WHO is Smoking and Using Tobacco in Muskegon and Michigan ? Farid - - PowerPoint PPT Presentation

WHO is Smoking and Using Tobacco in Muskegon and Michigan ? Farid Shamo: State Tobacco Control Program shamof@Michigan.gov

 Who is Smoking/Using Tobacco in Michigan and

Muskegon?

 Smoking Behavior Among ADULTS.  Prenatal Smoking in Michigan and Muskegon.  Smoking/Tobacco Use Among High School Students.

Tobacco Use in Michigan

 20.4% of Michigan adults currently smoke cigarettes

(BRFSS-2016)

 21.5% of Muskegon adults currently smoke cigarettes

BRFS 2014-2016)

 10% of Michigan high school students currently smoke

cigarettes (YRBS-2015)

 7.5% of Muskegon high school students currently smoke

cigarettes (YRBS-2015)

 23% of Michigan high school students currently use E-

Cigarette (YRBS-2015)

 17.5% of Muskegon high school students currently use E-

Cigarette (YRBS-2015)

23.3% 21.4% 20.7% 20.4% 21.2% 19.2% 17.5% 17% 26% 23.8% 22% 21.5% 0% 5% 10% 15% 20% 25% 30% 2011 2013 2015 2016

Adult smoking prevalence in Muskegon compared to Michigan and USA (BRFSS 2011-2016)

Michigan USA Muskegon

2 8 17 17 16 18 34 246

50 100 150 200 250 300

AIDS Homicide Alcohol Auto… Suicide Drug… Secondhan… Cigarettes

Deaths/ Year

* Source: CDC-SAMMEC- 2009 and MDHHS Vital Statistic 2015

Causes of Preventable Death Muskegon County-Michigan

Tobacco kills more people in Michigan * than AIDS, alcohol, auto accidents, cocaine, heroin, murders and suicides - combined.

43.2 46.3 39.3 42.9 40.3 39.7

[VALUE]%

27.4 26.4 25.5 26.7 25.8 25.8

[VALUE]%

8.8 8.8 8.1 7.2 7.3 7.5

[VALUE]%

5 10 15 20 25 30 35 40 45 50 2011 2012 2013 2014 2015 2016 2016

Adult Smoking Rates by Educational Levels over the period from 2011-2016 in Michigan (MiBRFSS) and Muskegon < HS HS College

35.3 39.9 37.5 36.4 35.5 35.7

[VALUE]%

21.5 20.6 21.6 21.3 21.8 21

22%

13.2 12.2 10.9 10.8 10.9 11

[VALUE]%

5 10 15 20 25 30 35 40 45 2011 2012 2013 2014 2015 2016 2016

Adult Smoking Rate by Household Income Level Over the Period From 2011-2016 (MiBRFSS) in Michigan and Muskegon

<$20K <$35-49K >$75K

[VALUE]% 19.7% 18.7 23.6% 5 10 15 20 25

Michigan Muskegon

Adult Smoking Rates By Gender in Michigan and Muskegon – 2016 BRFSS

Male Female

24.9% 28% 25.6% 32.3% 41.4% 39.8% 40.3% 46.2% 41%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% African American With disability Arab American ** Uninsured LGBT With poor Mental Health Native American Low SES HIV-positive person*

Adult Current Smoking Rates by Populations Disproportionately Impacted by Tobacco Use in Michigan, 2016 Behavioral Risk Factor Survey.

* HIV Client Survey 2017 ** Arab & Chaldean American Survey 2017 State Average = 20.4%

15.6% 25.3 26.9% 24.9

21.8%

[VALUE]% [VALUE]% [VALUE]% [VALUE]% [VALUE]% [VALUE]% [VALUE]% 11.4 6

5 10 15 20 25 30 35 18-24 years 25-34 35-44 45-54 55-64 65-74 75+

Adult Current Smoking Rate by Age Groups in Muskegon (Red columns) Compared to Michigan - BRFSS 2016

Muskegon average =21.5%

58.2% 41.8%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Current and former smokers Never smoked

Smoking Status Among Adults Ever Told They Have Cancer (other than skin cancer)* MiBRFSS 2016

* There is a statistically significant difference between the 2 groups of Cancers .

