Tobacco Harm Reduction Interim Study October 3 2012 October 3, - - PowerPoint PPT Presentation

Tobacco Harm Reduction Interim Study

October 3 2012 October 3, 2012 Keith Reed, RN, MPH, CPH Director, Center for the Advancement of Wellness Oklahoma State Department of Health

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Tobacco Use

• Leading cause of death on the United States
• Leading cause of death on the United States

and Oklahoma

Over 400 000 lives nationwide per year1 – Over 400,000 lives nationwide per year1 – Approximately 6,200 live in Oklahoma per year2 Oklahoma ranks 48th in the nation for smoking3 – Oklahoma ranks 48th in the nation for smoking3

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Smokeless Tobacco

• Smokeless tobacco is a known carcinogen
• Smokeless tobacco is a known carcinogen,

proven to cause cancer, and is addictive.

National Toxicology Program of the National – National Toxicology Program of the National Institutes of Health1,2 – National Cancer Institute3 – National Cancer Institute – American Cancer Society4 U S Surgeon General5 – U.S. Surgeon General5 – U.S. Public Health Service6

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The Harm Reduction Argument g

• The science from Sweden does not generalize

g to the United States.1

– Smokeless tobacco products are manufactured p differently.2,3

• Some Swedish brands contain a mere 2% of the tobacco

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specific nitrosamines found in U.S. counterparts.4

– Marketing of tobacco products, which influences b t t di i t itt d i usage by target audience, is not permitted in Sweden.2, 5, 6

• Marketing in the U S encourages dual use of smokeless
• Marketing in the U.S. encourages dual use of smokeless

tobacco and cigarettes.7,8,9,10

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Tobacco Use among Oklahoma Adults g

• 23 7 percent of Oklahoma adults smoke 1,2
• 23.7 percent of Oklahoma adults smoke.
• Nearly 6 percentage points higher than the national

average.2

• 7.3% of Oklahoma adults use smokeless

tobacco.1,2 tobacco.

• Double the national rate of 3.6%3
• Of Oklahoma adult smokers 9 2% also use

Of Oklahoma adult smokers, 9.2% also use smokeless tobacco (Dual Use).1,2

• 1 of every 7 males1

1 of every 7 males

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Tobacco Use and Youth

• According to the 2012 Surgeon General Report1:

– Nearly 9 out of 10 smokers start smoking by age 18. – 99% start by age 26.

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Smokeless Tobacco as a Gateway to y Cigarette Use

• Adolescent smokeless tobacco users are more likely than non-

users to start smoking cigarettes as adults.1,2,3,4

• Youth are encouraged to experiment with candy flavored and low-

Youth are encouraged to experiment with candy flavored and low nicotine starter products with the subsequent graduation to higher- level nicotine sources, including cigarettes.5,6,7,8,9

• Tobacco use among high school boys increased by 16% between

2003 and 2011, while decreases in smoking among the same age group slowed.5,6 g p

• Evidence indicates that smokeless tobacco use is a gateway to

cigarette use.1,2,3,4,6,10

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Smokeless Tobacco Use and Dual Use among Oklahoma Youth

• 1 in 4 Oklahoma middle school smokeless tobacco

users already smoke cigarettes1. O h lf f Okl h hi h h l k l

• Over half of Oklahoma high school smokeless

tobacco users also smoke cigarettes1. 18 4% f Okl h hi h h l b k l

• 18.4% of Oklahoma high school boys use smokeless

tobacco2. 40% higher than the national rate of 12 9%2 – 40% higher than the national rate of 12.9%2

• 30% of young adults in the U.S. who use tobacco

report dual use of cigarettes and smokeless tobacco 3 report dual use of cigarettes and smokeless tobacco.

