning flavored cigarettes, will give state authority to provide enforcement, which as I’ve mentioned, parents, retailers and teens all agree is key to effective policy interventions.That concludes the overview of the policy options we’re asking for feedback on today. Now we’ll finally stop talking and start getting more of your feedback!
  • Burden ppt final for stakeholder group

    1. 1. Colorado Department of Public Health and Environment<br />Helping Kids Make Healthy Choices<br />
    2. 2. Helping Kids Make Healthy Choices About Tobacco<br />What is the problem with youth smoking?<br />How does the tobacco industry & advertising contribute?<br />New Products<br />How is policy part of the solution?<br />
    3. 3. Problem: Tobacco is still the leading Cause of Preventable Death in the United States<br />In Colorado, nearly 4,400 deaths each year due to tobacco use.*<br />In the U.S., smoking causes more deaths than HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders COMBINED.†<br />* MMWR (2009), 58 (02); 29-33.<br />†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 .<br />
    4. 4. Problem: 80 - 90% of adult smokers first try tobacco before the age of 18†<br />†Surgeon General’s Report: Preventing Tobacco Use Among Young People, 1994.<br />* CDC: Best Practices for Tobacco Control Programs, 2007.<br />
    5. 5. Youth Cigarette Smoking in Colorado<br />
    6. 6. Problem:6 out of 10 Colorado high school students attempting to purchase cigarettes were successful.<br />
    7. 7. In Which Colorado counties are kids buying cigarettes illegally?<br />
    8. 8. Helping Kids Make Healthy Choices About Tobacco<br />What is the problem with youth smoking?<br />How does the tobacco industry & advertising contribute?<br />New Products<br />How is policy part of the solution?<br />
    9. 9. Problem:Youth are sensitive to tobacco advertising and placement.<br />
    10. 10. Tobacco Industry Spends $12.5 billion annually on marketing*<br />$170.7 million spent in Colorado<br />90% of marketing $$ spent at point of sale<br />Most of that – nearly 74% – is spent on price discounts and promotions to decrease the price of cigarettes<br />* FTC (2009) Cigarette Report For 2006<br />
    11. 11. From presentation by Frank Chaloupka, Ph.D., University of Illinois at Chicago, at CDC meeting, June 8, 2010: Atlanta, Georgia.<br />
    12. 12. and then there are the newer products…<br />Orbs, Sticks, Strips<br /><ul><li>Finely milled tobacco
    13. 13. Dissolvable
    14. 14. Requires no spitting
    15. 15. Last between 2-30 minutes
    16. 16. As much as 3.1 milligrams of nicotine (~1 milligram in one cigarette)</li></li></ul><li>Snus<br />Finely milled tobacco <br />Pouches<br />Requires no spitting<br />…like Snus<br />
    17. 17. …and E-Cigarettes,<br />
    18. 18. and Hookah…<br />
    19. 19. Helping Kids Make Healthy Choices About Tobacco<br />What is the problem with youth smoking?<br />How does the tobacco industry & advertising contribute?<br />New Products<br />How is policy part of the solution?<br />
    20. 20. From presentation by Ursula Bauer, Director, National Center for Chronic Disease Prevention and Health Promotion, CDC; June 7, 2010, Atlanta, Georgia<br />
    21. 21. Solution: Implement policies to prevent youth tobacco initiation<br />
    22. 22. Solution: Implement Policies to Prevent Youth Tobacco Initiation<br />Evidence-based interventions for reducing tobacco initiation among children and adolescents include: <br />enforcement of illegal sales to minors laws *°<br />youth-oriented mass media campaigns *°<br />Strengthening/implementing laws to prevent youth smoking°<br />tobacco price increases * °<br />*1994 Surgeon General's Report—Preventing Tobacco Use Among Young People<br />°CDC Taskforce on Community Prevention Services, 2005<br />
    23. 23. Will limiting youth smoking through policy reduce tobacco initiation?<br />YES! There is very strong evidence that limiting youth access directly impacts tobacco rates.∞<br />Youth who perceived cigarettes as relatively easy to get were more likely to become regular smokers (Annals of Family Medicine, 2008).<br />Stores located in states with fewer/weaker compliance policy measures were 36 percent more likely to illegally sell tobacco to minors (Food & Drug Administration, 2003). <br />A comprehensive youth access program in Woodridge, Illinois, reduced tobacco use among youth by over 50 percent (Journal of American Medical Association , 1991).<br />∞Enforcing Laws Prohibiting Cigarette Sales to Kids Reduces Youth Smoking. Campaign for Tobacco-free Kids. 2008<br />
