tobacco 101 part 2 lesson 3 - emory universitylesson three looks at three primary tobacco control...

Tobacco101PartTwo,LessonThree

2016

ASELF-GUIDEDE-BOOKINTWOPARTS

©2016EmoryCentersforTrainingandTechnicalAssistance2

IntroductiontoTobacco101WelcometoTTAC’sTobacco101!Tobacco101isaself-guidedtutorialthatprovidestheinformationandresourcesnecessarytounderstandwhytobaccouseisconsideredthe#1preventablecauseofdeathintheUS,aswellastheevidence-basedandpromisingstrategiesthatcanreducetobacco’stoll.Youcanbenefitfromthiscoursewhetheryouarenewtotobaccocontrolandneedanintroductiontokeytopics,orareanexperiencedprofessionallookingtorefreshandupdateyourknowledge.

Tobacco101wasrevisedinthespringof2013tocontainthelatestinformation,resources,andtoolsavailable.Theuser-friendlyself-guidedformatallowsyoutocompletethetutorialatyourownpaceandexplorethevariousexternalresourcesandtoolsasneeded.Tobacco101isorganizedintotwopartscomprisedoffourlessonseach.Optionalreviewquestionsareofferedattheendofeachlessontoallowyoutocheckyourunderstandingofthecontent,trysomeoftheresources,andreflectonhowtheinformationappliestoyourroleintobaccocontrol.

Youcanstartatthebeginningandreadthroughthecoursefrombeginningtoendorsimplyselectthosesectionsthatareofgreatestinterest.

Part1:IntroductiontoPreventionandControlofTobaccoUse• Lesson1:TheEvolutionofTobaccoControl• Lesson2:TobaccoUseintheUnitedStates• Lesson3:ImpactofTobaccoUse• Lesson4:FactorsthatDetermineTobaccoUse

Part2:ReducingtheProblemofTobaccoUse• Lesson1:CredibleTobaccoControlResourcesandKeyPartners• Lesson2:TobaccoControlModels• Lesson3:EffectiveTobaccoControlPolicies• Lesson4:StrategiesforSuccess

TTACalsoprovidestailored,on-siteTobacco101trainingsfororganizationswhowanttoincludeitinconferencesandworkshops.Tolearnmore,visitourwebsitewww.tacenters.emory.eduorcontactusattacenters@emory.edu.


TableofContentsPART2: REDUCINGTHEPROBLEMOFTOBACCOUSELESSON3

EffectiveTobaccoControlPolicies Page4

CheckforUnderstanding Page26

Sources Page28


Tobacco101PartTwo,LessonOneEffectiveTobaccoControlPolicies LessonThreelooksatthreeprimarytobaccocontrolpoliciesrecommendedbytheUSCentersforDiseaseControlandPrevention(CDC).Whenusedincombination,thesepoliciesareproventogeneratesignificantreductionsintobaccouse.Theinformationinthislessonbuildsonwhatwehavelearnedpreviouslyabouttheimportanceofimplementingcomprehensiveandintegratedapproachestotobaccocontrol.

LearningObjectivesAttheendofthislessonyouwillbeableto:

1. IdentifyanddescribethethreetobaccocontrolpoliciesrecommendedbytheCDC.TheCDCrecommendsincreasethecostoftobaccoproducts,enacting100%smoke-freelaws,andfundingsustainable,comprehensivetobaccocontrolprograms.

2. Describethecomponentsofacomprehensivetobaccocontrolprogramandexplainhowsucha

programiseffectiveinreducingtobaccouse.Wewilldescribethecomponentsofacomprehensiveprogramandexplorehowtheseprogramssupporttheotherrecommendedpolicies.

3. Citespecificexamplesofhowthesepolicieshaveworkedincombinationtoproducesignificant

reductionsintobaccouse.Inthislesson,wewillshowhowthesepolicieshavecontributedtosuccessesinseveralstates.


EffectiveTobaccoControlPolicies

Tobaccoisnowtheworld’sleadingkiller.Wehavetheprovenmeanstoreducetobaccouse,butpolicy-makersarenotyetapplyingtheseinterventions.

-MayorMichaelBloomberg

MayorBloombergofNewYorkwasthefirstmayorofamajorUScitytoinitiatecomprehensivesmoke-freeworkplacelawsandraisetheexcisetaxoncigarettes.ThetobaccocontrolmovementhasgainedmomentumbothgloballyandhereintheUnitedStates.However,moreneedstobedoneatthepolicyleveltodecreasethetobacco-relateddiseaseanddeathamongpeopleworldwideandinAmerica.

MuchliketheMPOWERmodeldiscussedinPartTwo,LessonTwo,theCDCmodelrecommendsasetofpoliciesproveneffectiveinreducingtobaccouseandinclude:

1. Increasethecostoftobaccoproducts.2. Enact100%smoke-freelaws.3. Fundsustainable,comprehensivetobaccocontrolprogramsthatincludecessation

servicesandmediacampaigns.

Thesethreepolicies,whenappliedincombination,significantlyreducethenumberofsmokers,thenumberofcigarettessmoked,andtheillnessanddiseaserelatedtobaccouse.

Wewillexamineeachoneindetailnext.

Forfurtherinformation….onhowstatescanusethesethreepolicies:

ReadtheTobaccoControlNetwork’sPolicyPlatform:http://www.tobaccocontrolnetwork.org


Policy#1:IncreaseCostofTobaccoProducts

StudiesintheU.S.andaroundtheworldindicatethatincreasingtobaccopricesisthemostdirectandreliablemethodfordecreasingtobaccoconsumption,especiallyamongyouth.Theprinciplemeanstoincreasethecostoftobaccoproductsisbyraisingtheexcisetax.