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Tobacco Cessation

• The 2008 Clinical Practice Guideline on Treating
• The 2008 Clinical Practice Guideline on Treating

Tobacco Use and Dependence1 reports:

Nicotine Gum 19% quit rate – Nicotine Gum – 19% quit rate – Nicotine Patches – 23.4% quit rate Nicotine Lozenges 24 2% quit rate – Nicotine Lozenges – 24.2% quit rate – Nicotine patch and gum combined – 36.5% quit rate

Ni i l h h i ifi

• Nicotine replacement therapy has a significant

quit rate when properly accessed and utilized. 1

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Evidenced Based Strategies Proven to g Reduce Smoking Rates and Improve Health Health

C h i ki b

1

• Comprehensive smoking bans.1
• Smoke free cities.1,2, 3
• Increasing the price of tobacco products.1

– Oklahoma taxes cigarettes at 43 cents less than the g national average.4,5

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Summary

• There remains proven evidenced based
• There remains proven, evidenced based

strategies to reduce smoking that have yet to be implemented in Oklahoma Until we have be implemented in Oklahoma. Until we have fully implemented the true science of tobacco control we must be cautious in adopting control, we must be cautious in adopting unproven strategies, especially any strategy that includes using known carcinogens to that includes using known carcinogens to reduce smoking rates.

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References

Slide 2

1 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Tobacco

Use; Targeting the Nation’s Leading Killer. 9 pages. February 22, 2011. Available at www.cdc.gov/chronicdisease/resources/publications/aag/osh.htm.

2 Centers for Disease Control and Prevention Smoking-Attributable Mortality Morbidity and Economic Costs (SAMMEC):

Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC): Adult SAMMEC and Maternal and Child Health (MCH) SAMMEC software, 2007. Available at www.cdc.gov/tobacco/sammec.

3 United Health Foundation. America’s Health Rankings – 2011: A Call to Action for Individuals & Their Communities.

Oklahoma, p 88. Available at www.americahealthrankings.org/OK. Slide 3 Slide 3

1 Integrated Laboratory Systems. NTP Report on Carcinogens Background Document for Smokeless Tobacco. Prepared for the

October 30-31, 12997 meeting of the Report on Carcinogens Subcommittee of the NTP Board of Scientific Counselors. 141 pages, March 1999. Available at http://ntp.niehs.nih.gov/files/Smokeless_Tobacco1.pdf.

2 International Agency on Research on Cancer (IARC). Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines. Lyon,

France: World Health Organization International Agency for Research on Cancer; 2007 IARC Monographs on the France: World Health Organization International Agency for Research on Cancer; 2007. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 89. Available at http://monographs.iarc.fr/ENG/Monographs/vol89/mono89.pdf.

3 National Cancer Institute. Smokeless Tobacco and Cancer. National Cancer Institute Fact Sheet 10.5; Bethesda, MD. October

25, 2010. Available at www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless.

4 American Cancer Society Smokeless Tobacco and How to Quit Fact Sheet December 16 2011 Available at 4 American Cancer Society. Smokeless Tobacco and How to Quit. Fact Sheet. December 16, 2011. Available at

www.cancer.org/acs/groups/cid/documents/webcontent/002979-pdf.pdf.

5 Carmona RH. Testimony Before the Subcommittee on Commerce, Trade, and Consumer Protection Committee on Energy and

Commerce United States House of Representatives. Can Tobacco Cure Smoking? A Review of Tobacco Harm Reduction (Remarks as Prepared; not a transcript). Available at www.surgeongeneral.gov/news/testimony/tobacco06032003.html.

6 Department of Health and Human Services Cullen JW (ed ) The Health Consequences of Using Smokeless Tobacco: A Report 6 Department of Health and Human Services, Cullen JW (ed.). The Health Consequences of Using Smokeless Tobacco: A Report

• f the Advisory Committee to the Surgeon General. Bethesda, MD: U.S. Department of Health and Human Services, Public

Health Service, NIGH Publication No. 86-2874. 1986. Available at http://profiles.nlm.nih.gov/ps/access/NNBBFC.pdf.

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References

Slide 4

1 Foulds J, Ramstrom L, Burke M and Fagerström K. Effect of smokeless tobacco (snus) on smoking and public health in

• Sweden. Tobacco Control 2003; 12: 349-359.

