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Tobacco 101. Introduction to Prevention and Control of Tobacco Use. Our Learning Environment. Training Topics. Learning Objectives. Describe the evolution of the tobacco control movement. Understand how events in U.S. history affected tobacco use.

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tobacco 101

Tobacco 101

Introduction to

Prevention and Control of Tobacco Use

learning objectives
Learning Objectives
  • Describe the evolution of the tobacco control movement.
  • Understand how events in U.S. history affected tobacco use.
  • Show you understand how tobacco use emerged as a public health problem.
learning objectives1
Learning Objectives
  • Look at the problem of tobacco use from a national perspective.
  • Obtain data on the prevalence and effects of tobacco use.
  • Understand the importance of local data.

Prevalence of Tobacco Use

learning objectives2
Learning Objectives

Impact of Tobacco Use

  • Discuss the health effects and health risks associated with tobacco use.
  • Discuss the health effects of exposure to secondhand smoke.
  • Understand and explain the economic effects of tobacco use.
learning objectives3
Learning Objectives
  • Discuss the physiological and psychological effects of tobacco use.
  • Describe how the tobacco industry influences tobacco use.
  • Discuss the government’s role in controlling tobacco use.

Factors that Influence Use

evolution of tobacco control2
Evolution of Tobacco Control

Source: Centers for Disease Control and Prevention Public Health Images Library

slide11

Evolution of Tobacco Control

Adult Per Capita Cigarette Consumption

NumberofCigarettes

Sources: Centers for Disease Control and Prevention and United States Department of Agriculture

slide12

Evolution of Tobacco Control

Adult Per Capita Cigarette Consumption

Broadcast

Ad Ban

Surgeon General’s

Report on Environmental

Tobacco Smoke

1st Surgeon

General’s Report

End of WW II

Master

Settlement

Agreement

Number of Cigarettes

Fairness Doctrine

Messages on TV and Radio

1st Smoking-

Cancer Concern

Family Smoking Prevention and Tobacco Control Act

Great Depression

Sources: Centers for Disease Control and Prevention and United States Department of Agriculture

evolution of tobacco control3
Evolution of Tobacco Control

1910 – 1970

  • U.S. enters World War I (1917)
  • The Great Depression (1929-early 1940s)
  • U.S. enters World War II (1941)
  • First modern reports link smoking & cancer (1950)
  • Surgeon General’s report on smoking and cancer (1964)
  • Fairness Doctrine messages on broadcast media (1967)
  • U.S. bans broadcast advertisements (1970)
evolution of tobacco control4
Evolution of Tobacco Control

1970 – 1998

  • Nonsmokers’ rights movement begins (1976)
  • Federal cigarette tax doubles (1983)
  • Coalescence of modern advocacy movement (early 1980s)
  • Synar Amendment enacted (1992)
  • Environmental tobacco smoke listed as known human carcinogen (1992)
  • The Master Settlement Agreement (1998)
  • Maryland bans smoking in private workplaces (1998)
evolution of tobacco control5
Evolution of Tobacco Control

1999 – 2003

  • Philip Morris reports “smoking saves money” to government of Czechoslovakia (2001)
  • Department of Transportation bans smoking on all international flights (2002)
  • WHO adopts Framework Convention on Tobacco Control (2003)
  • New York State smoking ban goes into effect (2003)
evolution of tobacco control6
Evolution of Tobacco Control

2004 – 2009

  • NASCAR drops R.J. Reynolds sponsorship (2004)
  • Westin prohibits smoking in all rooms (2005)
  • Annual reports on state tobacco funding begin (2005)
  • Adult smoking prevalence drops below 20% (2007)
  • Federal cigarette tax increases (2009)
  • FDA authority to regulate tobacco products (2009)
  • 18 states, DC, and Puerto Rico have smoke-free restaurants, bars, and workplaces (2010)
prevalence of tobacco use1
Prevalence of Tobacco Use

Current user:

A person who has smoked once in the last 30 days

Prevalence of tobacco use:

The proportion of current users in a population

Prevalence rates measure:

The use of cigarettes, cigars, pipes, and any other smoked tobacco products

prevalence of tobacco use2
Prevalence of Tobacco Use

Estimated deaths attributable to tobacco worldwide . . .

