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TOBACCO PREVENTION AND CONTROL
RISK FACTORS AND POLICY SOLUTIONS
PRESENTATION TO THE NEVADA CHRONIC DISEASE FORUM JANUARY 10TH, 2012
Christopher Roller Senior Government Relations Director, American Heart/American Stroke Association
Larry Matheis Executive Director, Nevada State Medical Society
OBJECTIVES
History of the problem in Nevada
Tobacco use and exposure as a risk factor
Impact of Tobacco in Nevada
Policy solutions to the problem
The future
Questions and discussion
HISTORY
HISTORY
For decades Nevada has been on the front
lines on the war against tobacco
Nevada has historically had higher than average
smoking rates
Nevada has ranked towards the bottom of states
in spending on tobacco programs, tobacco taxes
and higher in workplace exposure to SHS
Indoor/workplace smoking in casinos and bars
with gaming set the tone nationally
HISTORY
The Nevada Legislature passed an increase to
cigarette taxes from $.35 to $.80 per pack in a
special session in 2003
In 2006 Nevada voters approved the Nevada
Clean Indoor Air Act
The Nevada Legislature has not passed changes
to oral tobacco products advocated for by the
tobacco industry in multiple sessions
In the 2011 session Legislators approved a bill
improving warnings for smoking while pregnant
HISTORY
In the 2007, 2009 and 2011 sessions the Nevada
Legislature failed to pass multiple bills that
would have increased state tobacco taxes
The Nevada Legislature “swept” all state funding
of tobacco prevention in control programs in the
2010 special legislative session
The Nevada Legislature has weakened the voter
approved NCIAA in two successive sessions
The Nevada Legislature failed to pass a bill that
would have banned smoking on campuses of the
NSHE
TOBACCO AS A RISK FACTOR
TOBACCO AS A RISK FACTOR
Tobacco -
Contributes to 1 in 5 deaths in the United States
More than HIV, illegal drug use, alcohol use, vehicle
injuries and suicides combined
TOBACCO AS A RISK FACTOR
The CDC reports that 46.6
million adults in the US smoke
Each year, about 443,000
people die from smoking or
exposure to secondhand smoke
in the US
8.6 million suffer from
serious illnesses caused
by smoking
TOBACCO AS A RISK FACTOR
Smoking causes: Decreased oxygen to the heart and to other tissues in the body
Decreased exercise tolerance
Decreased HDL (good) cholesterol
Increased blood pressure and heart rate
Damage to cells that line coronary arteries and other blood vessels
Increased risk of developing coronary artery disease and heart attack
Increased risk of developing peripheral artery disease and stroke
Increased risk of developing lung cancer, throat cancer, chronic asthma, chronic bronchitis and emphysema
Increased risk of developing diabetes
Increased risk of developing a variety of other conditions including gum disease and ulcers
Increase tendency for blood clotting
Increased risk of recurrent coronary artery disease after bypass surgery
Increased risk of becoming sick (especially among children: respiratory infections are more common among children exposed to second-hand smoke)
Source: Cleveland Clinic
TOBACCO AS A RISK FACTOR
TOBACCO AS A RISK FACTOR
Smoking and CVD
People who smoke a pack or more a day have
more than twice the risk of a heart attack than
non smokers
Approximately 20% of heart disease cases are
caused by smoking
Smoking is a major cause of atherosclerosis (deterioration of normal artery walls and thickening and
blockage of arteries due to fatty deposits)
TOBACCO AS A RISK FACTOR
The nicotine present in tobacco smoke
causes heart disease by:
Decreasing oxygen to the heart.
Increasing blood pressure and heart rate.
Increasing blood clotting.
Damaging to cells that line coronary arteries and
other blood vessels.