2 Boon A. The United States Isn’t Sweden: Why UST’s Efforts To Make Comparative Health Claims, In The Continued Absence

• o .

e U ted States s t Swede : W y US s

• ts o

a e Co pa at ve ea t C a s, e Co t ued bse ce

• f FDA Regulation of All Tobacco Products, Won’t Work and Threatens Public Health. Washington, DC: Campaign for

Tobacco Free Kids, 2006.

3 Swedish Food Regulations, Food Act, SFS 2006: 804 (2006). 4 Brunnemann KD, Qi J and Hoffmann D. Aging of Oral Moist Snuff and the Yields of Tobacco-Specific N-Nitrosamines

(TSNA). A progress report prepared for the Massachusetts Tobacco Control Program, Department of Public Health. (TSNA). A progress report prepared for the Massachusetts Tobacco Control Program, Department of Public Health. Valhalla, NY: American Health Foundation. June 22, 2001.

5 Swedish National Institute of Public Health. Selling tobacco — A fast guide and practical advice. Undated. 6 The Tobacco Act (1993:581). Promulgated June 3, 1993, Translated into English June 2007. Reprinted SFS 2005-369. Sweden. 7 Tobacco Control Legal Consortium, Cause and Effect: Tobacco Marketing Increases Youth Tobacco Use, Findings from the

2012 Surgeon General’s Report (2012) 2012 Surgeon General s Report (2012).

8 Connolly GN. The marketing of nicotine addiction by one oral snuff manufacturer. Tobacco Control 1995; 4: 73-79. 9 Mushtaq N, Williams MB, and Beebe LA. Concurrent use of cigarettes and smokeless tobacco among US males and females.

Journal of Environmental and Public Health 2012, Article ID 984561, 11 pages.

10 Rath JM, Villanti AC, Abrams DB, and Vallone DM. Patterns of tobacco use and dual use in US young adults: The missing

li k b h i d d l i J l f E i l d P bli H l h 2012 A i l ID 679134 9 link between youth prevention and adult cessation. Journal of Environmental and Public Health 2012, Article ID 679134, 9 pages.

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References

Slide 5

1 Oklahoma State Department of Health. Oklahoma Behavioral Risk Factor Surveillance System (BRFSS) Data. Oklahoma City,

OK: Oklahoma State Department of Health, Health Care Information, 2010.

2 McClave A, Rock V, Thorne S, and Malarcher A. State-Specific Prevalence of Cigarette Smoking and Smokeless Tobacco Use

cC ave , oc V,

• e S, a d

a a c e . State Spec c eva e ce o C ga ette S o g a d S o e ess obacco Use Among Adults --- United States, 2009. Morbidity and Mortality Weekly Report (MMWR). Atlanta, GA: Centers for Disease Control and Prevention, 2010; 59(43): 1400-1406.

3 American Lung Association. Smokeless Tobacco Products. Washington, DC: American Lung Association, 2012. Available at

www.lung.org/stop-smoking/about-smoking/facts-figures/smokeless-tobacco-products.html. Slide 6 Slide 6

1 U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the

Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012. Slide 7

1 Tomar SL Is use of smokeless tobacco a risk factor for cigarette smoking? The U S experience Nicotine & Tobacco Research 1 Tomar SL. Is use of smokeless tobacco a risk factor for cigarette smoking? The U.S. experience. Nicotine & Tobacco Research

2003, 5(4): 561-569.

2 Tomar SL. Smokeless tobacco use is a significant predictor of smoking when appropriately modeled. Nicotine & Tobacco

Research 2003, 5(4):571-573.

3 Haddock CK, Weg MV, DeBon M, Klesges RC, et al. Evidence That Smokeless Tobacco Use is a Gateway for Smoking

Initiation in Young Adult Males Preventive Medicine 2001 32: 262 267 Initiation in Young Adult Males. Preventive Medicine 2001, 32: 262-267.

4 Tomar SL, Alpert HR, and Connolly GN. Patterns of dual use of cigarettes and smokeless tobacco among US males: findings

from national surveys. Tobacco Control 2010; 19: 104-109.