1965: 1 million

2000: 4.9 million

By 2020: >9 million

Source: World Health Organization & American Cancer Society, Tobacco Control Country Profiles 2003

prevalence of tobacco use3
Prevalence of Tobacco Use

US Centers for Disease Control and Prevention

Cigarette smoking

is the single most preventable

cause of premature death

in the United States.

trends in smoking among adults aged 25 years by level of education united states 1970 2006
Trends in SmokingAmong Adults Aged ≥25 Years, by Level of Education United States, 1970-2006

Source: Robert Wood Johnson ImpactTeen Tobacco Chart Book

prevalence in smoking 2009
Prevalence in Smoking, 2009

US rates 2009

Men: 21.3%

Women: 18.4%

Total: 19.8%

State with highest prevalence: Kentucky

Men: 28.8% Women: 27.8%

States with the lowest prevalence:

Men: Connecticut16.6% Women: Utah8%

Source: CDC : BRFSS, MMWR 2009;58:221-226

trends in smoking among adults aged 18 years by race or ethnicity 1978 2007
Trends in Smoking Among Adults Aged ≥18 Years, by Race or Ethnicity, 1978-2007

Source: Robert Wood Johnson ImpactTeen Tobacco Chart Book, 2009

prevalence in cigarette smoking
Prevalence in Cigarette Smoking

Current Smoking – by Age, 2009

Percent

Source: CDC, Office on Smoking and Health, 2008

trends in cigarette smoking current smoking adults by poverty status 1983 2007
Trends in Cigarette SmokingCurrent Smoking- Adults by Poverty Status 1983-2007

Source: Robert Wood Johnson ImpactTeen Tobacco Chart Book

trends in smoking high school students and adults
Trends in Smoking High School Students and Adults

Source: CDC, Office on Smoking and Health

prevalence of tobacco use4
Prevalence of Tobacco Use

Current Smoking: Youth Data, 2008

3 million kids under 18 are current smokers

22% of high school students

6% of middle school students

3,500 kids try a cigarette each day

1,000 kids become regular smokers each day

Source: Campaign for Tobacco Free Kids – Tobacco Use Among Youth, Smoking and Kids

prevalence of tobacco use5
Prevalence of Tobacco Use

Where do I find prevalence data specific to my state?

  • CDC State Highlights
  • National Youth Tobacco Survey (NYTS)
  • Global Adult Tobacco Survey (GATS)
  • State Tobacco Activities Tracking and Evaluation (STATE) System
  • Behavioral Risk Factor Surveillance System (BRFSS)
prevalence of tobacco use6
Prevalence of Tobacco Use

2007 Smoking Prevalence Rates

Percent

Source:Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2007

your state s prevalence
Your State’s Prevalence

Presenters

Please change title and add data for the state where you’re conducting the training.

Thank you.

impact of tobacco use1
Impact of Tobacco Use
  • Tobacco Users’ Health
  • Secondhand Smoke
  • Economy
  • Tobacco Industry
impact of tobacco use2
Impact of Tobacco Use

“…the history of tobacco use can be thought of as the conflict between tobacco as an agent of economic gain and tobacco as an agent of human harm.”

