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Making Progress in Tobacco Control: The Good, Bad, and Ugly

Making Progress in Tobacco Control: The Good, Bad, and Ugly. Michael Kretz, M.D. 7/22/05 President Pierce-St. Croix Tobacco Free Coalition. Corporate Tobacco. Spends $23 in marketing for every $1 we spend on prevention and helping people quit.

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Making Progress in Tobacco Control: The Good, Bad, and Ugly

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  1. Making Progress in Tobacco Control: The Good, Bad, and Ugly Michael Kretz, M.D. 7/22/05 President Pierce-St. Croix Tobacco Free Coalition

  2. Corporate Tobacco • Spends $23 in marketing for every $1 we spend on prevention and helping people quit. • In 2004, spent $12.7 billion in marketing and promotion. • Spent $247 million in Wisconsin in 2004. • They market to the less affluent, lesser educated, certain racial/ethnic groups, and kids. (www.tobaccofreekids.org)

  3. Plasma Nicotine Levels after a Smoker Has Smoked a Cigarette, Received Nicotine Nasal Spray, Begun Chewing Nicotine Gum, or Applied a Nicotine Patch. The amount of nicotine in each product is given in parentheses. The pattern produced by the use of the nicotine inhaler (not shown) is similar to that of nicotine gum. (Garret, 2001)

  4. Annual Smoking Deaths Average Annual Number of U.S. Deaths Attributable to Cigarette Smoking, 1995-99 (Total average number, 442,532) (CDC)

  5. Morbidity and Mortality 2005

  6. Wisconsin spends about 2.4% of the $423.6 million in tobacco-generated revenues on tobacco prevention (Rank 24th). (www.tobaccofreekids.org) 46% of Wisconsin smokers tried to quit in the past 12 months (421,000 smokers)! 2. 80% tried to quit on their own (337,000) at a success rate of 5%. (www.ctri.wisc.edu) Insights: Smoking in Wisconsin 2002 Doubly Ugly

  7. State Snapshot 2004 from the National Healthcare Quality Report

  8. 3 Focus Groups Lack of access to care (affordable health insurance) Poor diet/exercise Tobacco, alcohol, drugs Health Survey (683) Health insurance cost Cost of prescriptions 5. Health care cost 2003: St. Croix County Community Health Needs Assessment

  9. Lung cancer Cost: $23,247 Number: 2,325 Smoking % 88 Total hospital cost due to smoking: $47.5 million COPD (emphysema) Cost: $11,116 Number : 7,277 Smoking %: 83 Total hospital cost due to smoking: $67.4 million Smoking-caused lung diseases(Department of Health and Family services, 2002)

  10. Heads-Up on Health Costs Average 65-year-old couple (first 15 to 20 years of retirement) • Medicare Premiums $58,900 • Prescription Drugs $62,700 • Other health-care needs $68,400 $190,000 (Study by Fidelity Investments)

  11. National Report CardState of Tobacco Control 2004 Grades: • Cessation F • Framework Convention D on Tobacco Control • FDA Tobacco Regulation F • Cigarette tax F (www.lungusa.org)

  12. Wisconsin Report Card State of Tobacco Control 2004 Grades: • Smokefree Air F • Youth Access D • Tobacco Prevention and Control Spending F • Cigarette Tax D (www.lungusa.org)

  13. Building Infrastructure—the Tobacco Control System • Wisconsin Tobacco Quit Line (36,000 calls) • 230 Wisconsin Referral Resources • Fax-to-Quit Sites (522) • 384 Clinics • 110 First Breath Sites • 28 Employer Sites • Center for Tobacco Research and Intervention (CTRI) • Outreach • Research • Presentations to health care providers (>10,000) • FACT (6,000) • Tobacco Free Coalitions (7744) • Wisconsin Wins (33.78.3%) • First Breath Sites (111) • Information distribution (www.tobwis.org)

  14. Wisconsin Tobacco Quit Line • 44,000 calls • 7,500 smokers quit • Quit Rate 4 X greater than “cold turkey” • $24 million in health care costs saved • $1,623 saved annually • 6:1 return on investment

  15. Western Cultures Independence (go it alone) Individualism (be unique) Competition (go for the gold) Involvement (them and us thinking) Eastern Cultures Interdependence (all together) Collectivism (blend in) Collaboration (team first) Partnership (we and ours thinking) Key Cultural Values (Hantiuk and Gebretensae 2005)

