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 1
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 year 1 Over 400 000 lives nationwide per year 1 – Approximately 6,200 live in Oklahoma per year 2 – Oklahoma ranks 48 th in the nation for smoking 3 Oklahoma ranks 48 th in the nation for smoking 3 2
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 Health 1,2 – National Cancer Institute 3 – National Cancer Institute – American Cancer Society 4 – U.S. Surgeon General 5 U S Surgeon General 5 – U.S. Public Health Service 6 3
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 specific nitrosamines found in U.S. counterparts. 4 4 – Marketing of tobacco products, which influences usage by target audience, is not permitted in b t t di i t itt d i 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 4
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 males 1 1 of every 7 males 5
Tobacco Use and Youth • According to the 2012 Surgeon General Report 1 : – Nearly 9 out of 10 smokers start smoking by age 18. – 99% start by age 26. 6
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 7
Smokeless Tobacco Use and Dual Use among Oklahoma Youth • 1 in 4 Oklahoma middle school smokeless tobacco users already smoke cigarettes 1 . • Over half of Oklahoma high school smokeless O h lf f Okl h hi h h l k l tobacco users also smoke cigarettes 1 . • 18.4% of Oklahoma high school boys use smokeless 18 4% f Okl h hi h h l b k l tobacco 2 . – 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. 8
Tobacco Cessation • The 2008 Clinical Practice Guideline on Treating • The 2008 Clinical Practice Guideline on Treating Tobacco Use and Dependence 1 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 • Nicotine replacement therapy has a significant Ni i l h h i ifi quit rate when properly accessed and utilized. 1 9
Evidenced Based Strategies Proven to g Reduce Smoking Rates and Improve Health Health • Comprehensive smoking bans. 1 C h i ki b 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 10
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. 11
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 of the Advisory Committee to the Surgeon General . Bethesda, MD: U.S. Department of Health and Human Services, Public 12 Health Service, NIGH Publication No. 86-2874. 1986. Available at http://profiles.nlm.nih.gov/ps/access/NNBBFC.pdf.
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