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FDA Stakeholders Meeting on Disparities Oakland, CA February 2011

FDA Stakeholders Meeting on Disparities Oakland, CA February 2011. Jeannette Noltenius, MA, PhD National Director National Latino Tobacco Control Network. Network of Organizations/ Experts. Indiana Latino Institute, Inc.* (Lead Agency) Campaign for Tobacco Free Kids ClearWay Minnesota  

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FDA Stakeholders Meeting on Disparities Oakland, CA February 2011

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  1. FDA Stakeholders Meeting on DisparitiesOakland, CA February 2011 Jeannette Noltenius, MA, PhD National Director National Latino Tobacco Control Network

  2. Network of Organizations/ Experts • Indiana Latino Institute, Inc.* (Lead Agency) • Campaign for Tobacco Free Kids • ClearWay Minnesota   • ETR Associates   • Hispanic/Latino Partnership Unidos por la Salud UNIDOS* University of Southern California • HMA Associates • Indiana Tobacco Prevention Cessation • Latino Commission on AIDS  • Midwest Latino Health Research, Training & Policy Center* University of Illinois, at Chicago • National Association of Chronic Disease Directors • Tobacco Control Network • Tobacco Technical Assistance Consortium • University of Puerto Rico, Cancer Center   • 11 members of Advisory Committee  

  3. Mission To build leadership, inform, support and energize a National Network of tobacco control experts and activists to work with Latino communities, states and coalitions to address the health burdens created by tobacco consumption by promoting policies and programs to prevent youth initiation, increase quit rates and assure smoke-free environments.

  4. Services • Directory (+480 Latinos and experts) • Website: www.latinotobaccocontrol.org • Newsletter, alerts, media alerts, Facebook, • +2500 advocates, experts & CBO receiving news • 1000 media outlets focusing on Hispanic/Latinos • Technical Assistance and Training • Policy Advocacy, Smoke Free Air, Taxes • Promising Practices, Repository of 550 docs

  5. Demographics • Exponential growth • 15% of Population • 45 million + 3.9 mil in PR • 2050 1 in 4 will be H/L • 20 States H/L Largest Minority • 10 Top counties 86% + in TX • Emerging population centers • 100-200% growth: NC, SC, GA, AL, KS, IN, NV, FL, ID, and CT • Diversity in population • 34% less 18 years old, 27.6 med, very young • 64% Mexican, 17.7% Central/S • 9% PR, 3.4 % Cubans, 3.10% Salvadorans, 2.8% Dominicans • Language use • Majority 39% of Hispanics prefer to speak Spanish. • 24% Spanish more English • 23% Equal Spanish/English • 9% Mostly English • 5% English Only

  6. Tobacco prevalence data NOT collected on high school drop outs and foreign born. Lower educational attainment = lower SES, risk of becoming smokers, work with Smokers, construction, agriculture, landscaping, services, live in apartments that may not be smoke free,

  7. State-specific Prevalence of Smoking Among Adults, 2009 Illinois 18.6% California 12.9% Kentucky 25.6% Nevada 22.0% New York 18.0% Utah 9.8% Florida 17.1% Indiana 23.1% Texas 17.9% Centers for Disease Control and Prevention. (2009) BRFSS NLTCN & UIC Midwest Latino Health Research, Training & Policy Center

  8. Percentage of persons aged ≥18 years who were current cigarette smokers,* by state --- Behavioral Risk Factor Surveillance System, United States, 2009 According to 2009 BRFSS Hispanic Rates went down to 14.5% 19% men and 9.8% Women, but data based on land line surveys, H/L don’t low/intermittent smoking 5 cig/per day smoking

  9. 21.1% Hispanic Men, and 11.1% Hispanic Women, 70% low and intermittent ˃5 per day, Lack of data by subgroups and LGBT, LGBT 40-70% more likely to smoke than non LGBT (landlines vrs. Cell phones) 2000-05 NSDUD Men Women Total Aggregate 30.1% 17.5% 23.9 % Mexican 31.0% 15.7% 23.8% Puerto Rican35.6% 28.0% 31.5% Central/South 25.3% 14.7% 20.2% Cuban 29.3% 21.5% 26.2^ Centers of Disease Control, Smoking and Tobacco Use, Fact Sheet, Hispanics and Tobacco (May 2007). Page 1. Http://www.cdc.gov/tobacco/data_statistics/fact_sheets/populations/hispanics_tobacco.htm

  10. Percentage of Smokers Who Use Menthol Cigarettes by Race/Ethnicity—United States, 2002-2007 37% H/L Women Native Hawaiian and Other Pacific Islander American Indian and Alaska Native African American Multi-racial Asian Hispanic White §National Surveys on Drug Use and Health, 2002-2007, Caraballo, R, Rock, V, Overview of Current Use of Menthol Cigarettes and Trends in Recent Years, 2nd Menthol Conference, Oct 2009

  11. Problems with Menthol • Menthol smoking highest in populations of color. • It’s a gateway to smoking for new smokers • Its heavily used by those who have harder time quitting smoking than the general population; • It is aggressively marketed to poor urban African American, Latino, Native Hawaiian, Asian populations with larger price discounts and more prominent displays than found in other communities; • Its heavily used by populations with high rates of tobacco related diseases.

