Nur512 tobacco prevention and control (1)

Lynne Mahaffey; Jacksonville University NUR512 Presentation

1. Tobacco Prevention and control Battling Public Health Enemy # 1

2. Why address tobacco use? Cigarette smoking is the #1 cause of preventable deaths and illnesses from several types of cancers, heart and lung disease in the United States Accounts for nearly 20% of all deaths annually in the U.S. Approximately 480,000 deaths per year (CDC, 2015) Over 16 million Americans live with smoking-related diseases (CDC, 2015) O ver $289 billion total economic costs due to tobacco annually Second hand smoke exposure related diseases claims 600,000 lives worldwide (WHO, 2014) Parental smoking linked to: Poor pregnancy outcomes, SIDS, increased middle ear & respiratory infections, decreased lung capacity ( Knickman & Kovner , 2015) Societal impact: Poor health status impairs worker productivity and national readiness ( Knickman & Kovner , 2015)

3. Centers for disease control and prevention takes action In 1965 the CDC established the National Clearinghouse for Smoking and Health Now the Office on Smoking and Health (OSH) a division of the National Center for Chronic Disease Prevention and Health Promotion, part of the CDC’s Coordinating Center for Health Promotion OSH is the leading federal organization for comprehensive tobacco prevention & control OSH is dedicated to reducing the death and disease caused by tobacco use and exposure to secondhand smoke. OSH Mission is to “develop, conduct and support strategic efforts to protect the public’s health from the harmful effects of tobacco use” (CDC, 2015)

4. Why evaluate tobacco prevention and control programs M onitor progress toward the program’s goals D emonstrate effectiveness of a particular tobacco control program or activity Determine if program components are producing the desired effects Allows comparisons among groups, especially populations with disproportionately high tobacco use and related poor health outcomes Justifies the need for further funding and support L earn ways to improve programs Helps ensure effective programs are maintained and resources are not wasted on ineffective programs (McDonald et al., 2001)

5. CDC’s “introduction to Program Evaluation for Comprehensive Tobacco Control Programs”: 6-Step framework Engage stakeholders Describe the program Focus the evaluation and design Gather credible evidence Justify conclusions Ensure use of evaluation findings and share lessons learned (MacDonald, 2001)

6. OSH Program goals Prevent youth and young adults from starting tobacco use Reach out to all adults and youth tobacco users to promote its cessation Eliminate environmental tobacco smoke (ETS) exposure to nonsmokers Smoking bans Examine tobacco-related disparities across regions of the country so they can be eliminated race ethnicity educational level socioeconomic status

7. Osh Partners with local and global agencies Broaden the scientific base of effective tobacco control Create sustainable, comprehensive tobacco control programs Provide timely and pertinent information to stakeholders, the public and policy makers Organize strategic initiatives to support tobacco control priorities that include policy development and partnerships with agencies Collaborate globally to enhance tobacco control through surveillance, capacity building, and information exchange (CDC.gov, 2015)

8. National Tobacco Control program Established by the OSH in 1999 Encourages coordinated efforts to reduce tobacco-related diseases and deaths Provides funding and technical support to all 50 state and territorial health departments to meet the OSH objectives outline in “Best Practices for Tobacco Control Programs” 4 Components Population-based community interventions Counter-marketing Program policy/regulation Surveillance and evaluation

9. Best Practices for Comprehensive Tobacco Control Programs: Evidence-based Program interventions Price increases and regressive tax on tobacco detract some high-risk populations from using tobacco Smoking bans & restrictions reduce second-hand smoke exposures Mass media campaigns that target youth who have started smoking to encourage cessation 1-800-QUIT-NOW – cost free counselling and medications offered by states Provides easier access to evidence-based cessation programs for vulnerable and underserved populations (Community Preventive Services Task Force, 2016)

10. Tobacco prevention and control Program outcomes Tobacco prevention and control has been lauded as one of the most successful public health programs of the last 50 years! ( Knickman & Kovner , 2015) Program outcomes are monitored and evaluated by multiple agencies and all report progress continues to be made CDC Surgeon General Cochrane Library World Health Organization Yet the Healthy People 2020 goals have not yet been achieved