2000 Surgeon General’s Report: Reducing Tobacco Use

slide38

Impact of Tobacco Use

Tobacco Users’ Health

Source: Office on Smoking and Health and The American Lung Association

impact of tobacco use3
Impact of Tobacco Use
  • Body systems affected by tobacco:
    • Reproductive system
    • Immune system
    • Nervous system
    • Cardiovascular system
    • Respiratory system
    • Muscular skeletal system
  • Organs affected by tobacco:
    • Stomach
    • Liver
    • Pancreas
    • Bladder
    • Larynx
    • Pharynx
    • Oral cavity
    • Lungs
    • Eyes
impact of tobacco use4
Impact of Tobacco Use
  • Other conditions associated with tobacco use:
    • Oral/Laryngeal/Esophageal diseases
    • Dermatologic conditions
  • Tobacco use has been linked to
    • Cataracts
    • Macular degeneration
    • Gum disease
    • Osteoporosis
    • Peptic ulcers
impact of tobacco use5
Impact of Tobacco Use
  • Maternal tobacco use affects the health of the unborn baby.
  • Tobacco use increases the risk for miscarriage, stillbirth, and premature births.
impact of tobacco use tobacco users health
Impact of Tobacco UseTobacco Users’ Health
  • Q: How many people will die prematurely from a tobacco-related disease by 2030, if this level of tobacco use continues?

Source: Centers for Disease Control and Prevention

Each year in the United States:

443,000people in U.S. die of a

smoking-attributable illness

slide43

Impact of Tobacco Use443,000 Deaths Each Year Attributable to Smoking 2000-2004

Other

diagnosis

44,000

Other cancers

35,300

Stroke

15,900

Lung cancer

128,900

Chronic lung

disease

92,900

Heart

disease

126,000

Source:CDC, Office on Smoking and Health

impact of tobacco use secondhand smoke1
Impact of Tobacco UseSecondhand Smoke
  • Mainstream smoke
  • Sidestreamsmoke
  • Passiveand involuntary smoking
  • Environmental tobacco smoke

Secondhand smoke affects

both nonusers and users

impact of tobacco use secondhand smoke2
Impact of Tobacco UseSecondhand Smoke
  • SHS contains
    • 250 toxic chemicals
    • Over 50 carcinogens
  • Each year it causes
    • 3,400 deaths from lung cancer
    • Between 22,700 and 69,600 deaths from coronary heart disease
    • 8,000–26,000 new cases of asthma in children

Source: CDC, Office on Smoking and Health and Campaign fro Tobacco-Free Kids

impact of tobacco use secondhand smoke3
Impact of Tobacco UseSecondhand Smoke

There is no risk-free level of exposure to secondhand smoke.

Even brief exposure is dangerous.

2006 Surgeon Generals Report, Health Effects of Secondhand Smoke Exposure

impact of tobacco use secondhand smoke children
Impact of Tobacco UseSecondhand Smoke – Children

280 children die each year

1,900 SIDS deaths

300 injuries from fires started by cigarettes

Over 1 million illnesses in children

Source:Campaign for Tobacco-Free Kids

impact of tobacco use secondhand smoke4
Impact of Tobacco UseSecondhand Smoke

Source: CDC, Office on Smoking and Health

Cotinine is a biomarker of secondhand smoke exposure.

With the increase in smoke-free air laws and the decrease in tobacco use, cotinine levels in nonsmokers have halved.

Levels of cotinine fell by 70% from 1988-1991 to 2001-2002.

impact of tobacco use secondhand smoke5
Impact of Tobacco UseSecondhand Smoke
  • Nonsmokers are still suffering from the effects of secondhand smoke.
  • Industries whose employees are disproportionally affected by secondhand smoke:
    • Restaurant/bar industry
    • Casino/gaming industry
    • Other service industries

CDC, Office on Smoking and Health

impact of tobacco use secondhand smoke6
Impact of Tobacco UseSecondhand Smoke
  • Waitresses have the highest death rate among women in any occupation.

How many times higher?

Source:DR Shopland, KK Gerlach, DM Burns, AM Hartman, Journal of Occupational & Environmental Medicine.

impact of tobacco use secondhand smoke7
Impact of Tobacco UseSecondhand Smoke

Levels of secondhand smoke in casinos can be 2.4 to 18.5 times higher than in offices and 1.5 to 11.7 times higher than in restaurants.