Anexcisetaxiscollectedfromtheproducer,andistypicallyimposedasafixedamountoftaxperunitofmeasure(forexample,somanycentsperpackofcigarettes)ratherthanasapercentageofthesaleprice,whichwouldbeasalestax.Althoughtheproducerorwholesalerpaysthetaxdirectlytothegovernment,theconsumerultimatelybearsthecost,asitisincludedinthesalepriceoftheproduct.IntheUSthereisafederalcigaretteexcisetax,astatetaxthatvariesbetweenstates,andinsomeareasalocaltaximposedbyacountyorcitygovernment.Somestatesalsochargesalestaxesontobaccoproducts,whichfurtherincreasethepriceoftheproducttoconsumers.Note:Differenttobaccoproductsmayalsobetaxedatdifferentlevels.Forthesakeofthisdiscussion,wewillfocusoncigarettetaxes.However,itisimportanttomonitorhowalltobaccoproductsarebeingtaxedinyourstate.Ifaproductisnotbeingtaxedashighascigarettes,someconsumerswillswitchtolesscostlyproducts,mitigatingtherevenueandhealthimpactsofthecigarettetax.

Forfurtherinformation….Abouteffectivelyaddressingtobaccopricingpolicies

TakealookatthePricingStrategiesToolkit:http://ttac.org/services/pricing_strategies/index.html


IncreasedCost:CigaretteExciseTaxesTheaveragecostofapackofcigarettesintheUS,includingfederal,state,andmunicipalexcisetaxeshavesteadilyincreasedoverthepastfewdecades,inlargepartduetotaxes.Forexample,in1970,theaveragecostofapackofcigaretteswas$0.38,comparedwith$5.33in2009.Thegraphbelowshowshowstateandfederaltaxeshaveincreased.Thefederaltaxhasbeenincreasedthreetimessince1995,aslistedinthetablebelowandindicatedbythestarsonthechart.

Stateandfederalcigaretteexcisetaxesbyyear,1995to2009

2000 2002 2009

FederalTaxIncrease(perpack) $0.10 $0.05 $0.68

NewFederalTax(perpack) $0.34 $0.39 $1.01

$0.34 $0.39

$1.01


IncreasedCost:StateCigaretteExciseTaxes

Increasesinfederalandstateexcisetaxesovertimehavehelpedtoincreasethepriceofcigarettesthroughoutthecountry.Theaveragestateexcisetaxoncigarettesis$1.48–butthistaxvariesconsiderablystatetostate.Forexample,in2012,NewYorkhadthehighesttaxat$4.35perpackandMissourithelowestat$0.17perpack.Theresultofthisisthatthecostofapackofcigarettesvariesgreatlybystate.Themapaboveshowsthetaxratesineachstatein2012.Nowthatweknowalittlemoreaboutwhattobaccoexcisetaxesare,let’snowlookathoweffectiveexcisetaxescanbeinreducingtobaccouse.


IncreasedCost:EffectsofCigaretteExciseTaxes

Asyoucanseeinthegraphabove,increasesincigarettepricesleadtosignificantreductionsincigarettesmoking.Increasesincigarettepricescanleadtosignificantreductionsinsmokinginthreeways:

1. Increasethenumberofsmokerswhoquit.2. Reducetheamountofcigarettesconsumedbysmokers.3. Preventyoungpeoplefromeverstarting.

However,itisimportanttoviewthisdatainthelargercontextofothertobaccoproducts.In2012,CDCreportedatrendofcigarettesmokersswitchingtootherformsofcombustibletobaccosuchascigarsandpipetobaccoasaresultofthoseproductsnotbeingsubjecttothe2009federaltobaccotaxincrease.Thisexampleunderscorestheimportanceofincreasingtaxesproportionatelyacrossalltobaccoproductsaspoliciesarebeingdevelopedandimplemented.


IncreasedCost:EffectsonYouthSmoking

Numerouseconomicstudiesinpeer-reviewedjournalshavedocumentedthatcigarettetaxorpriceincreasesreduceyouthandyoungadultsmoking.Asthisgraphillustrates,youngpeopleareparticularlyaffectedbytobaccopriceincreases.Thegeneralconsensusisthatevery10%increaseinthepriceofcigarettesreduces:

• Overallcigaretteconsumptionbyapproximately3-5%• Youngadultsmokersby3.5%• Kidswhosmokeby6–7%

Highertaxesonsmokelesstobaccoalsoreducesitsuse,particularlyamongyoungmales,andincreasingcigarpricesthroughtaxincreaseshelpstoreduceadultandyouthcigarsmoking.

Forfurtherinformation….onhowthepriceoftobaccoinfluencesyouth-

CheckoutthisfactsheetfromtheCampaignforTobaccoFreeKids:http://www.tobaccofreekids.org/research/factsheets/pdf/0146.pdf


IncreasedCost:EffectsonQuitlineUseThetablebelowshowstheeffectsofthe2009federalcigarettetaxincreaseontheuseofseveralquitlinesacrossthecountry.Thefederaltaxoncigarettesincreasedfrom62centsto$1.01perpackonApril1,2009.

Theabovetableillustratessomespecificexamplesofhowataxincrease,inthiscasethe2009federaltobaccotaxincrease,impactscessationefforts.Alloftheseexamplesillustratethatinthesimplestterms,pricegreatlyaffectsconsumerbehavior.Similareffectsfromincreasedpricinghavealsobeenobservedwithmanyotherproductsandcanbeevenmoreevidentwithspecificpopulations.

