Effective Strategies to Reduce Tobacco Use

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Effective Strategies to Reduce Tobacco Use
Presented by Les Hagen, Executive Director Action
on Smoking Health (ASH)
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Background on ASH

• Action on Smoking Health (ASH) is Western
  Canadas leading health agency devoted to tobacco
  reduction
• Founded in 1979, ASH is one of Canadas longest
  serving tobacco control organizations
• ASH has provided local, regional, provincial and
  national leadership

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ASHs strategies include

• Public awareness and education
• Healthy public policy
• Media advocacy and promotion
• Community mobilization

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Albertas Tobacco Epidemic

• Tobacco use is the leading avoidable
• killer in Alberta - an estimated 3,458 deaths
  resulted from smoking in 1997
• Twenty percent of all deaths in Alberta (one in
  five) result from tobacco use
• Tobacco kills more Albertans than alcohol,
  traffic accidents, suicide, illicit drug use, and
  AIDS combined
• Source Alberta Tobacco Control Centre

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Albertas Tobacco Epidemic

• Unique characteristics of tobacco
• no safe level of consumption
• nicotine is highly addictive
• the vast majority of users are addicted
• tobacco is the only legal product known to be
  lethal when used exactly as intended by its
  manufacturers

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Albertas Tobacco Epidemic

• Smoking rate in Canada, 1996 27
• Smoking rate in Alberta, 1996 28
• Smoking rate in Northern Lights
• Health Region, 1996 39
• Source 1995/96 National Population Health Survey

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Albertas Tobacco Epidemic

• Smoking rate in Canada, 1999 25
• Smoking rate in Alberta, 1999 26
• Smoking rate in B.C., 1999 20
• Source Canadian Tobacco Use Monitoring Survey,
  Health Canada

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Albertas Tobacco Epidemic

• Smoking rate in Canada, 1999 25
• Smoking rate in Alberta, 1999 26
• Smoking rate in B.C., 1999 20
• Source Canadian Tobacco Use Monitoring Survey,
  Health Canada

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Albertas Tobacco Epidemic

• More than 35,000 potential years of life were
  sacrificed to tobacco use in Alberta in 1992
• An estimated 300,000 hospital days are attributed
  to tobacco use annually
• Of course, the human costs of this epidemic are
  intangible
• Source Canadian Centre for Substance Abuse, 1996

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Albertas Tobacco Epidemic

• Tobacco use cost the Alberta economy 728 million
  in 1992 alone
• These costs include
• Direct health care costs 215 million
• Productivity losses 508 million
• Other 5 million
• Other includes prevention investment of less
  than 1 million
• Source Canadian Centre on Substance Abuse

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Albertas Tobacco Epidemic

• Cost of Smoking in the Workplace per
• Smoking Employee - Canada, 1995
• Decreased productivity 2,175
• Increased absenteeism 230
• Increased life insurance 75
• Smoking area costs 85
• TOTAL 2,565
• Source Conference Board of Canada, 1995

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Effective Strategies to Reduce Tobacco Use

• Recent Best-Practice Reports
• U.S. Task Force on Community Preventive Services,
  2001
• U.S. Surgeon General, 2000
• U.S. Public Health Service, 2000
• U.S. National Association of City and County
  Health Officials, 2000
• U.S. Centres for Disease Control, 1999

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Effective Strategies to Reduce Tobacco Use

• The most effective strategies include
• 1. Tobacco tax increases
• 2. Smoking bans and restrictions
• 3. Mass media education

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Effective Strategies to Reduce Tobacco Use

• Effective cessation strategies include
• Provider reminder systems
• Provider reminder provider education
• Treatment subsidy programs
• Telephone quitlines

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Effective Strategies to Reduce Tobacco Use

• Insufficient evidence
• Smoke-free home campaigns
• Smoking cessation media series
• Smoking cessation contests
• Standalone provider education
• Provider feedback system

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Effective Strategies to Reduce Tobacco Use

• Success stories
• California, Massachusetts, Oregon, and Florida
  have been achieving record-setting declines in
  tobacco use
• Strategies include tax/price increases, smoking
  bans, mass media education, and comprehensive,
  well-funded evidence-based program

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Effective Strategies to Reduce Tobacco Use

• Results
• Tobacco consumption is down by over 50 in
  California since 1988
• Smoking prevalence has dropped from 23 to 18
  since 1988
• Lung cancer and heart disease have declined by
  14-15

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Effective Strategies to Reduce Tobacco Use

• No Canadian jurisdiction has adopted a
  comprehensive evidence-based strategy that
  reflects available best-practice guidelines
• 5/capita to 10/capita is required for a
  comprehensive, evidence-based strategy
• Bill S-15 would provide the required funding
  through a 19 cent/carton levy applied to tobacco
  manufacturers

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Effective Strategies to Reduce Tobacco Use

• AADAC is leading the development of an
  intergovernmental strategy that will be announced
  this spring
• The need for more tobacco reduction initiatives
  was addresses in the Throne Speech and the PC
  Election Platform
• Health Minister Gary Mar is committed

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Effective Strategies to Reduce Tobacco Use

• Program and Funding Guidelines for Comprehensive
  Local Tobacco Control Programs
• - U.S. National Association of City and County
  Health Officials (NACCHO)
• - Based on CDC Best Practice Guidelines

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Effective Strategies to Reduce Tobacco Use

• Components of NACCHO Guidelines
• 1. Community programs
• 2. School Programs
• 3. Counter-Marketing
• 4. Cessation

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Effective Strategies to Reduce Tobacco Use

• Components of NACCHO Guidelines
• 5. Enforcement
• 6. Administration and Management
• 7. Surveillance and Evaluation

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Effective Strategies to Reduce Tobacco Use

• Examples of local programs
• Community education of the health effects of
  secondhand smoke
• School-based prevention programs
• Community mobilization for a local tobacco
  licensing bylaw
• Subsidized cessation treatment

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Effective Strategies to Reduce Tobacco Use

• More examples
• Pre/post natal education program
• Merchant enforcement program
• Regional telephone quitline
• Youth-driven counter-marketing effort
• Provider education initiative

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Effective Strategies to Reduce Tobacco Use

• The Costs (urban/rural region)
• 1. Community education .94
• 2. School programs .88
• 3. Counter-marketing .68
• 4. Cessation 1.44
• 5. Enforcement .40
• 6. Surveillance and evaluation .44
• 7. Administration and management __.22
• TOTAL 5.00/capita

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Effective Strategies to Reduce Tobacco Use

• Rationale
• Northern Lights Region has the highest smoking
  prevalence in Alberta
• Smoking rates among Aboriginals and 20-24
  year-old blue collar/pink collar workers is
  particularly high
• A major first step has already been taken with
  the passage of the smoke-free bylaw
• Northern Lights could be a national model for
  other health regions