62.7% 37.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Current and former smokers Never smoked

Smoking Status Among Adults Ever Told They Have Stroke* MiBRFSS 2016

* There is a statistically significant difference between the 2 groups

68% 32.4%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Current and former smokers Never smoked

Smoking Status Among Adults Ever Told They have Heart Attack* MiBRFSS 2016

* There is a statistically significant difference between the 2 groups

55% 45%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Current and former smokers Never smoked

Smoking Status Among Adults Ever Told They Have Diabetes MiBRFSS 2016

42.9% 40.6% 39.2% 38.2% 38.0% 39.8% 23.3% 23.3% 21.4% 21.2% 20.7% 20.4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2011 2012 2013 2014 2015 2016

Current Smoking Rate Among Adults Reporting Poor Mental Health* Compared to the State Average, Michigan BRFSS 2011-2016

Adults With Poor Mental Health State Average

* With Poor Mental Health 14 or More Days of the Past 30 Days.

36.9% 41.2% 42.2% 39.3% 39.0% 35.3% 23.3% 23.3% 21.4% 21.2% 20.7% 20.4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2011 2012 2013 2014 2015 2016

Current Smoking Rate Among Adults Who are Heavy Alcohol Drinkers* Compared with the State Average, MiBRFSS 2011-2016

Adults Who are Heavy Alcohol Drinker State Average * Heavy Alcohol Drinker = consuming an average of > 2 alcoholic drinks per day for men and > 1 per day for women

[Y VALUE]% 26.5 [Y VALUE]% [Y VALUE]% [Y VALUE]% [Y VALUE]% 29 [Y VALUE]% [Y VALUE]% 24.5% [Y VALUE]% [Y VALUE]% [Y VALUE]% 17.7 19.3 19.8 [Y VALUE]% [Y VALUE]% [Y VALUE]% 16%

12 17 22 27 32

2006 2008 2010 2012 2014 2016 2018

%

Rate of Live Births to Mothers Who Smoked During Pregnancy in Muskegon Compared to Michigan for the years 2007-2016 (MDHHS-Vital Statistics)

Muskegon Michigan

[VALUE]% [VALUE]% [VALUE]% [VALUE]% [VALUE]% [VALUE]% 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 2011 2012 2013 2014 2015 2016 Prevalence of Current Smoking During Pregnancy Among Pregnant Women in Muskegon, Vital Statistics 2011-2016

[VALUE]% 24.9 15.3 11.1 5 10 15 20 25 30 All ages 18-24 Yr 25-34 Yr 35-45Yr

Smoking Rates of the Pregnant Women by Age Groups in

• Michigan. Vital Statistics 2015

17.3 32.4 26.8 17.3 2.7 5 10 15 20 25 30 35 All Levels Less than High School High School Some College College

Smoking Rates of the Pregnant Women by Educational Levels in

• Michigan. Vital Statistics 2015

17.3 18.6 16.6 42.3 11.5 1.9 2.6 [VALUE]%

5 10 15 20 25 30 35 40 45 All Races White Black Native American Hispanic Asian Arab Other

Smoking Rates of the Pregnant Women By Their Race in Michigan. Vital Statistics 2015

27.9 28.4 28.8 23.6 8.9 18.3 7.3 6.1 5 10 15 20 25 30 35 All ages 18-24 Yr 25-34 Yr 35-45Yr

Smoking Rates of the Pregnant Women by their Type of Health Insurance Plans in Michigan. Vital Statistics 2015

Medicaid Private insurance

8.7 8.5 9.1 8.7 9.5 10.4 6 5.8 6.1 6.4 5.9 6.1 2 4 6 8 10 12 2010 2011 2012 2013 2014 2015

%

Infant Mortality Rate in Michigan by Smoking Status of the Mother for the Period from 2010-2015 (per 1000 live births-Vital Statistics)

Smoking Mom Non-smoker

Quitlines are effective and recommended in Pregnancy :

Because Pregnant Women does not need to leave her

home.

Because of social stigma attached to “Smoking during

Pregnancy” the Quitline may be the most attractive method.

May work very well when there are transportation

barriers or mobility issues for some pregnant women.