Quitline Effect

NationalJewishHealthquitline • Callstripled

Arkansasquitline • Jan2009:550callsperweek• Mar2009:>2000callsperweek

FreeandClear(nowAlereWellbeing)(operatorof17statequitlines)

• 3250callsonApril1,2009(dateoftaxincrease)• 369%increaseincallsonApr1,2009comparedto

numberofcallsonApril1,2008


IncreasedCost:ImpactsonMinorityPopulationsItisevidentfromthegraphbelowthatpriceincreasesontobaccobywayofexcisetaxesgreatlyaffectpopulationsthatarehighusersoftobaccoproductsandthereforesufferdisproportionatelyfromtobacco-relateddiseaseanddeath.Afteranincreaseintobaccotaxes,thedataforHispanicsandnon-Hispanicblacksshowsignificantdeclinesinsmoking,particularlysmokingbyyoungadults.Sincethesepopulationsareathighriskfortobacco-relateddisease,theargumentforraisingexcisetaxeshasevengreaterweight.


Policy#2:100%Smoke-FreePolicieshttp://www.no-smoke.org/pdf/ANR-OrderForm.pdfThenextprovenpolicythatreducessmokingis100%smoke-freelawsandpoliciesforpublicplacesandworksites.Enactingsmoke-freepoliciesisthebestwaytoprotectpeoplefromtheserioushazardsofsecondhandsmokeexposure.Smoke-freepoliciescontributedgreatlytoreducingsmokingprevalenceincitiessuchasNewYork,whichsawsignificantdeclinesinsmokingratesinjusttwoyearsfollowingadoptionofasmoke-freelaw.AsmorestateandlocallawspassedacrosstheUS,theycontributedtoreducingthenationalprevalenceofsmokingtobelow20%in2008. AsofJanuary2013,24states,twoU.S.territories,andWashingtonDChaveenacted100%smoke-freepublicplaceslawsthatincludenon-hospitalityworkplaces,restaurants,andbars.Instateswithoutthoselaws,manycountiesandcitieshaveadoptedordinancesspecifictotheirjurisdiction.TheAmericansforNonsmokers'Rightsmaintainsupto-datemapsandliststhatidentifysmoke-freestatesandotherjurisdictions.


BenefitsofSmoke-freePolicies

http://www.no-smoke.org/pdf/ANR-OrderForm.pdf Smoke-freepoliciesprovideseveraladvantagesinreducingtobaccouseandexposure:Smoke-freelawsimprovehealth.Afterreviewingmountingevidence,TheInstituteofMedicineestablishedthatthenumberofpeopledyingasaresultoftobacco-relatedheartdiseasedeclinesinareaswheresmoke-freelawshavepassed.Thisdecreasecannotbeattributedonlytothedecreaseincigarettesmokers.Itispartlyduetothedecreaseinnonsmokers’exposuretosecondhandsmoke.Thehealthofworkersinplacesthathavegonesmoke-freealsoimproves.Smoke-freelawschangesocialnorms.Ifpeoplearenotallowedtosmokeinpublicplaces,thenotionthatsmokingisacceptablebehaviorisdecreased.Thischangeinbeliefisespeciallycriticalforadolescentsandyoungadults.

Smoke-freelawshelpsmokersquit.Notbeingabletosmokeinpublicplaceshelpssmokerswhowanttoquit.Notonlyaretheylimitedbythereductioninplaceswheretheycansmoke,buttheyarenottemptedbyotherpeople’ssmokeinrestaurants,bars,andotherpublicvenues.Smoke-freelawsdonothurtbusinesses.Despiteanecdotalreportsthatsmoke-freelawshurtbusinesses,reputable,peer-reviewedstudiesshowthisisnotthecase.Infact,smoke-freelawsarepopularamongthecustomersandownersofbarsandrestaurants.Clickheretoreadmoreaboutthe

economicimpactofsmoke-freepolicy.


ExpandingSmoke-FreePolicies:Multi-UnitHousingItistypicalthatonceindoorpublicplacesbecomesmoke-free,attentionturnstootherspaces.InMulti-UnitHousing(MUH),suchasapartmentsorcondominiums,manypeoplecomeintocontactwithsecondhandsmokethatdriftsintotheirunitfromotherunitsorcommonareas.InJuly2009,thefederalHousingandUrbanDevelopment(HUD)OfficeofPublic&IndianHousingissuedamemorandumtitledSmoke-FreePoliciesinPublicHousing,which“stronglyencouragesPublicHousingAuthoritiestoimplementnon-smokingpoliciesinsomeoralloftheirpublichousingunits.”InSeptember2010,HUD'sMulti-FamilyHousingSectionissuedanoticetitledOptionalSmoke-FreeHousingPolicyImplementationtoencourageownersandmanagersofHUDMulti-FamilyHousingrentalassistanceprograms,suchasSection8,toadoptandimplementsmoke-freepoliciesforsomeoralltheirproperties.Additionally,theCDCrecommendsthatsmoke-freeMUHpoliciesdesignateallunitsandcommonareasassmoke-free.AsofJanuary2011,over230localhousingauthoritiesin27stateshaveadoptedsmoke-freepolicies.