  16. Gallup Survey (1993) • 94% feel responsibility to speak up to a friend or loved one about an unhealthy behavior 2. Only 38% felt comfortable or confident

  17. Reluctance is cultural! • “If you can’t say something nice, don’t say anything at all.” • “Judge not lest be judged.” • “What if I make a mistake and say something wrong.” • “I do not want to get involved in someone’s personal business.” • “If you live in a glass house…”

  18. More than Quitting…Processes of change for the smoker 1) Consciousness-raising 2) Social Liberation 3) Emotional arousal 4) Self re-evaluation 5) Commitment 6) Countering 7) Environmental control 8) Reward 9) Helping relationship (Prochaska, James O. 1994—Stages of Change/Transtheoretical Model)

  19. Pieces of Child Development • Physical • Emotional • Social • Language • Cognitive (not either/or—school is part of child development)

  20. Overarching Goals • Improve the health of the public 2. Reduce disparities 3. Transform the Public Health System

  21. Keys to Successful Change • Empathy, communication, participation • Communication means more than “telling.” It means “creating understanding.” (Managing Change Effectively: Kirkpatrick, 2001)

  22. Model = Capacity • Holistic (everyone has a role) • Ecological (all interrelated and interdependent—no silos) • Natural Systems (sustainability) • Developmental • Proactive • “upstream perspective” • “Giving the work back to the people” • Approach is positive (not deficit focused) • Individual still matters! • Choice is informed

  23. From Benjamin Franklin and Stephen Covey Franklin: “Teach me and I will forget; show me and I may remember; involve me and I will learn.” Covey: Involvement plus patience = Commitment

  24. An opportunity for … • sharing experiences and problems (successes and “failures”) • interactive learning from each other (synergy/feedback) • building trust (removing fear) and competence for enhanced capacity (self-efficacy) • Integrating the work of the Public Health System into other systems (involvement)

  25. We represent the people. We advocate, treat, promote, prevent We offer life, liberty, pursuit of happiness. They represent ? (the shareholder). They addict the poor, young, less educated, ethnic/minorities They offer human suffering, disability, and death. Public Health versus Tobacco

  26. My Perspective/RelationshipsGetting Organized… • River Falls Community Partnership For Youth • Pierce-St. Croix Tobacco Free Coalition • Pierce County Healthy Eating and Active Living Coalition • Pierce-St. Croix County Medical Society • Health and Human Services Board Committee-St. Croix County • Board of Director—Wisconsin Child Care Improvement Project • University Committee on Health and Wellness

  27. Breathing Secondhand Smoke = InvoluntaryCigarette Smoking Two hours in a smoky bar = = Two hours in a nonsmoking section of restaurant 24 hours living with a pack-a-day smoker = JAMA, July 28, 1993—Vol. 270, No. 4, pp. 490-493

  28. Household Contamination • Vapor phase • Components deposit/are absorbed onto walls, furniture, clothes, toys within minutes • Re-emitted into air over hours to months • Particulate phase • May deposit on surfaces within hours and re-suspend • Contaminates house dust, carpet, furniture for weeks and months • Nicotine (Matt, 2004)

  29. (Wisconsin Tobacco Facts 2004)

  30. Support for new smoking bans • 74% favored smoking bans • 80% “go out” as often—or more often • 13% drove at least once to other communities to smoke in bars and restaurants • Most people consider secondhand smoke a health hazard (MPAAT, 2005)

  31. Take control of your health… 2/3rds of cancer deaths prevented by: • Not using tobacco products • Maintaining a healthy body weight • Getting plenty of physical activity • Eating healthy food • Avoiding the midday sun and protecting skin with a hat, shirt, and sunscreen (American Cancer Society 2005)

  32. Conclusions • Tobacco control is the work of Public Health. • New Institute of Medicine’s Model includes everyone as members of the Public Health System . • Our cultural values are a barrier to a healthier population. • Broader understanding of successful child development equals public health. • Opportunities for improving population health are everywhere!

  33. Contact me at … dkretz@pressenter.com Phone (715) 377-0101 Michael Kretz, MD 256 Troon Court Hudson, WI 54016

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