    24. 24. Will limiting youth smoking to tobacco through policy reduce tobacco initiation?<br />YES! There is very strong evidence that limiting youth access directly impacts tobacco rates.<br />Results from a study in 14 Minnesota communities showed that an intervention involving local ordinances and enforcement to limit youth access to tobacco significantly reduced adolescent smoking rates (American Journal of Public Health, 1998)<br />A study in Ft. Morgan demonstrated that strong retailer enforcement reduced sales to minors, which reduced the overall cigarette supply for minors. (Preventive Medicine, 2007)<br />
    25. 25. Helping Kids Make Healthy Choices About Tobacco<br />What is the problem with youth smoking?<br />How does the tobacco industry & advertising contribute?<br />New Products<br />How is policy part of the solution?<br />
    26. 26. Policy Option:Remove tax penalty on localities for licensing or taxing cigarettes<br />Cities and towns will lose share (27%) of state cigarette tax if they impose “fees, licenses or taxes” on cigarettes.<br />Increase locality authority to monitor and enforce restrictions on sales to minors through local licensing.<br />Grants localities the authority to raise additional revenue if they choose.<br />Reduce youth smoking in communities that increase the price of cigarettes.<br />
    27. 27. Policy Option:Enact a statewide retailer license for selling tobacco products<br />Colorado is one of 7 states without any retailer license provisions.<br />Retailer licensing can be an effective tool for enforcing laws preventing tobacco sales to minors.<br />Stricter enforcement of illegal sales to minors laws may reduce overall tobacco supply to minors.<br />Other provisions can be included within comprehensive retailer license law.<br />
    28. 28. Policy Option:Prohibit sale of single tobacco/nicotine products<br />Prohibit sale of single tobacco/nicotine products<br />FDA law bans sale of single cigarettes; does NOT ban sales of single cigars, other products<br />Healthy Kids Colorado Survey indicates that cigar use INCREASED among teens between 2001 and 2008, even while cigarette smoking has gone down.<br />Prohibitions on single products most likely to discourage more price-sensitive consumers, such as teens.<br />
    29. 29. Policy Option:Restrict price manipulation strategies; Establish minimum price<br />Every 10% increase in REAL price of cigarettes, reduces number of kids who smoke 6-7%.<br />Single most effective policy intervention to decrease smoking rates is to increase cost of cigarettes<br />Tobacco industry uses a variety of tools – coupons, etc. to counteract cigarette taxes and other efforts to increase the price of tobacco<br />25 states have enacted minimum price laws<br />
    30. 30. Policy Option:Restrict Flavored nicotine products<br />FDA bans flavored cigarettes, but doesn’t address other flavored products popular with teens, like smokeless, cigars and newer products.<br />New products look like candy, easily concealed<br />FDA ban on flavored cigarettes does not include menthol<br />
    31. 31. Policy Option:Prohibit tobacco sales near youth-oriented facilities<br />One study found that stores where teens shop have higher amount of tobacco advertising<br />Teens are more susceptible to advertising than adults<br />Most tobacco industry marketing occurs at point of sale – advertising and price discounts<br />
    32. 32. Policy Option:Update Tobacco-free schools law<br />Prohibits use of tobacco by students, faculty and staff on school property and at school functions<br />Law was originally enacted in 1994<br />Rocky Mountain Center conducting a stakeholder process with schools to get feedback on possible amendments to the tobacco-free schools law.<br />
    33. 33. Policy Option:Enact selected provisions of FDA law into state law<br />Grants state authority to enforce provisions, such as: <br />ban on flavored cigarettes<br />Prohibition of self-service displays or vending machines where youth may be present <br />State cannot regulate product or manufacturing standards, registration, premarket review<br />