Forfurtherinformation….Aboutsmoke-freemulti-unithousing-

ReadthispolicybrieffromtheAmericanLungAssociation:http://www.lung.org/assets/documents/healthy-air/smuh-policy-brief-update.pdf


ExpandingSmoke-FreePolicies:CampusesandWorksites

CollegeCampuses:Smoke-freepoliciesarealsobecomingincreasinglypopularamongcollegecampuses.AsofJanuary2013,over1,100collegesoruniversitiesintheU.S.haveadopted100%smoke-freecampuspoliciesthateliminatesmokinginindoorandoutdoorareasacrosstheentirecampus,includingresidences.Thisnumberhasalmostdoubledsince2010.Curbingtobaccoinfluenceoncampusescouldhelppreventanewcohortoflifetimesmokers.HealthcareFacilities:Moreandmorehealthcarefacilitiesarealsoadoptingvoluntary100%smoke-freepoliciesandinsomecasetobacco-freecampuspolicies,reinforcingtheirmissiontopromoteandprotecthealth.Infact,asofJanuary2013,fournationalhealthcarecompaniesandover3,500localhospitalsandclinicshaveadopted100%

smoke-freecampuspolicies.Notonlydopoliciesfurtherpromoteahealthcarefacility'shealthmission,butsmoke-freehealthcarefacilitiesaidincommunity,employee,andpatientcessationefforts;lowermaintenancecosts;andincreaseworkerproductivity.

Uptodateinformationaboutsmoke-freepoliciesthathavebeenenactedinthevenuesdescribedhere,canbefoundontheAmericansforNonsmokers’Rightswebsite(www.no-smoke.org),underthe“smokefreelists,maps,anddata”section.


Policy#3:FundingforComprehensiveTobaccoControlPrograms

ThethirdcrucialpolicydescribedbytheCDCisstatefundingforcomprehensivetobaccocontrolprograms.Twocriticalcomponentsofcomprehensiveprogramsare:

1. Cessationservices:Ensuringaccesstoacomprehensivesetofcessationservicesisanessentialprogramcomponent.Cessationservicesthathavereducedsmokingprevalencethemostservelargepopulationsandprovidecounseling,nicotinereplacementmedications,andprescriptionmedications.

2. Effectivemediacampaigns:Mediacampaignshavebeenshowntoeffectivelyreducetobacco

initiation,decreaseconsumptionoftobaccoproducts,andincreasetobaccocessation.Mediacampaignsaremosteffectivewhenusedincombinationwithotherinterventions,likesmoke-freeairpoliciesorpricingstrategiesthatareknowntoreducetobaccouse.

Acomprehensiveprogramincludesstateandcommunityinterventionstocreatesystemsandprogramsthathelppreventyouthfromstartingtousetobaccoandsupportthoseadultswhowanttoquit.Theseprogramscreatepublicsupportfortobaccoproducttaxesandsmoke-freepoliciesaswellasoptimizethetobaccoreductionimpactthesepolicieshaveonceimplemented.Evidencehasshownthatstatesthatinvestinacomprehensiveprogramalongwithtaxandsmoke-freepolicesexperiencethegreatestreductionsintobaccouseandtobacco-relateddisease.


CessationServices:Quitlines

Providingaccesstoacomprehensivesetofcessationservicesisanessentialtobaccocontrolprogramcomponent.Onepartofthissetofcessationservicesaretelephonequitlines.Quitlinesareacost-effectivewaytoprovidecessationservices,producingquitratescomparabletoindividualandgroupinterventions–andtobaccousersaremorelikelytousequitlinesthantoparticipateinthoseinterventions.Quitlinesareespeciallyeffectivewhentheycombinecounselingwithpharmacologicalsupport.Somequitlinesofferservicesinmultiplelanguagesandtreatmentcurriculumspecifictopeoplewithmedicalconditionslikediabetes.

Telephonequitlineshaveawidereachinhelpingtobaccousersquit.Since2004,800-QUIT-NOWhasservedasanationwidenumberforaccessinglivecessationassistancebyroutingcallerstoquitlinesinall50states,andWashington,DC.Through2012,800-QUIT-NOWhashandledmorethan4.6millioncallers.Thetotalnumberofcallstoquitlinesismuchgreater,asmanypeoplealsoaccessthesestate-specificquitlinesdirectlythroughphonenumbersprovidedbytheirstate,healthplan,oremployer.

Similarly,cessationwebsitescanprovidequittools,informationaboutlocalresources,interactivehelpfromcessationexperts,andameanstogetsupportfromotherpeoplemakingattemptstoquit.Belowaretwogreatexamplesofcomprehensivecessationwebsites.Legacy’s“EX”websiteandtheU.S.DepartmentofHealthandHumanServices’“BeTobaccoFree”websitearetwogreatexamplesofcomprehensivecessationwebsites


CessationServices:RoleofHealthcareSystemsHealthcaresystemsplayanimportantroleinthehelpingpatientsthatusetobaccopreparetomakesuccessfulquitattempts–healthcareprovidersaskabouttobaccouse,adviseuserstoquit,andreferuserstocessationresources.Healthcareproviderscanbepersuasivemessengersaboutthehealthrisksoftobaccouseandcanmotivatetobaccouserstomakeaquitattempt.

Inaddition,havingaccesstocessationservicesthroughhealthinsuranceincreasesthenumberofpeoplemakingsuccessfulquitsbyreducingout-of-pocketexpenses.Itisthereforerecommendedthatinsurersprovidetobaccocessationbenefitsthatdothefollowing:

• Coveratleastfourcounselingsessionsofatleast30minuteseach,includingproactivetelephonecounselingandindividualcounseling.Whileclassesarealsoeffective,fewsmokersattendthem.

• Coverbothprescriptionandover-the-counternicotinereplacementmedication.

• Providecounselingandmedicationcoverageforatleasttwosmokingcessationattemptsperyear.