……………………………. BUT

354 194 168 148 1114 1287 1602 2350

500 1000 1500 2000 2500 2013 2014 2015 2016

Number of Successful Intake Calls for Fax Referred Smokers Compared to Unreachable Phones- “Quitline database 2013-2016”

Intake calls Unreachable Phones

What can we do to increase reachability and enrollment

Educate and train providers:

 To convince the pregnant to quit, and this will cover the 3 As (Advise, Assess and

Assist)

 To fill out patient’s information completely in the FAX referral form specifically her

preferred time to be reached by quitline..

 To be sure that patient/client likes and understands the fax referral to quitline.  Tell patient/client to expect a call from “1800-784-8669” the quitline number next

day or so.

 Ask patient/client to save the quitline number 1(800)-784-8669 in her cell phone as

the “Quitline” (When applicable)

 Follow up calls to ask about patient/client’s quitting status.

 There are specially trained counselors who have been

dedicated to working with prenatal callers

 Prenatal enrollees will receive 9 counseling calls:

• 5 calls prior to delivery and
• 4 calls post-partum

 Prenatal enrollees receive incentives for participation

Quitline Prenatal Protocol

Quitline Prenatal Incentives

 Studies have shown that incentives are effective in the

prenatal population.

 Prenatal Calls –

For each counseling call an enrollee completes with her coach, she will receive a $5 Visa gift card. (5 in total=$25)

 Postpartum Calls –

For each counseling call completed after delivery, the enrollee will receive a $10 gift Visa gift card. (4 in total=$40)

 Total incentives = $65 (when complete all 9 calls)

4% 2.1% 7% 6.8% 13% 8.4% 0% 2% 4% 6% 8% 10% 12% 14% 2014 2016

Percentage of Current Cigarette Smoker Among School Students by grade and year of the survey in Muskegon Co. MiPHY 2014 and 2016

7th Grader 9th Grader 11th Grader

[VALUE] 6.8% 8.4% 5.6% 15.5% 20%

0% 5% 10% 15% 20% 25%

7th grader 9th grader 11th grader

Percentage of Current Cigarette Smokers compared to E-cigarette Users By grade of the students in Muskegon, MiPHY 2016

Current cigarette smokers E-cigarette user

23% [VALUE]* 23.5% 10% [VALUE]* 10.8% 0% 5% 10% 15% 20% 25% Michigan Muskegon USA

Current Cigarette Smoker and Current E-cigarette User Rates Among High School Students in Muskegon Compared to Michigan and USA- Average. YRBS 2015 * Michigan Profile for Healthy Youth 2015-2016-Muskegon

E-cigarette Users (Current) Cigarette Smoker(Current)

Five Myths about E-Cigs we need to know:

Myth 1: There is no gateway effect. A recent meta-analysis shows 100% consistent evidence that never cigarette smoking youth who begin nicotine use with e-cigarettes are significantly more likely to progress to cigarette smoking than youth who do not use e-cigarettes

Myth 2: E-cigarettes increase smoking cessation.

A meta-analysis showed that e-cigarettes are associated with depressed cessation. Myth 3: E-cigarettes are 95% safer than conventional cigarettes. There has been a substantial literature published indicating important cardiovascular and pulmonary risks associated with e-cigarette use.

Five Myths about E-Cigs we need to know:

Myth 4: Even if smokers don’t quit when they use e-cigarettes they

smoke fewer cigarettes and the health risks go down Even low levels of smoking convey substantial risks, especially for cardiovascular disease, where smoking even a few cigarettes is as dangerous as smoking 20 cigarettes a day. Myth 5: Nicotine is addictive, but it doesn’t pose any other substantial risks. While not a carcinogen, nicotine plays an important role in promoting tumor progression by promoting cell proliferation and inhibiting normal cell death. Nicotine also promotes the angiogenesis needed to supply blood to growing tumors

Surgeon General Report-2016

 U.S. Surgeon General Dr. Vivek H.

Murthy SAID, in releasing the report : “All Americans

need to know that e- cigarettes are dangerous to youth and young adults,”.

* * *

• 1. Adults–Both Genders -Low Education-Low Income.
• 2. Native Americans and black Americans – LGBT- Poor

Mental Health – Uninsured - with chronic diseases (Cancer, Stroke, Heart Attack, Diabetes)

• 3. Women of 18-44 years, Pregnant women (18-24 yrs. -

Low Education - Have Medicaid )

• 4. High School Students, Tobacco use in general and

E-cigarette specifically.