5 Boonn A. Smokeless Tobacco and Kids. Washington, DC: Campaign for Tobacco Free Kids, 2012.

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References

Slide 7 con’t

6 Substance Abuse and Mental Health Services Administration. The NSDUH Report: Smokeless Tobacco Use, Initiation, and

Relationship to Cigarette Smoking: 2002 to 2007. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applies Studies, 2009.

7 Marketing Innovations, Inc. Project Report – Youth Cigarette – New Concepts. September 1972, Brown & Williamson. Bates

• No. 170042014. http://legacy.library.ucsf.edu/tid/oyq83f00.

8 Donati J; Tatham Laird. Conference Report #23. June 5, 1974. RJ Reynolds. Bates No. 500254578/4580.

http://legacy.library.ucsf.edu/tid/vai89d00.

9 RM Manko Associates. Summary Report New Flavors Focus Group Sessions. Lorillard. Bates No. 85093043/3071.

RM Manko Associates. Summary Report New Flavors Focus Group Sessions. Lorillard. Bates No. 85093043/3071. http://legacy.library.ucsf.edu/tid/wjx31e00.

10 Johnston LSD, O’Malley PM, Bachman JG and Schulenberg JE. Monitoring the Future National Results on Adolescent Drug

Use: Overview of Key Findings, 2009. (NIH Publication No. 10-7583). Bethesda, MD: National Institute on Drug Abuse, 2010. Slide 8 Slide 8

1 Oklahoma State Department of Health. Oklahoma Youth Tobacco Survey (Middle School and High School) Data. Oklahoma

City, OK: Oklahoma State Department of Health, Center for the Advancement of Wellness, 2011.

2 Oklahoma State Department of Health. State and National Trends in Youth Tobacco Use: Youth Tobacco Survey 1999-2011.

Oklahoma City, Oklahoma: Oklahoma State Department of Health, Center for the Advancement of Wellness. October 2012.

3 Rath JM Villanti AC Abrams DB and Vallone Patterns of Tobacco Use and Dual Use in US Young Adults: The Missing Link 3 Rath JM, Villanti AC, Abrams DB and Vallone. Patterns of Tobacco Use and Dual Use in US Young Adults: The Missing Link

between Youth Prevention and Adult Cessation. Journal of Environmental and Public Health. 2012. Article ID 679134, 9 pages.

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References

Slide 9

1 Fiore M, Jaen C, Baker T, et al. A Clinical Practice Guideline for Treating Tobacco Use and Dependence: 2008 Update.

American Journal of Preventive Medicine. AHRQ 09-R003, 2008. Available at http://www.ahrq.gov/clinic/tobacco/treating_tobacco_use08.pdf. Slide 10

1 Task Force on Community Preventive Services. Recommendations Regarding Interventions to Reduce Tobacco Use and

Exposure to Environmental Tobacco Smoke. American Journal of Preventive Medicine. 2001; 20(2S): 10-15.

2 O’Connor JC, McNeil A, Chiriqui JF, Tynan M, et al. Preemption of Local Smoke-Free Air Ordinances: The Implications of

Judicial Opinions for Meeting National Health Objectives. Journal of Law, Medicine & Ethics. 2008 (Summer): 403-412. Judicial Opinions for Meeting National Health Objectives. Journal of Law, Medicine & Ethics. 2008 (Summer): 403 412.

3 Mowery PD, Babb S, Hobart R, Tworek C and MacNeill A. the Impact of State Preemption of Local Smoking Restrictions on

Public Health Protections and Changes in Social Norms. Journal of Environmental and Public Health. 2012; Article ID 632629, 8 pages.

4 Orzechowski and Walker, 2011. The Tax Burden on Tobacco – Historical Compilation. Volume 46. Arlington, VA:

Orzechowski and Walker Consulting Orzechowski and Walker Consulting.

5 Boon A. State Cigarette Excise Tax Rates & Rankings. Washington, DC: Campaign for Tobacco Free Kids, 2012.

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