• Eliminateorminimizeco-paysordeductiblesforcounselingandmedications,asevensmallcopaymentsreducetheuseofproventreatments.

Statewidecessationpoliciescancreateopportunitiestotargetpopulationswithhighersmokingprevalence.Forexample,MassachusettsenactedandpromotedacomprehensiveMedicaidcessationbenefitin2005.Anevaluationofitsimpactfouryearslatershowedadecreaseinsmokingprevalenceform38%to28%andareturnonthecostoftheprogramof$2savedinmedicalcostsforevery$1investedincessationtreatment.


MediaCampaigns

Manystateshaveconductedmediacampaignstoeducateyouthandadultsaboutthedangersoftobaccouse,increaseawarenessoftobaccoindustrytactics,andtopromotecessation.However,itisimportantthatmediacampaignsaredonecorrectlytoensuretheireffectiveness.Theadvertisementsneedtobethoroughlytestedwiththeaudiencetargetedforthetobaccopreventionorcessationmessage.Also,themedia(television,radio,print)purchasedtoruntheadvertisementneedstobesufficienttoensurethemessageisbroadcastfrequentlyenoughtoreachthemajorityoftheaudience.WhilesocialmediasuchasFacebookandTwitterarecreatinglesscostlymeanstoreachlargepopulations,theymaynotbeastargetedastraditionalmedia.

CDC’sOfficeofSmokingandHealthMediaCampaignResourceCentermaintainsaclearinghouseofstatemediacampaignmaterials.Sincemediacampaignscanbecostly,thoseresourcesshouldbeexploredbeforedecidingtocreatenewcampaign.Inaddition,nationalpartnerssometimesrunmediacampaignsthatreachpopulationsinyourstate.Coordinatingstatemediaandotherprogramstrategieswithnationalcampaignscanextendtheirreachandimpact.

Again,massmediacampaignsaremosteffectivewhenusedincombinationwithotherevidence-basedstrategies.Forexample,inspring2012,CDCairedTipsfromFormerSmokers(TIPS),thefirstfederallyfunded,nationwide,paid-mediatobaccoeducationcampaignintheUnitedStates.TheTIPScampaignfeaturedformersmokerstalkingabouttheirexperienceslivingwithdiseasescausedbysmoking.TotalquitlinecallvolumeduringtheTIPScampaignwas365,194calls-morethanthedoubletherateduringtheprevious12-weekperiod.Inthiscase,combiningamassmediacampaignwiththeprovisionofquitlineswasaneffectivewaytoincreaseawarenessofthequitlineandmotivatequitattempts.


ComprehensiveTobaccoControlProgramExamplesNowthatwehavedescribedallthreeCDC-recommendedpolicies,wewillseehowincreasingthepriceoftobacco,enactingandenforcingsmoke-freeairlaws,andfundingcomprehensivestateprogramshasreducedthesmokingprevalenceinseveralstates.Statesthatutilizethesestrategies,particularlyincombination,producethegreatestreductionsintobaccouse.Next,we’lltakeacloserlookatafewoftheexamplesshownbelowtoseehowtobaccocontrolprogramsinthesestatesusedthestrategiespresentedinthislessontoachievetheseresults.

NewYorkCutyoungadultsmokingby30%from2000to2010

MassachusettsCutadultsmokingby21%from1993to2000

WashingtonCutadultsmokingby33%from1999to2010

CaliforniaCutadultsmokingby 47%from 1988to2010

MaineCuthighschoolsmokingby61%from1997to2011

NorthDakotaCuthighschoolsmokingby13.5%from2009to2011


Example:StateofCaliforniaInCalifornia,adultsmokingratesdroppedfrom22.7%to11.9%from1998to2010.Additionally,smokingprevalenceamonghighschoolstudentsdecreasedfrom21.6%to13.8%from2000and2010.HowdidCaliforniaaccomplishthis?

In1988,CaliforniavotersapprovedProposition99,aballotinitiativethatincreasedstatecigarettetaxesandearmarked20%ofthefundsforhealtheducationagainsttobaccouse.Thestate’sTobaccoControlProgrambeganin1990,andhasbeenhighlysuccessfulinreducingsmokingratessincethenbyfocusingonsocialnormchangethroughmediacampaignsandlocal-levelprogramming.TheCaliforniatobaccocontrolprogramproducedthelargestsmokingreductionswhenitwasfundedatitshighestlevels.Progressstalledwhentheprogram’sfundingwascutinthemid-1990s,butthestategotbackontrackwhenprogram

fundingwaslaterpartiallyrestored.Researchshowsthattobaccocontrolprogramfundingisdirectlytiedtoreductionsinsmokingratesandcigaretteconsumptionpersmoker.


Example:StateofMainePriorto1997,Mainehadoneofthehighestyouthsmokingratesinthecountry.By2011,thesmokingprevalenceamonghighschoolstudentsdroppedby61%.WhatdidMainedo?In1997,MaineincreasedthestatecigaretteexcisetaxandusedaportionofthosefundstoestablishacomprehensivetobaccopreventionprogramknownasthePartnershipforaTobacco-FreeMaine,whichwaslatersupplementedwithproceedsfromthe1998statetobaccosettlement.Mainehasalsoraisedcigarettetaxestwice,toitscurrenttaxof$2.00perpack.Mainehassuccessfullyenacted100%smoke-freeairlawsthatcoverworkplaces,restaurants(includingoutdooreatingareas),bars,andstateparksandhistoricalsites.Takentogether,thesemeasureshadalargeimpactonyouthsmokingratesinMaine.


