CDC’s Winnable Battles (CDC, 2012)
Goals:
♨ Track tobacco use and prevention policies.
♨ Use effective media to highlight the dangers of tobacco.
♨ Reduce exposure to secondhand smoke.
♨ Provide effective cessation services and offer help to quit tobacco use.
♨ Restrict and/or reduce tobacco advertising, promotion and sponsorship.
♨ Make tobacco use less attractive and affordable.
Other Goals: (CDC {2}, 2012, going to guess the date on this one since there isn’t one on the pdf)
By 2015, the CDC aims to:
♨ Decrease the percent of adults who smoke cigarettes by 21%.
♨ Decrease the percent of youth who smoke cigarettes by 11%.
♨ Increase the proportion of the U.S. population covered by smoke-free laws by 104%.
CDC 2015 Tobacco Targets
Overarching Goal:
♨ Prevent the initiation of tobacco use, promote quitting, and ensure smoke–free environments
Key Actions:
♨ Track tobacco use and prevention policies.
♨ Reduce exposure to secondhand smoke.
♨ Offer help to quit tobacco use.
♨ Use effective media to warn about the dangers of tobacco.
♨ Reduce exposure to tobacco advertising, promotion and sponsorship.
♨ Make tobacco use less attractive and affordable Targets.
Targets:
| Indicator | Baseline | 2015 Target |
| Decrease the percentage of adults who smoke cigarettes | 20.6% (2008) | 16.3% (21% reduction) |
| Decrease the percentage of youth who smoke cigarettes | 20% (2007) | 17.27% (11% reduction) |
| Increase the proportion of the U.S. population covered by smoke-free laws | 38.2% (2008) | 78.1% |
Table Data Source:
http://www.cdc.gov/WinnableBattles/targets/Tobacco/
Table Data Source:http://www.cdc.gov/WinnableBattles/targets/Tobacco/
http://www.cdc.gov/WinnableBattles/targets/Tobacco/
According to these charts also provided by the CDC that look at American trends, the United States is on its way to meeting these goals!
 | |||
| Image Credit (all): http://www.cdc.gov/WinnableBattles/targets/Tobacco/ |
There are also some objectives listed at the CDC's site that correlate with the Healthy People 2020 Initiative, and those are:
| TU 1.1 | Reduce cigarette smoking by adults. 2020 Target: 12.0% Baseline: 20.6% (2008) |
| TU 2.2 | Reduce cigarette smoking (past month) by adolescents. 2020 Target: 16.0% Baseline: 19.5% (2009) |
| TU 11.1 | Reduce the proportion of children aged 3 to 11 years exposed to secondhand smoke. 2020 Target: 74.0% Baseline: 82.2% (2005–08) |
| TU 11.2 | Reduce the proportion of adolescents aged 12 to 17 years exposed to secondhand smoke. 2020 Target: 70.2% Baseline: 78.0% (2005–08) |
| TU 11.3 | Reduce the proportion of adults aged 18 years and older exposed to secondhand smoke. 2020 Target: 68.0% Baseline: 75.5% (2005–08) |
| TU 13 | Establish laws in States, District of Columbia, Territories, and Tribes on smoke-free indoor air that prohibit smoking in public places and worksites. 2020 Target: 50 states and DC (100% of the population) Baseline: 25 states and DC (2010) |
More will be discussed about Healthy People 2020 soon!
Some Statistics:
Mortality:
Lung cancer causes more deaths than the three most common cancers combined colon, breast and prostate. (American cancer society, 2012)
Smokeless tobacco is part of this statistics
♨ 443,000 deaths annually including deaths from secondhand smoke and smokeless tobacco.
(CDC ,2012)
♨ 49,400 deaths per year from secondhand smoke exposure(CDC,2012)
♨ 269,655 deaths annually among men (CDC,2012)
♨ 173,940 deaths annually among women (CDC,2012)
♨ Approximately 373,489 Americans are living with lung cancer today.(American cancer
society,2012)
♨ During 2012, an estimated 226,160 new cases of lung cancer were expected to be
diagnosed, representing almost 14 percent of all cancer diagnoses. (American cancer
society,2012)
♨ On average, smokers die 13 to 14 years earlier than nonsmokers (CDC,2012)
Annual Cigarette Smoking-Related Mortality in the United States:
Table Data Source: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/
Gender Difference In Tobacco Use:
♨ According to CDC 45.3 million people in United States smoke cigarettes. (CDC,2011)
♨ Cigarette smoking is more common among men than in women 21.5% compared to 17.3 %
(CDC, 2011).
