CHANGING TOBACCO POLICY TO REDUCE HEART DISEASE

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CHANGING TOBACCO POLICY TO REDUCE HEART
DISEASE STROKE Beverly J. May,
M.P.A.Regional Director, Western States and
OhioCampaign for Tobacco-Free KidsSeptember 20,
2007
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Lets all get ALONG!!
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Tobaccos Toll in U.S.

• Tobacco is the leading preventable cause of
  death, killing more than 400,000 each year
• Tobacco kills more people than from AIDS,
  alcohol, car accidents, murders, suicides, and
  fires combined
• Tobacco results in 96.7 billion in annual health
  care costs
• Nearly 90 of lung cancer cases, 1/3 of total
  cancer deaths, and 1 in 5 deaths from heart
  disease are tobacco related

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Tobaccos Toll in U.S.

• 4,000 kids try their first cigarette every day
• More than 1,000 kids become regular daily smokers
  every day one-third will die from
  smoking-related diseases
• 23 of high school students smoke, according to
  CDC
• 28.4 used some tobacco product in the last month

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Tobacco-Related Deaths
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Tobacco Heart Disease

• 1 in 5 cardiovascular deaths are caused by
  smoking.
• Cigarette smokers are 2-4 times more likely to
  develop coronary heart disease than nonsmokers.
• Cigarette smokers risk of dying from heart
  disease is 2-3 times higher than nonsmokers
  risks.
• Smokers risk of having a stroke is about 2 times
  higher than nonsmokers risk.
• The risk for developing cardiovascular disease,
  the number 1 killer of women, is greatly
  increased in women who smoke.

Sources CDC, AHA
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Secondhand Smoke Heart Disease

• More than 35,000 people die each year from
  coronary heart disease due to exposure to
  secondhand smoke.
• Nonsmokers who are exposed to secondhand smoke
  increase their risk of developing heart disease
  by 25-30.

Source CDC Barnoya Glantz, 2005
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Domestic Cigarette Advertising and Promotional
Expenditures 1998 - 2005(thousands of dollars)
15.15 Billion
14.15 Billion
13.11 Billion
12.47 Billion
11.22 Billion
9.59 Billion
8.24 Billion
6.73 Billion
9.8b price discounts
10.9b price discount
10.8b price discount
7.9b price discount
Source Federal Trade Commission Cigarette Report
for 2004 and 2005
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• EVIDENCE BASED SOLUTIONS

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Key Components of FDA Regulation

• Regulating the marketing of tobacco products
• Regulating the product itself
• Using a Public Health standard, which takes
  into account not just the impact on the
  individual smoker but on encouraging initiation
  and discouraging cessation

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Effects of a 10 Increase in Price

• Nearly 7 decline in youth prevalence
• A 2 decline in adult prevalence
• A 4 decline in overall consumption

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Recent Cigarette Tax Increases
WASHINGTON 202.5
MONTANA 170
MAINE 200
NORTH DAKOTA 44
VT179
MINNESOTA 149.3
OREGON 118
VT
IDAHO 57
NH 80
WISCONSIN 77
SOUTH DAKOTA 153
NEW YORK 150
MA
MA151
WYOMING 60
RI246
MICHIGAN 200
CT
CT151
IOWA 136
PENNSYLVANIA 135
NJ258
NEBRASKA 64
NEVADA 80
OHIO 125
DELAWARE55
UTAH 69.5
IN 55.5
ILLINOIS 98
WV 55
30 VIRGINIA
MARYLAND100
COLORADO 84
KANSAS 79
MISSOURI 17
DC100
87
KENTUCKY 30
CALIFORNIA
NORTH CAROLINA 35
TENNESSEE 20
OKLAHOMA 103
ARKANSAS 59
ARIZONA 200
NEW MEXICO 91
SOUTH CAROLINA 7
GEORGIA 37
ALABAMA 42.5
MS 18
TEXAS 141
36 LOUISIANA
ALASKA 180
HAWAII 160
FLORIDA 33.9
States that have not passed tax increases since
before 2001
States that have recently passed or implemented a
cigarette tax increase (since 1/1/2002)
AZs tax rate is effective 5/1/07. Upcoming
increases AK increase to 200 cents per pack on
7/1/07 HIs increase to 180 cents per pack on
9/30/07 VT increase to 199 cents per pack on
7/1/07.
March 2007
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Effects of Smoke-free Laws