Example:NewYorkCity From2002to2004,theestimatedadultsmokingprevalenceinNewYorkCitydecreasedfrom21.5%to18.4%,representingnearly200,000fewersmokers.Youthsmokingratesdeclined40%from2000to2005.NewYorkCitywasabletoaccomplishthisbecauseofacomprehensiveprogramputinplaceatboththestateandcitylevel.

Between2000and2003,NewYorkStateandNewYorkCityeachenactedsmoke-freeworkplacepoliciesandincreasedtobaccotaxes,whilealsoprovidingcessationservices:

ExciseTaxIncreases Smoke-freeWorkplaceLaws

NewYorkState$0.55increaseinMarch2000

$0.39increaseinApril2002EnactedJuly2003

NewYorkCity $1.42increaseinJuly2002 EnactedMarch2003

Asaresultofthiscomprehensiveapproachtotobaccocontrol,thenumberofsmokersinNewYorkCitydeclinedsubstantially.Asyoucanseeinthechartbelow,thesmokingprevalencedecreasedamongbothadultsandyouth.ThecombinationofNewYorkStateandNewYorkCity’spolicyinterventionsisagreatexampleforwhatcanhappenwhenraisingthecostandpassingsmoke-freelawsareusedincombination.

0

5

10

15

20

25

2001 2003 2005 2007 2009 2011

Percen

tageofN

YCPop

ulation

Year

TrendsinYouthandAdultSmokinginNYC,2001- 2011

YouthSmoking AdultSmoking


PartTwo,LessonThree:ConclusionInthislessonwetalkedaboutthethreepoliciestheCDCrecommendsforeffectivetobaccocontrol:

1. Increasethecostoftobaccoproducts.2. Enact100%smoke-freelaws.3. Fundsustainable,comprehensivetobaccocontrolprogramsthatincludecessationservicesand

mediacampaigns.Wedescribedwhatacomprehensiveapproachtotobaccocontrolconsistsof,andhowitworkstocreatesupportfortheotherrecommendedpolicies.Finally,wediscussedsomeexamplesofhowstatesusethesepoliciesincombinationtoproducesignificantreductionsintobaccouse.Next,wewilldiscusswhatyoucandotohaveacomprehensiveapproachtotobaccocontrolimplementedand

sustainedinyourstatesandcommunities.


LessonThreeCheckforUnderstanding

1. WhichofthefollowingisNOToneofthethreepoliciesrecommendedbytheCDCproventobeeffectiveinreducingtobaccouse?

a. Increasethecostoftobaccoproducts.b. Enact100%smoke-freelaws.c. Fundsustainable,comprehensivetobaccocontrolprograms,includingcessationservicesand

mediacampaigns.d. Promotetheuseofnon-tobaccoalternativeproducts

2. Whichtwopopulationsaremostaffectedbyincreasesinpricesofcigarettes?a. YouthandMinorityPopulationsb. ElderlyandMinorityPopulationsc. MalesandYouthpopulationd. FemalesandElderlyPopulation

3. WhathasresearchshowntoNOTbeanimpactofsmoke-freepolicies?

a. Socialnormssurroundingtobaccousechange.b. Businesseswhoenactsmoke-freepoliciessufferfinancially.c. Thehealthofsmokersandnonsmokersimproves.d. Currentsmokerstryingtoquitareassistedbyreducedlocationstosmokeandless

temptationtosmoke.4. BrieflyexplainhowtobaccocontrolpolicieshaveaffectedsmokingratesinNewYorkStateand

NewYorkCity.Ifyouneedtoreview,gobacktothe“ComprehensiveTobaccoControlProgramExamples”and“ComprehensiveTobaccoControlProgramExample:CombinedApproach”pages.

5. Whataspectofacomprehensiveapproachtotobaccocontroldoyouthinkismostneededinyour

state?Why?


LessonThreeCheckforUnderstandingAnswers

1. WhichofthefollowingisNOToneofthethreepoliciesrecommendedbytheCDCproventobeeffectiveinreducingtobaccouse?

a. Increasethecostoftobaccoproducts.b. Enact100%smoke-freelaws.c. Fundsustainable,comprehensivetobaccocontrolprograms,includingcessationservicesand

mediacampaigns.d. Promotetheuseofnon-tobaccoalternativeproducts

Correctanswer:d.Needtoreview?Gobacktothe“EffectiveTobaccoControlPolicies”page.

2. Whichtwopopulationsaremostaffectedbyincreasesinpricesofcigarettes?e. YouthandMinorityPopulationsf. ElderlyandMinorityPopulationsg. MalesandYouthpopulationh. FemalesandElderlyPopulation

CorrectAnswer:a.Needtoreview?Gobacktothe“IncreaseCost:ImpactsonMinorityPopulations”page.

3. WhathasresearchshowntoNOTbeanimpactofsmoke-freepolicies?e. Socialnormssurroundingtobaccousechange.f. Businesseswhoenactsmoke-freepoliciessufferfinancially.g. Thehealthofsmokersandnonsmokersimproves.h. Currentsmokerstryingtoquitareassistedbyreducedlocationstosmokeandless

temptationtosmoke.

CorrectAnswer:b.Needtoreview?Gobacktothe“BenefitsofSmoke-freePolicies”page.

4. BrieflyexplainhowtobaccocontrolpolicieshaveaffectedsmokingratesinNewYorkStateandNewYorkCity.Ifyouneedtoreview,gobacktothe“ComprehensiveTobaccoControlProgramExamples”and“ComprehensiveTobaccoControlProgramExample:CombinedApproach”pages.

