Tobacco Control Tobacco Control Integration Project Integration Project

(TCIP)(TCIP)

Addressing the Burden Addressing the Burden

of Tobacco Useof Tobacco Use

in Populations with Fewer in Populations with Fewer ResourcesResources

Why TCIP?Why TCIP?

By SES: What Percent By SES: What Percent Smoke?Smoke?

Oregon BRFSS

0%

10%

20%

30%

40%

50%

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Low SES

Not Low SES

44%

34%

19%

13%

Defining Low Socio-Economic Defining Low Socio-Economic Status Status

Low SES if: Low SES if: Did not graduate high schoolDid not graduate high school HH income is less than $25KHH income is less than $25K On Oregon Health PlanOn Oregon Health Plan UninsuredUninsured

Smoking prevalence among Oregon adults by race, 2004-2005

31%38%

50%

17%

50%

15%19% 20%

30%

10%

38%

14%

0%

20%

40%

60%

All Oregon White AfricanAmerican

Asian andPacific Islander

AmericanIndian/Alaska

Native

Latino(a)

Population Group

Perc

ent C

urre

nt S

mok

er

Oregon adults who havelower income or have notfinished high school

Oregon Adults

Adult Smoking Prevalence by Education, Oregon, 1999-2007

0%

5%

10%

15%

20%

25%

30%

35%

1999 2000 2001 2002 2003 2004 2005 2006 2007

% of

Adult

s Who

Smok

e

High school grad. or less

Some college

College graduate

By Low-SES: What about Secondhand By Low-SES: What about Secondhand Smoke?Smoke?

Smoking Ban In the Home

82%

63%

93%

80%

0%

20%

40%

60%

80%

100%

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Low SES

Not Low SES

Oregon BRFSS

18%

44%

4%

18%

0%

10%

20%

30%

40%

50%

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

What about Secondhand Smoke?What about Secondhand Smoke?

Smoking In Homes with Kids

Low SES

Not Low SES

Oregon BRFSS

Medicaid BurdenMedicaid Burden

In 2007, adult smoking prevalence:In 2007, adult smoking prevalence:

37% - Medicaid recipients - adults37% - Medicaid recipients - adults

19% - Oregon adults19% - Oregon adults

Financial costs to Financial costs to Medicaid Medicaid in Oregonin Oregon

Medicaid costs for smoking Medicaid costs for smoking related disease: related disease:

$287 million per year$287 million per year

EExposure to Smoking in the xposure to Smoking in the WombWomb

Oregon Birth Files

22%

45%

12%

24%

0%

10%

20%

30%

40%

50%

Births paid by Medicaid

All births

Intention to Quit Smoking by Intention to Quit Smoking by SES, SES,

Oregon, 2007Oregon, 2007

Oregon BRFSS 2007

25%

19%

36%

46%

40%

36%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Low SES

Not Low SES

Do not want

to quit

Plan to quit in 6 months

Plan to quit in 30 days

RJ Reynolds, chew addict, died from pancreatic RJ Reynolds, chew addict, died from pancreatic cancer (according to the WWW which is always cancer (according to the WWW which is always

accurate)accurate)

What is TCIP?What is TCIP?

What the Tobacco Prevention and What the Tobacco Prevention and Education Program knows about Education Program knows about

tobacco control +tobacco control +

What DHS/OHA Divisions know What DHS/OHA Divisions know about their clients and workforce =about their clients and workforce =

TCIP!TCIP!

Tobacco Control Integration Tobacco Control Integration ProjectProject

DHS/OHA touches 1 million Oregonians DHS/OHA touches 1 million Oregonians yearlyyearly

Weaving Tobacco Prevention and Education Weaving Tobacco Prevention and Education throughout DHS/OHAthroughout DHS/OHA

Policy and procedure changesPolicy and procedure changes

Projects in each Division of DHS/OHAProjects in each Division of DHS/OHA

Temporary Assistance to Temporary Assistance to Needy Families Needy Families

In April ‘09, TANF served 25,178 one In April ‘09, TANF served 25,178 one and two parent families. The current and two parent families. The current maximummaximum benefit for a family of benefit for a family of three is $528. three is $528.

Over a third of the adults in those Over a third of the adults in those families smoke.families smoke.

TANF, Cont.TANF, Cont.

At $4.00 per pack, a two pack per At $4.00 per pack, a two pack per day smoker spends $240 per month day smoker spends $240 per month on cigaretteson cigarettes

If both adults smoke, they may If both adults smoke, they may easily spend easily spend moremore on cigarettes on cigarettes than they receive through TANFthan they receive through TANF

Food StampsFood Stamps

In April ’09, over 300,000 households In April ’09, over 300,000 households and almost 600,000 persons received and almost 600,000 persons received food stamps.food stamps.

This is more than a tenth of our This is more than a tenth of our populationpopulation

Over a third of these Oregonians smokeOver a third of these Oregonians smoke

Food stampsFood stamps

In 2007, the average family food In 2007, the average family food stamp benefit was stamp benefit was $127 per month$127 per month..

A one-pack per day smoker spends A one-pack per day smoker spends about about $120 per month$120 per month on on cigarettes. cigarettes.

Food InsecurityFood Insecurity

Archives of Pediatric and Adolescent Archives of Pediatric and Adolescent Medicine, 2008:Medicine, 2008:

Living with adult smokers doubles the Living with adult smokers doubles the rate of adult and child food insecurity rate of adult and child food insecurity and triples the rate of severe food and triples the rate of severe food insecurity. insecurity.

Vs.

Divisions of the Department of Divisions of the Department of Human Services (DHS) and the Human Services (DHS) and the Oregon Health Authority (OHA) Oregon Health Authority (OHA)

include:include:

Public Health DivisionPublic Health Division Addictions and Mental Health DivisionAddictions and Mental Health Division Division of Medical Assistance ProgramsDivision of Medical Assistance Programs Children, Adults and Families DivisionChildren, Adults and Families Division Seniors and People with DisabilitiesSeniors and People with Disabilities Administrative Services DivisionAdministrative Services Division

What is TCIP doing now?What is TCIP doing now?

Projects include:Projects include:

Contract languageContract language Website buttonsWebsite buttons Targeted mailingsTargeted mailings Quit Line promotionQuit Line promotion Home Care workersHome Care workers

But what is TCIP REALLY But what is TCIP REALLY doing??doing??

Changing systems, policies and Changing systems, policies and procedures to create procedures to create sustainable sustainable environmental support for environmental support for becoming and remaining becoming and remaining tobacco-free.tobacco-free.

ARRA GoalsARRA Goals

To increase 100% tobacco-free or To increase 100% tobacco-free or smokefree policies in facilities smokefree policies in facilities serving DHS/OHA clientsserving DHS/OHA clients

To increase policies requiring To increase policies requiring promotion of, access to and delivery promotion of, access to and delivery of cessation resources to DHS/OHA of cessation resources to DHS/OHA clients and employeesclients and employees

ARRA Goals, Cont.ARRA Goals, Cont.

To implement a hard hitting counter-To implement a hard hitting counter-advertising campaign targeted to advertising campaign targeted to people with fewer resourcespeople with fewer resources

To raise the price of tobacco by 10%To raise the price of tobacco by 10%

VisionClients and employees of DHS

have improved health and quality of life due to the

elimination of tobacco use and exposure to secondhand smoke.

MissionTobacco use reduction is an integral part of work in each division of DHS.