11. Progress towar d achieving program goals: 3 reports The 2014 Surgeon General’s Report marked the 50 th Anniversary of their landmark 1964 report that first reported health consequences of smoking. Smoking rates cut in half since 1964 in the U.S. CDC : Adult smoking has declined from 20.9% in 2005 to 16.8 % in 2014 (CDC.gov, 2015 ) Cohrane Systematic Review : Legislative smoking bans worldwide contribute to improved health outcomes Reduced tobacco consumption & second-hand smoke (SHS) exposure Reduced admissions for acute coronary syndrome & improved outcomes for cardiovascular health Reduced mortality from smoking-related illnesses Improved respiratory symptoms and lung function (Frazer et al., 2016)

12. Funding and resource accountability 2009 Children’s Health Insurance Program Reauthorization Act included an unprecedented $0.62 tax increase that raised the federal excise tax to $1.01 per pack of cigarettes The President’s Fiscal Year 2014 Budget included a $0.94 per pack Federal tobacco tax increase “Increasing the cost of cigarettes is one of the most powerful interventions used to prevent smoking and reduce prevalence .” (Surgeon General, 2014 ) Improved health outcomes and reduction in tobacco use demonstrate accountability

13. 2014 Surgeon General’s report: revising interventions through legislation 2009 Family Smoking Prevention and Tobacco Control Act ( Tobacco Control Act) aims to reduce harm caused by tobacco products U.S . Food and Drug Administration gained authority to regulate tobacco products. Critical for reducing the harm caused by tobacco products Tobacco manufacturers will pay “user fees” that provide sustained funding for public education media campaigns that targets youth prevention and cessation The 2010 Affordable Care Act (ACA) E xpands access to smoking cessation services Requires most insurance companies to cover cessation treatments. The Affordable Care Act’s Public Health and Prevention Fund S upports innovative, effective community-based programs Provides for public education campaigns to promote prevention and cessation

14. Work still to be done: Revising program interventions Adolescent (grades 9-12) smoking is showing reduction: 2009 – 19.5% have smoked in the past 30 days 2011 – 18.6% have smoked in the past 30 days Healthy People 2020 Goal: 16% CDC reports 2014 Adolescent smoking rate 9.2% (CDC statistics, 2015) Adult smoking is making progress toward Healthy People 2020 goal of 12% 2008 – 20.6% 2014 – 16.8% (CDC, 2015) Ambulatory care settings: Increased t obacco screening and counseling in but still below Healthy People 2020 goals ( Knickman & Kovner , 2015) If current trends continue… 5.6 million children alive today under age 18 will die prematurely and… Nearly 500,000 adults will still die prematurely because of smoking (Surgeon General, 2014 ) Disparities still exist among some high risk populations ( Knickman & Kovner , 2015)

15. Conclusion Rate of smoking continues to fall and progressing toward HP2020 goal Health outcomes and incidences from tobacco-related illnesses appears to be declining worldwide (Frazer et al., 2016) Legislation is in place to increase funding to sustain tobacco control and prevention programs & prevention of environmental smoke exposure to nonsmokers Population disparities still exist: Native Americans, Military members and Veterans, LGBT, Adults living with HIV, Adults with mental health illnesses, Adults with disabilities, Adults with lower education, Adults living in poverty (CDC, 2015)

16. references Centers for Disease Control and Prevention. (2016). National Tobacco Control Program. Retrieved from http:// www.cdc.gov/tobacco/stateandcommunity/tobacco_control_programs/ntcp/index.htm Centers for Disease Control and Prevention. (2016 ). Office on Smoking and Health. Retrieved from http:// www.cdc.gov/tobacco/about/osh/index.htm Centers for Disease Control and Prevention. (2016). Retrieved from http :// www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm Community Preventive Services Task Force. (2016). The guide to community preventive services: What works to promote health. Retrieved fromhttp://www.thecommunityguide.org/index.html Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. (2016). Legislative smoking bans for reducing harms from second hand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews . Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3 . MacDonald G, Starr G, Schooley M, Yee SL, Klimowski K, Turner K ., (2001). Introduction to program evaluation for comprehensive tobacco control programs . Atlanta (GA): Centers for Disease Control and Prevention. U.S. Department of Health and Human Services. (2014). The health consequences of smoking-50 years of progress: A report from the Surgeon General. Retrieved from http://www.surgeongeneral.gov/library/reports/50-years-of-progress/front-matter.pdf