NIOSH Report, 2009

impact of tobacco use economic
Impact of Tobacco UseEconomic

$96 billion (healthcare)

$97 billion (lost productivity)

~$193 billion

Annual Tobacco-Related Monetary Costs in the USA

Source:Centers for Disease Control and Prevention: MMWR, November 2008

impact of tobacco use economic1
Impact of Tobacco UseEconomic

$4.98 billion is spent annually on healthcare solely because of the effects on children of exposure to secondhand smoke.

Tobacco-Related Monetary Costs in the U.S.

Campaign for Tobacco-Free Kids, 2009

impact of tobacco use economic2
Impact of Tobacco UseEconomic

Annual tax burden from

government spending caused by smoking:

$70 .7 billion/ $630 per household

Q: What is the total economic costs associated with cigarettes/per pack sold in the U.S.?

$10.47 per pack

Source:Campaign for Tobacco Free Kids - Toll of Tobacco in the United States of America (2009)

impact of tobacco use economic3
Impact of Tobacco UseEconomic

Average retail price of a pack of cigarettes in the U.S.

Cigarette Excise Taxes

1970: $0.38

2000: $3.16

2008: $4.35

2009: $5.12

CDC, Office on Smoking and Health

slide59

Cigarette Tax Rates (cents per pack)State Average is $1.34 Per Pack

WASHINGTON

202.5

MONTANA

170

MAINE

200

NORTH DAKOTA

44

VT:224

MINNESOTA

156

OREGON

118

VT

IDAHO

57

NH

NH: 178

WISCONSIN

252

SOUTH DAKOTA

153

NEW YORK

275

MA

MA:251

WYOMING

60

MICHIGAN

200

CT

RI:346

CT:200

IOWA

136

PENNSYLVANIA

135

NJ:270

NEBRASKA

64

NEVADA

80

OHIO

125

DELAWARE:160

UTAH

69.5

IN

99.5

ILLINOIS

98

WV

55

30

VIRGINIA

MARYLAND:200

COLORADO

84

KANSAS

79

MISSOURI

17

87

DC:250

KENTUCKY

60

CALIFORNIA

NORTH CAROLINA

45

TENNESSEE

62

OKLAHOMA

103

ARKANSAS

115

ARIZONA

200

NEW MEXICO

91

SOUTH CAROLINA

7

GEORGIA

37

ALABAMA

42.5

MS

68

ALASKA

200

TEXAS

141

36

LOUISIANA

HAWAII

260

States that have not passed tax increases since 1999

FLORIDA

133.9

States that have recently passed or implemented a cigarette tax increase (since 1999)

August 2009

impact of tobacco use7
Impact of Tobacco Use

Tobacco Industry

slide61

Source:University of California, San Francisco Legacy Tobacco Documents Library

Benson & Hedges Fax

Assessing users of mild and light cigarettes

and

Indicating a “need for ‘lights’ variant to attract health- conscious smokers.”

impact of tobacco use tobacco industry
Impact of Tobacco UseTobacco Industry

Source:Campaign for Tobacco Free Kids Ad Gallery

impact of tobacco use tobacco industry1
Impact of Tobacco UseTobacco Industry

- 1978 Imperial Tobacco document

“We have evidence of virtually no quitting

among smokers of these brands, and there are

indications that the advent of ultra low tar cigarettes

has actually retained some potential nonsmokers in the

cigarette market by offering them a viable

alternative.”

impact of tobacco use tobacco industry2
Impact of Tobacco UseTobacco Industry

Lozenge containing Star-cure™ tobacco, nicotine, and other substances that comes in Mint and Java flavors

Smokeless, spitless mint and cinnamon flavored tobacco sachet

Bottled water with added nicotine

factors that influence use nicotine addiction
Factors that Influence UseNicotine Addiction

45.3 million adults in the United States smoke cigarettes, although this single behavior results in disability or premature death for

half of all regular users.