• Protect everyone from secondhand smoke
• Prompt more smokers to try to quit
• Increase the number of successful quit attempts
• Reduce the number of cigarettes that smokers
  consume
• Discourage kids from starting
• Do NOT hurt business

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Smoke-Free Laws

• In Helena, MT, during the 6 months that a local
  law that prohibited smoking in most workplaces,
  including restaurants and bars, was enforced, the
  number of hospital admissions for acute
  myocardial infarction fell significantly, from an
  average of 40 admissions during the same months
  in the years before and after the law to a total
  of 24 admissions during the six months the law
  was in effect. Sargent et al., 2004
• In part, due to the Helena study, along with a
  growing body of scientific data, experts at the
  CDC advised all clinicians to tell their patients
  who have a history of coronary heart disease, to
  avoid all indoor environments that permit
  smoking. Pechacek Babb, 2004

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Smoke-Free Laws

• If all workplaces went smoke-free, an estimated
  6250 myocardial infarctions and 1270 strokes
  would be prevented, and 279million would be
  saved in direct medical costs annually.
• Ong Glantz, 2004, 2005

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Smoke-Free Laws
Restaurants Bars
Restaurants
Arizona law effective 5/1/07 New Mexico law
effective 6/15/07
March 2007
The Montana and Utah laws extend to bars in
2009.
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Comprehensive Programs Help Adult Smokers Quit
Maine Cut adult smoking by 12.5 b/t 2001 and
2004
WA Cut adult smoking by 20 between 1999 and 2005
Massachusetts Cut adult smoking by 21
between 1993 and 2000
California Cut adult smoking by 32.5 between
1988 and 2004
New York cut adult smoking by 14 between 2001
and 2004
Arizona Cut adult smoking by 21 between 96
and 99
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Comprehensive ProgramsReduce Youth Smoking
WA Cut youth smoking by 50 b/t 2000 and 2004
Maine Cut high school smoking by 59 b/t
1997 and 2005
Indiana Cut high school smoking by 32.5 b/t
2000 and 2004
Oregon Cut smoking by 63 among eighth
graders between 96 and 2004
Florida Cut middle school smoking by 47
high school smoking by 30 b/t 1998 and 2001
Mississippi Cut smoking among public middle
school students by 48 in 5 years
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Funding for Tobacco Prevention Cessation
States that have funded tobacco prevention
programs at a level that meets the CDCs minimum
recommendation. States that have committed
substantial funding for tobacco prevention
programs (more than 50 of CDC minimum). States
that have committed modest amounts for tobacco
prevention programs (25 - 50 of CDC minimum).
States that have committed minimal amounts for
tobacco prevention programs (less than 25 of CDC
minimum). States that have committed no tobacco
settlement or tobacco tax money for tobacco
prevention programs.
December 5, 2006
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FY 2007 Tobacco Money for Tobacco Prevention
21.7 Billion
7.0 Billion Tobacco Settlement Revenues
14.7 Billion Tobacco Tax Revenues
1.6 Billion
597.5 Million
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          Because everyone deserves a second
chance!
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Policy Success in New York City

• The city and states combined comprehensive
  approach of excise tax increases, smoke-free
  workplace laws and assistance for smokers who
  want to quit drastically reduced smoking.
• The number of adult smokers in NYC declined by
  15 in just 2 years thats 188,000 fewer
  smokers.