Openended:answerswillvary.5. Whataspectofacomprehensiveapproachtotobaccocontroldoyouthinkismostneededinyour

state?Why?

Openended;answerswillvary.


SourcesThroughout:CentersforDiseaseControlandPrevention.Bestpracticesforcomprehensivetobaccocontrolprograms,2007.Available:http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm

Throughout:TobaccoControlNetwork.TCNPolicyPlatform.Available:http://www.ttac.org/TCN/materials/pdfs/TCN_Policy_Platform_2012.pdf

Throughout:GiovinoGA,ChaloupkaFJ,HartmanAMetal.CigaretteSmokingPrevalenceandPoliciesinthe50States:AnEraofChange–TheRobertWoodJohnsonFoundationImpacTeenTobaccoChartBook.Buffalo,NY:UniversityatBuffalo,StateUniversityofNewYork,2009.Availableat:http://impacteen.org/statetobaccodata/chartbook_final060409.pdf

Throughout:RobertWoodJohnsonFoundation:TheImpactofTaxandSmoke-FreeAirPolicyChanges.Available:http://www.rwjf.org/en/research-publications/find-rwjf-research/2011/03/preface/the-impact-of-tax-and-smoke-free-air-policy-changes.html

Slide2:Quote:MayorRichardBloomberg.Available:http://archive.tobacco.org/news/230156.html

Slide3,4:FederalandStateCigaretteExciseTaxes---UnitedStates,1995—2009(2009,May22)MMWR:MorbidityandMortalityWeeklyReport,58(19);524-527Available:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5819a2.htm

Slide4:CentersforDiseaseControlandPrevention,OfficeonSmokingandHealth.TrendsinStateandFederalCigaretteTaxandRetailPrice-UnitedStates,1970-2009(2010,September17).Available:http://www.cdc.gov/tobacco/data_statistics/tables/economics/trends/index.htm

Slide5:CampaignforTobacco-FreeKids.MapofStateCigaretteTaxRates.Available:http://www.tobaccofreekids.org/research/factsheets/pdf/0222.pdfSlide6:CentersforDiseaseControlandPrevention.EconomicFactsaboutU.S.TobaccoProductionandUseWebsite(2012).Available:http://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/index.htm

Slide6,7:CampaignforTobaccoFreeKids.RaisingCigaretteTaxesReducesSmoking,EspeciallyAmongKids(AndtheCigaretteCompaniesKnowit)Available:http://www.tobaccofreekids.org/research/factsheets/pdf/0146.pdf

Slide6:CentersforDiseaseControlandPrevention.ConsumptionofCigarettesandCombustibleTobacco—UnitedStates,2000–2011.MorbidityandMortalityWeeklyReport.61(30);565-569.Available:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6130a1.htm?s_cid=mm6130a1_w

Slide9:ResponsetoIncreasesinCigarettePricesbyRace/Ethnicity,Income,andAgeGroups--UnitedStates,1976-1993.MorbidityandMortalityWeeklyReport.July31,1998/47(29);605-9.Available:http://www.cdc.gov/mmwr/preview/mmwrhtml/00054047.htm

Slide10:CentersforDiseaseControlandPrevention.Smoke-FreePoliciesReduceSmoking.Available:http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/protection/reduce_smoking/index.htm

Slide10:AmericansforNonsmokers’Rights.U.S.100%SmokefreeLawsinNon-HospitalityWorkplacesANDRestaurantsANDBars.Available:http://www.no-smoke.org/pdf/WRBLawsMap.pdf

Slide11:InstituteofMedicine.SecondhandSmokeExposureandCardiovascularEffects:MakingSenseofEvidence.(2009,October15)Available:http://www.iom.edu/Reports/2009/Secondhand-Smoke-Exposure-and-Cardiovascular-Effects-Making-Sense-of-the-Evidence/Report-Brief-Secondhand-Smoke.aspx


Slide11:CentersforDiseaseControlandPrevention.Smoke-FreePoliciesImproveHealth.Available:http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/protection/improve_health/index.htm

Slide11:AmericansforNonsmokers’Rights.EconomicImpactofSmokefreeOrdinances:AnOverview.Available:http://no-smoke.org/document.php?id=219

Slide12:U.S.DepartmentofHousingandUrbanDevelopment,OfficeofPublicandIndianHousing,OfficeofHealthyHomesandHeadHazardControl.Smoke-FreePoliciesinPublicHousingAvailable:http://portal.hud.gov/hudportal/documents/huddoc?id=12-25pihn.pdfSlide12:U.S.DepartmentofHousingandUrbanDevelopment.OptionalSmoke-FreeHousingPolicyImplementation.Available:http://www.tcsg.org/sfelp/HUD-SFHsgImplemt091510.pdfSlide13:AmericansforNonsmokers’Rights.U.S.CollegesandUniversitieswithSmokefreeandTobacco-FreePolicies(January2,2013).Available:http://www.no-smoke.org/pdf/smokefreecollegesuniversities.pdfSlide13:AmericansforNonsmokers’Rights.100%SmokefreeU.S.HospitalsandPsychiatricFacilities(January2,2013).Available:http://www.no-smoke.org/pdf/smokefreehealthcare.pdfSlide13:AmericansforNonsmokers’Rights.BusinessCostsinSmoke-FilledEnvironments.Available:http://no-smoke.org/document.php?id=209Slide13:CentersforDiseaseControlandPrevention,NationalCancerInstitute,Smokefree.govWebsite.Available:smokefree.govSlide15:LegacyFoundation.EXWebsite:Available:http://www.becomeanex.orgSlide15:Free&Clear.QuitforLifeProgram.Availableat:http://www.freeclear.com/quit-for-life/Slide15:NorthAmericanQuitlineConsortium.1-800-Quit-NowStats.Available:http://www.naquitline.org/?page=800QUITNOWstats

Slide15:NorthAmericanQuitlineConsortium.1-800-Quit-NowStats,Map.Available:http://map.naquitline.org/

Slide15:CentersforDiseaseControlandPrevention.TelephoneQuitlines:AResourceforDevelopment,Implementation,andEvaluation.Atlanta,GA:U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention,NationalCenterforChronicDiseasePreventionandHealthPromotion,OfficeonSmokingandHealth,FinalEdition,September2004.