TOBACCO AS A RISK FACTOR
IMPACT OF TOBACCO IN NEVADA
Tobacco use and exposure remains the leading
cause of preventable illness and death globally,
nationally, and locally
Tobacco use and exposure contributes to the top
four causes of death in Nevada:
Heart Disease, including heart attacks
Cancer
Chronic Obstructive Pulmonary Disease
(COPD)
Stroke
IMPACT OF TOBACCO IN NEVADA
Nevada ranks 3rd highest in the nation for
smoking-attributable mortality
Estimated annual deaths from smoking in Nevada:
Adults who are smokers: 3,100
Kids now under 18 who will die prematurely
from smoking: 47,000
Adult nonsmokers who will die from exposure
to secondhand smoke: 220 to 620
IMPACT OF TOBACCO IN NEVADA
Tobacco use and exposure costs Nevada millions every year:
Annual health care costs in Nevada directly caused by smoking: $565 million
Portion covered annually by the state Medicaid program: $123 million
Smoking related productivity loses in Nevada: $832 million
Residents’ annual state & federal tax burden from smoking related government expenditures: $563 per household
Source: Campaign for Tobacco Free Kids
IMPACT OF TOBACCO IN NEVADA
The Institutes of Medicine and National Institute for Occupational Safety and Health Reports on health impacts of secondhand smoke (SHS), 2009
The evidence is consistent about the relationship between SHS exposure and heart attacks, between smoke-free laws and decreases in acute coronary events
Health of casino and other service employees impacted by exposure to SHS
The 2006 passage of the Nevada Clean Indoor Air Act is an example of a policy action that has been taken in Nevada to reduce the impact of tobacco use and exposure
POLICY SOLUTIONS
POLICY SOLUTIONS
Although numerous policy solutions exist,
we will focus on three:
Smoke free/tobacco free laws
Tobacco prevention and control program funding
Tobacco tax increases
POLICY SOLUTIONS
Smoke Free Laws
Surgeon General:
“No safe level of exposure to second hand
smoke”
POLICY SOLUTIONS
Smoke Free Laws
Benefits include:
Reduction in exposure to SHS by workforce and the public
Reduced health care costs
Increased productivity and less sick days
Reduced insurance costs
Reduced cleaning and maintenance costs
Reduced death and disability
Prolonged work life
Reduced smoking rates
POLICY SOLUTIONS
Smoke Free Laws
In Nevada:
NCIAA passed by 54% of voters in 2006
Twice weakened by the Nevada Legislature
Local communities fighting back
A matter of time?
POLICY SOLUTIONS
Tobacco Program Funding
The Centers for Disease Control and Prevention
(CDC) recommends Nevada spend $32 million
annually on tobacco prevention and control.
Why?
POLICY SOLUTIONS
Tobacco Program Funding
The Centers for Disease Control and Prevention
(CDC) recommends Nevada spend $32 million
annually on tobacco prevention and control.
Annual tobacco industry marketing
expenditures nationwide - $13.4 billion
Annual tobacco industry marketing
expenditures in Nevada: $115.6 million
POLICY SOLUTIONS
Tobacco Program Funding
Current state tobacco prevention funding in
Nevada:
Funding Sources Tobacco revenue $ to Tobacco Prevention
MSA $42 million $0
Tobacco Tax $139.97 million $0
General Fund $0 $0
Total $181.97 million $0
POLICY SOLUTIONS
Tobacco Program Funding
Dead Last
POLICY SOLUTIONS
Tobacco Program Funding
Since funding began, smoking rates have
decreased significantly:
1999 2007
Youth smoking rate 33% 13.6%
Adult smoking rate 31.5% 21.5%
However, these trends may be changing…
POLICY SOLUTIONS
Tobacco Program Funding
Research indicates that once tobacco prevention
funding is eliminated or reduced, smoking rates
quickly increase
Other states that have reduced or eliminated
tobacco prevention funding have seen increases
in smoking rates and an alarming increase in
illegal sales of tobacco to minors
POLICY SOLUTIONS
Tobacco Program Funding
A continued reduction of Nevada’s investment in
tobacco prevention may result in:
Increased smoking rates
Increased complications of smoking
Increased medical costs
Increases in chronic disease, and
An increase in state Medicaid expenditures
POLICY SOLUTIONS
Tobacco Taxes
*A $1.00 per pack increase in cigarette taxes will produce the following:
Additional revenue in the first year of $75.7 million
Decrease in youth smoking rate estimated at 17.4%
16,400 adults estimated to quit smoking
Long term savings from adult and youth smoking declines of an estimated $600 million
*Campaign for Tobacco Free Kids
POLICY SOLUTIONS
Tobacco Taxes
Public support exists for an increase in
state tobacco tax rates
Polls conducted during the 2009 and 2011
legislative sessions showed approximately 70%
public support
POLICY SOLUTIONS
Tobacco Taxes
Political will is needed
THE FUTURE
Nevada needs a commitment to a
comprehensive strategy towards tobacco
control
THE FUTURE
This is about investing
Every $1 invested in tobacco prevention and
control programs saves $4 in reduced health care
costs, increased productivity, etc.
$ not spent on tobacco products are used in other
areas of our economy (example: A two pack a day
smoker has approximately $4300 additional to
spend on other consumer products, services, etc)
THE FUTURE
Combining tobacco tax increases with expanded
state tobacco prevention and control efforts and
increased protection against SHS would result in
larger tobacco use declines in the state and a
reduction in SHS exposure, thereby saving even
more lives and more dollars.
This has been proven to occur both in other
states and in the past in Nevada.
QUESTIONS AND DISCUSSION