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Policy Success in California
By 2010, 50,000 Californians lives will be saved
due to the states anti-smoking laws, including a
comprehensive prevention program, higher
cigarette taxes, and clean air laws. Pacific
Institute for Research and Evaluation, March 1,
2007
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Impact of Reduced Smoking on Heart Disease
Stroke

• Decreasing smoking rates by one percentage point
  per year Lightwood Glantz, 1997

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Adult Smoking Trends1992 - 2005
Adult Smoking Rate
N/A
Year
Data are from the National Health Interview
Survey
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Our Role

• COMMUNICATIONS Keep tobacco issue visible to
  public and framed as a serious public problem
  that requires action
• POLICY PROMOTION Promote public policies that
  reduce tobacco use
• BUILDING THE MOVEMENT Strengthen and mobilize
  effective support for tobacco control

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Go Forward Together!!
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• Engage a broad coalition
• and involve them early and often

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Campaign for a Healthier Colorado

• Building the coalition
• Cast a wide net, identified all possible
  stakeholders
• Met with all potential stakeholders to learn what
  needs, priorities and concerns were
• Involved them early and often
• Built trust
• Had them invest early (staff time/resources,
  sharing in costs for research, etc.)

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Shared Challenge Broadening the Issue Beyond
Tobacco

• Some complacency with tobacco prevention issues
• Need to give the issue immediacy, urgency
• Broaden public appeal and allied support
• Healthcare is a major priority for voters
• National research shows Americans concern about
  healthcare is second only to jobs/the economy
  and equal to national security
• All recent successful tobacco tax ballot
  campaigns tied tobacco to healthcare
• WA in 2001 OR AZ in 2002 CO in 2004
• Need a middle class sell beyond healthcare for
  the poor

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• Positioning Tobacco Control
• as Part of Larger Policy Discussion
• on Healthcare

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• Write a policy-sound, simple
• and politically viable measure

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Case Study Campaign for a Healthier Colorado

• Steering committee started with list of 17
  programs
• Through facilitated discussion and using guiding
  principles list was reduced to 7 programs
• Policy papers made the case for each of the 7
  programs
• Program / principle matrix summarized information
  in policy papers into format based on guiding
  principles

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Guiding Principles

• 1. Fund sound programs that benefit the health of
  Coloradans. Funded programs must
• Be cost effective
• Have evaluation and accountability mechanisms
• Have a proven track record
• 2. Build a politically viable package. The
  package must be
• Supported by the public
• Able to attract the necessary resources to
  support the campaign
• Clear and concise, limited to 3 or 4 areas of
  funding
• Favor programs that leverage money from
  governmental or non-governmental agencies
• 4. Do not duplicate or supplant existing funding

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No surprises!!!
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Campaign for a Healthier Colorado

• Ended up with
• Constitutional amendment increasing tobacco
  excise tax by 64 cents/pack and 20 on other
  products
• Revenue would be divided as follows
• 46 for public health insurance expansion
  (CHP/Medicaid)
• 19 for comprehensive primary care through
  clinics
• 16 for prevention, detection treatment of
  cancer, cardiovascular and pulmonary diseases
• 16 for comprehensive tobacco control
• 3 hold-harmless provision

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So, What Happened on Election Day?

• A35 passed with more than 61 voter support
  becoming Colorados first statewide tax increase
  in over 10 years
• Carried traditionally Republican and Democratic
  strong-holds

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PARTY PARTY!!!!
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After the Campaign

• Coalition decided to stick together through the
  legislative session to ensure that Amendment 35
  is implemented as intended (Nov. 04 May 05)
• Helped draft implementing language, found
  sponsors, lobbied the bill, passed it through
  House and Senate
• Governor signed bill into law on June 2, 2005
• And MORE . . . .

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PARTY PARTY!!!!
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You Can Help

• Get Involved with State or Local Tobacco Control
  Coalition
• Learn more at our website www.tobaccofreekids.or
  g
• Become a TFK E-Champion

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Beverly J. May, M.P.A. Regional Director
Western States and Ohio
Campaign for Tobacco-Free Kids 801-824-0084 202-48
1-9384 bmay_at_tobaccofreekids.org www.tobaccofreekid
s.org