Source:CDC, Office on Smoking and Health

factors that influence use nicotine addiction1
Factors that Influence UseNicotine Addiction

Smokers give several general reasons for smoking.

  • Stimulation
  • Handling the cigarette
  • Relaxation
  • Help for tension
  • Craving
  • Habit * (Addiction)

* The preferred term in Tobacco Control is addiction, not habit.

factors that influence use nicotine addiction2
Factors that Influence UseNicotine Addiction

Addiction

Addiction: Habitual psychological and physiological dependence on a substance beyond one's voluntary control

factors that influence use nicotine addiction3
Factors that Influence UseNicotine Addiction
  • Withdrawal Symptoms
  • Irritability
  • Anxiety
  • Difficulty concentrating
  • Increased appetite

.

factors that influence use nicotine addiction4
Factors that Influence UseNicotine Addiction
  • Adrenaline—rush of energy
  • Acetylcholine—awake and stimulated
  • Dopamine—relaxed and feeling good
  • Endorphins—natural painkillers
  • Glutamate--learning and memory

Source:How Stuff Works, Inc.

factors that influence use physiological effects1
Factors that Influence UsePhysiological Effects

Withdrawal symptoms are REAL and can range in severity.

Q: Do you know the signs of withdrawal from nicotine?

factors that influence use physiological effects2
Factors that Influence UsePhysiological Effects
  • People who stop smoking greatly reduce their risk of dying prematurely.
  • The younger a smoker quits, the greater the health benefits.
  • But, stopping at any age is beneficial to health.

CDC, Office on Smoking and Health

factors that influence use1
Factors that Influence Use

PhysiologicalEffects

factors that influence use tobacco products1
Factors that Influence UseTobacco Products

Additives are also in cigars, pipe tobacco, and spit tobacco for taste and addictive properties.

factors that influence use tobacco products3
Factors that Influence UseTobacco Products
  • Clove Cigarettes or Kreteks
  • 70% tobacco and 30% cloves
  • Clove numbs throat
  • Densely rolled = higher exposure to carcinogens
factors that influence use tobacco products4
Factors that Influence UseTobacco Products

Bidis

  • Non-filtered, sweet-flavored cigarette
  • Higher levels of carbon monoxide, nicotine, and tar than cigarettes
  • Popular with young people
factors that influence use tobacco products5
Factors that Influence UseTobacco Products

Cigars and Cigarillos

  • Tobacco wrapped in a tobacco leaf
  • Can contain as much tobacco as a pack of cigarettes
  • Growing popularity among young people
factors that influence use tobacco products6
Factors that Influence UseTobacco Products
  • Hookah
  • Traditional Middle Eastern and Asian device for smoking shisha tobacco
  • Perceived as less risky
  • Growing popularity in U.S. among young people
factors that influence use tobacco products7
Factors that Influence UseTobacco Products

E-Cigarettes

Nicotine delivery systems that use water, a heating element, and electricity to mimic the sensation of smoking a cigarette

factors that influence use tobacco products9
Factors that Influence UseTobacco Products

Snus

  • Taboka was the tobacco industry’s first attempt at Snus.
  • A smokeless form of tobacco that comes in pouches.
  • Originated in Sweden, new to the U.S.
factors that influence use social norms
Factors that Influence UseSocial Norms
  • Behavioral norm: the most common actions or behaviors exhibited in a social group.
  • Attitudinal norm: the most widely shared beliefs or expectations in a social group about how people or members of the group ought to behave.

National Social Norms Resource Center, 2009

factors that influence use movies
Factors that Influence UseMovies

“In contrast to the health groups, who saw smoking as a medical issue, the tobacco industry has always seen smoking as a cultural issue. And there is not a better way to control pop culture worldwide than through movies…”

Professor Stanton Glantz

factors that influence use movies1
Factors that Influence UseMovies
  • Smoking in the most popular, youth-oriented, PG-13 movies has increased.
  • Teenagers are more readily influenced than other age groups.
  • Tobacco companies benefit financially from individuals who start to use tobacco at an early age.
  • Tobacco companies have violated the tobacco settlement and have a long history of marketing their products to young people.