Slide15,16:CentersforDiseaseControlandPrevention.BenefitsSummary.Available:http://www.cdc.gov/tobacco/quit_smoking/cessation/coverage/page1/index.htm

Slide16:CentersforDiseaseControlandPrevention.APracticalGuidetoWorkingwithHealth-CareSystemsonTobacco-UseTreatment.Atlanta,GA:U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention,NationalCenterforChronicDiseasePreventionandHealthPromotion,OfficeonSmokingandHealth;2006.Available:http://www.cdc.gov/tobacco/quit_smoking/cessation/practical_guide/pdfs/practical_guide.pdf

Slide16:MassachusettsDepartmentofPublicHealth.MassHealthSmokingCessationBenefitBriefingNotes.Available:http://www.mass.gov/eohhs/docs/dph/tobacco-control/masshealth-smoke-cessation-benefit.pdf

Slide17:IncreasesinQuitlineCallsandSmokingCessationWebsiteVisitorsDuringaNationalTobaccoEducationCampaign—March19–June10,2012(2012,August31)MMWR:MorbidityandMortalityWeeklyReport,61(34);667-670Available:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6134a2.htm


Slide17:CentersForDiseaseControlandPrevention.TipsFromFormerSmokers.Available:http://www.cdc.gov/tobacco/campaign/tips/

Slide17:CentersforDiseaseControlandPrevention.MediaCampaignResourceCenter.Available:http://www.cdc.gov/tobacco/media_campaigns/index.htm

Slide14,18,19,20:CampaignforTobaccoFreeKids.ComprehensiveTobaccoPreventionandCessationProgramsEffectivelyReduceTobaccoUse.Available:http://www.tobaccofreekids.org/research/factsheets/pdf/0045.pdf

Slide21:DeclineinSmokingPrevalence---NewYorkCity,2002—2006.(2007,June22)MMWR:MorbidityandMortalityWeeklyReport,56(24);604-608.Available:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5624a4.htm

Slide21:NewYorkCityDepartmentofHealthandMentalHygieneEpiQuerySystem:YRBSSurveyTrends“currentlySmoker”Available:https://a816-healthpsi.nyc.gov/epiquery/

Slide21:NewYorkCityDepartmentofHealthandMentalHygieneEpiQuerySystem:CommunityHealthSurveyTrends“currentSmoker”Available:https://a816-healthpsi.nyc.gov/epiquery/


ImagesSlide2:SayNoToCancerJoeImage:TrinketsandTrashWebsite.Available:http://www.trinketsandtrash.org/detail.php?artifactid=3685

Slide4:Graph:FederalandStateCigaretteExciseTaxes---UnitedStates,1995—2009.MMWR:MorbidityandMortalityWeeklyReport,58(19);524-527Available:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5819a2.htm

Slide5:MapofStateCigaretteTaxRates,CampaignforTobacco-FreeKids.Available:http://www.tobaccofreekids.org/research/factsheets/pdf/0222.pdfSlide6:GraphofU.S.CigarettePricesvs.Consumption1970-2007.CampaignforTobacco-FreeKids:RaisingCigaretteTaxesReducesSmoking,EspeciallyAmongKids(AndtheCigaretteCompaniesKnowIt).Available:http://www.tobaccofreekids.org/research/factsheets/pdf/0146.pdf

Slide7:GraphofU.S.YouthSmokingPrevalencevs.CigarettePackPrice.CampaignforTobaccoFreeKids:RaisingCigaretteTaxesReducesSmoking,EspeciallyAmongKids(AndtheCigaretteCompaniesKnowIt).Available:http://www.tobaccofreekids.org/research/factsheets/pdf/0146.pdf

Slide9:Graphofpercentagedeclineinsmokinginresponseto10%priceincreaseoncigarettes,byageandracial/ethnicgroup.ResponsetoIncreasesinCigarettePricesbyRace/Ethnicity,Income,andAgeGroups--UnitedStates,1976-1993(1998,July31).MMWR:MorbidityandMortalityWeeklyReport,47(29);604-9Available:http://www.cdc.gov/mmwr/preview/mmwrhtml/00054047.htm

Slide10:NoSmokingSignImage.TrinketsandTrashwebsite.Available:http://www.trinketsandtrash.org/detail.php?artifactid=3699

Slide14:QuitSmokingTodayBannerImage:CentersforDiseaseControlandPrevention,NationalCancerInstitute,Smokefree.govWebsite.Available:smokefree.govSlide15:QuitlineMagnetImage.TrinketsandTrashwebsite.Available:http://www.trinketsandtrash.org/detail.php?artifactid=2088

Slide17:“FairEnough”Anti-tobaccoAdImage.TrinketsandTrashwebsite.Available:http://www.trinketsandtrash.org/detail.php?artifactid=4759

tobacco 101 part 2 lesson 3 - emory universitylesson three looks at three primary tobacco control...

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