• 1. Low SES visit FQHCs/Community Dental Clinics/Health Department

clinics/ WIC …etc.

• 2. Train and Educate Providers in 5As and how correctly do the FAX

referral.

• 3. Reach out to African Americans, Native Am. and LGBT community.
• 4. Work with Muskegon Community Mental Health to offer training,

educations and materials for TF campuses and 5As adoption.

• 5. Work with Women of 18-44 yrs. & pregnant women:

(a) OB/GYN clinics (b) WIC clinics (c) Family planning clinics (d) Native Am., White & African Am. (e) Work w/local DHHS for Medicaid beneficiaries

• 6. Normalize Tobacco Free Environment and Culture:

TF parks - Comprehensive TF schools and colleges – Tobacco 21- …etc

• 7. Media campaign to educate the public on the harms of

E-cigarette

• 8. You can submit a complaint anonymously to the FDA

about a violation like selling e-cigarettes /hookah to minors here; it is very easy BUT important: HTTPS://WWW.ACCESSDATA.FDA.GOV/SCRIPTS/PTVR/ INDEX.CFM

94% 93% 54% 49% 48% 46% 45% 44% 42% 39% 39% 37% 36% 35% 33% 28% 25% 24% 23% 22% 21% 19% 17% 14% 12% 11% 11% 10% 10% 10% 10% 9% 9% 8% 6% 5% 5% 3% 3% 3% 2% 2% 2% 2% 1% 1% 1% 1%

0% 20% 40% 60% 80% 100% California Alaska

North Dakota Delaware Hawaii Colorado Oklahoma Wisconsin Vermont Minnesota South Dakota Utah Montana Florida Maine Arizona New Mexico Arkansas Mississippi Maryland Oregon New York Idaho Iowa Nebraska Pennsylvania West Virginia Indiana South Carolina Louisiana Ohio Virginia D C Tennessee Massachusetts Illinois Kentucky Nevada Kansas Rhode Island Alabama Washington North Carolina Texas Michigan Georgia New Hampshire New Jersey

Percentages of CDC Recommended Current Spending for the Tobacco Program by the States for 2018*

Michigan is among the lowest States in spending

• n tobacco

prevention in the Nation!

$1.267 B $ 954.5M $256 M $57 M $1.6M $295.3M

Total Tobacco Revenue Tobacco Excise Tax Tobacco Settlement (MSA) Tobacco Sales Tax Tobacco Prevention Annual Tobacco Company Marketing in MI

Michigan Tobacco Revenues By (Millions) compared to the Funding for the Tobacco Prevention -2015

0.5 1.0 1.5 2.0 1 25 49 73 97 121

Figure 1 The rate of asthma hospitalizations from 2002-2012

Hospitalizations Model Model No Ban

2008 2002 2006 2010 2012 2004

Smoke Free Law

RACIAL DISPARITIES IN MICHIGAN ASTHMA HOSPITALIZATIONS FOLLOWING THE SMOKE FREE AIR LAW: A LONGITUDINAL COHORT STUDY

RACIAL DISPARITIES IN MICHIGAN ASTHMA HOSPITALIZATIONS FOLLOWING THE SMOKE FREE AIR LAW: A LONGITUDINAL COHORT STUDY

 After adjusting for age, sex, race, insurance type

and month of year, there was an 8% reduction in the population-wide rate of asthma hospitalizations in the 12 months after the implementation of the SFA law.

 The study published in peer reviewed journal

“Preventing Chronic Disease Journal” This is the link:

http://dx.doi.org/10.5888/pcd12.150144.

RACIAL DISPARITIES IN MICHIGAN ASTHMA HOSPITALIZATIONS FOLLOWING THE SMOKE FREE AIR LAW: A LONGITUDINAL COHORT STUDY

 We found the average charge for hospitalizations in

Michigan citing asthma as the primary diagnosis to be $15,047 per one hospital stay only, in 2011 dollars.

 In the 32 months following implementation of the

SFA law, our model shows a reduction of 3,230 adult asthma hospitalizations, saving approximately $48.6 million (=3,230 X $15,047) in health care costs.