Ng & Dakake. 2002. MASSPIRG.

factors that influence use movies2
Factors that Influence UseMovies
  • Tobacco use has increased 50% since the MSA.
  • Tobacco use remains prevalent in PG-13, youth-oriented movies.
  • Most films portray smokers and smoking in a positive or neutral light.
  • Fewer films feature negative statements about tobacco use.
  • Several films show identifiable, brand name cigarette packs.
  • Big name stars smoked in both pre- and post-settlement films.

Ng & Dakake. 2002. MASSPIRG.

factors that influence use movies3
Factors that Influence UseMovies
  • Efforts are being made to get smoking out of the movies.
  • Programs such as Screen Out! and California Youth and Advocacy Network’s (CYAN’s) “Tobacco and Hollywood Campaign” are raising awareness of this problem and endorsing change.
factors that influence use the power of advertising
Factors that Influence UseThe Power of Advertising

Campaign for Tobacco Free Kids Ad Gallery, 2009

factors that influence use the power of advertising1
Factors that Influence UseThe Power of Advertising

Campaign for Tobacco Free Kids Ad Gallery

factors that influence use the power of advertising2
Factors that Influence UseThe Power of Advertising

Campaign for Tobacco Free Kids Ad Gallery

factors that influence use targeting specific populations
Factors that Influence UseTargeting Specific Populations
  • African Americans
  • Hispanics and Latinos
  • Native Americans and Alaskan Natives
  • Asian Americans and Pacific Islanders
  • Lesbians, Gays, Bisexuals and Transgenders (LGBT)
  • Low SES
factors that influence use targeting specific populations1
Factors that Influence UseTargeting Specific Populations

Targeting Cigarettes at African Americans RJR, 1977

Campaign for Tobacco Free Kids Ad Gallery

“RJR's business among Blacks is underdeveloped....

Further, given their strong preference for menthol flavor, we probably need to devote more attention to Blacks...

In fact, I even feel that a project designed to develop a cigarette for Blacks may be a viable business proposition.”

factors that influence use targeting specific populations2
Factors that Influence UseTargeting Specific Populations

Campaign for Tobacco Free Kids Ad Gallery

factors that influence use targeting specific populations4
Factors that Influence UseTargeting Specific Populations

Campaign for Tobacco Free Kids Ad Gallery

factors that influence use targeting specific populations5
Factors that Influence UseTargeting Specific Populations

Campaign for Tobacco Free Kids Ad Gallery

factors that influence use tobacco product enhancement
Factors that Influence UseTobacco Product Enhancement

How could they possibly enhance that image?

National Cancer Institute, Visuals Online

factors that influence use tobacco industry enhancement1
Factors that Influence UseTobacco Industry Enhancement

Why the name change?

  • Official reason: Represents diversity of products
  • Real Reason: disassociates company from its strong tobacco identity.
slide117

Factors that Influence UseTobacco Industry Enhancement

In 2001, the manufacturer of Skoal chewing tobacco changed its name from “United States Tobacco Company” to disassociate from smoking and auxiliary issues like smoke-free air.

review
Review

Prevalence of Tobacco Use

  • Described the history and evolution of the tobacco control movement.
  • Learned the impact that events had on tobacco use throughout U.S. history
  • Learned where to obtain data on the prevalence and impact of tobacco use.
  • Learned the importance of using local data.
review1
Review

Impact of Tobacco Use

  • Discussed the health effects and health risks associated with tobacco use.
  • Discussed the health effects of secondhand smoke.

Factors that Influence Use

  • Discussed the impact of addiction.
  • Analyzed how the tobacco industry influences tobacco use.
slide120

Tobacco Technical Assistance Consortium

Rollins School of Public Health

Emory University

Atlanta, Georgia

To contact: ttac@sph.emory.edu

Phone: 404-712-8474