  12. Hispanic/Latino Youth • 22% grades 9 through12 smoke • 9.9 % middle school vrs. 8.5 percent of white, 7.6 percent of African American, and 2.7 percent of Asian American middle school students. • 8.2% middle school smoke CIGARS compared with 6.9% African Americans, 4.4% Whites and 1.2% Asian Americans • Hispanic middle school students smoke at higher rates than the national average for students in these grades. CDC estimates that 20.0% of adults with diabetes smokes. CDC, Division of Diabetes Translation, July 2009 http://www.oas.samhsa.gov/NSDUH/2k7NSDUH/tabs/Sect2peTabs17to21.pdf SAMHSA, HHS, Calculated based on data in 2006 National Household Survey on Drug Use and Health, http://www.oas.samhsa.gov/nsduh.htm. See also, HHS, Youth and Tobacco: Preventing Tobacco Use among Young People: A Report of the Surgeon General, 1995, http://sgreports.nlm.nih.gov/NN/B/C/L/Q/_/nnbclq.pdf (pg 49).

  13. Unintented Consequences of Current Tobacco Policies • Sale of “loosies”, = little cigars, cigarrillos, smokeless marketing, More RyO, use of pipe tobacco for RyO, generics, E cigs +PR, impact on Warning Labels for all products • Non-traditional SALE outlets, smuggling border areas, car trunks, markets, purchases in bodegas/under counter, imports • 70% Low Intermittent, ˃5, “maintenance level- Long term impact, Epi data, “addiction model” 20 cigs questioning for Latinos/others, PH Guidelines • Unequal protection from SHS (CA, NY) less 5 employees • Cessation access, culture/language, local cessation services more culturally sought after • Less funding in States for tobacco control in priority populations, less infrastructure, leadership void locally

  14. CONCERNS OF NLTCN MEMBERS • Ban Menthol • Select Strong Warning Labels (People of Color Pictures) • Assure Point of Sale/Magazine Ads have Warnings in Spanish • Warning Labels on Exported and Imported Cigarrettes   • Warning Labels on all tobacco products • Add 1-800-QUITLINE to Warnings & adds • Equity in Enforcement of all Provisions of FDA • Equity in Educational/Promotional Campaigns • Community Driven Interventions and Actions

  15. Culturally, Linguistically, Community Appropriate Outreach • Make all materials readable at a 5th grade or lower reading level, more images, images of people of color • Fund community organizing efforts that will help store owners refuse or decrease price discounts, special promotions, and heavy shelving space devoted to menthol, provide “counter incentives”, highlight “good practices”, local enforcement new products • Increase multimedia campaigns in Spanish language (television, radio, local journalists). • Make sustainable and consistent campaigns “stigma free” for those living with HIV/AIDS, Hep C • Assure research of impact of tobacco use, nicotine/ARVs, increase research on NRT use in those living with HIV/AIDS, diabetes and other chronic diseases.

  16. Suggestions for FDA • Create Office of Disparities at FDA 36% pop+LGBT • Hire several FTEs (5) to address community needs =interlocutors = internal advocates + action • Hire multicultural/multilingual staff • Fund National, State and Local groups to engage in FDA implementation, qualitative data collection, marketings, promotion, Spanish campaigns. • Collect disaggregated data, local, useful to communities, in partnership with communities • Assure implementation in Territories (Puerto Rico) • Work with existing Enforcement Efforts to reach “bodegas, mercados” minority merchants, border areas, work in partnership with Tribes

  17. Partnership with FDA • Print Articles on specific FDA topics in Newsletter, create specific Alerts, Spanish versions to reach 2500 members • Hold press conferences/1000 Media Outlets • Link to FDA Website, post special reports • Assist in gathering Hispanic/Latinos to discuss topics of mutual interest • Assist in holding focus groups, data collection • Participate in meetings in DC as necessary • Support actions in Puerto Rico

  18. THANK YOU MUCHAS GRACIAS Jeannette Noltenius, PhD National Director National Latino Tobacco Control Network 1869 Park Road, NW Washington, DC 20010 (202) 328-1313 phone (202) 329-6045 cell (202) 797-9856 fax jnoltenius@sswdc.com www.latinotobaccocontrol.org

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