♨ 19.3% of all adults aged 18 years or older, in the United States smoke cigarettes. (CDC,2011)
♨ Among adults age 18 and older, national data from 2010 showed 5% of men and less than
1% of women were current users of smokeless tobacco. (Cancer facts and figures, CDC,2012)
♨ Nationwide, about 13% of US male high school students and more than 2% of female high
school students were using chewing tobacco, snuff, or dip in 2011. (Cancer facts and figures,
CDC,2012)
Secondhand smoke:
♨ 126 million nonsmokers are exposed to second hand smokes in homes, vehicles, workplaces
and public places. (CDC,2007)
♨ 60% of the children in United States aged 3-11 years are exposed to second hand smoke.
(CDC,2007)
♨ Living with a smoker increases an individual’s chance of developing lung cancer by 20 to
30%.( Lynne Eldridge MD,2012)
Survival Rates:
♨ The five-year survival rate for lung cancer is 52.6 percent for cases detected when the
disease is still localized within the lungs.(American lung association,2012)
♨ For distant tumors (spread to other organs) the five-year survival rate is only 3.5 percent.
.(American lung association,2012)
♨ Over half of people with lung cancer die within one year of being diagnosed. .(American lung
association,2012)
A History of the CDC’s Surgeon Generals Report:
Healthy People 2020 is a United States Government initiative that provides the public with “science-based, 10-year national objectives for improving the health of all Americans.” (U.S. Department of Health and Human Services, 2012) . By the year 2020, they aim to improve the nation’s health (U.S. Department of Health and Human Services, 2012). Tobacco use is one of their topics, and their goal with this issue specifically is to “Reduce illness, disability, and death related to tobacco use and secondhand smoke exposure.” (U.S. Department of Health and Human Services, 2013). HP2020 states that tobacco use is the single most preventative cause of death and disease in the United States, and related illnesses cause 443,000 Americans to die each year (U.S. Department of Health and Human Services, 2013). Also, the Americans lost each year are not the only ones who are affected; for every one death, 20 more suffer with at least 1 serious tobacco-related illness. So roughly taking these numbers and crunching them, this brings us to 9.3 million Americans affected by tobacco-illnesses or death each year. And if the US population is estimated to be around 313 million, that works out to be almost 3% of the population that is affected, a pretty sizeable chunk. HP2020 believes that the following factors within their framework can help reduce tobacco use in America (U.S. Department of Health and Human Services, 2013):
♨ Fully funding tobacco control programs.
♨ Increasing the price of tobacco products.
♨ Enacting comprehensive smoke-free policies.
♨ Controlling access to tobacco products.
♨ Reducing tobacco advertising and promotion.
♨ Implementing anti-tobacco media campaigns.
♨ Encouraging and assisting tobacco users to quit.
They also have objectives that are organized into 3 key areas (U.S. Department of Health and Human Services, 2013):
1. Tobacco Use Prevalence: Implementing policies to reduce tobacco use and initiation among youth and adults.
2. Health System Changes: Adopting policies and strategies to increase access, affordability, and use of smoking cessation services and treatments.
3. Social and Environmental Changes: Establishing policies to reduce exposure to secondhand smoke, increase the cost of tobacco, restrict tobacco advertising, and reduce illegal sales to minors.
Also within their framework, they suggest that leadership forms initiatives to help smokers quit (U.S. Department of Health and Human Services, 2013). There is a greater benefit for people who quit at a younger age, however there are still health benefits for anyone no matter what time they quit (U.S. Department of Health and Human Services, 2013). In Colorado, there have been some great programs and initiatives to help Coloradans start meeting these goals and objectives!
What is Colorado Doing to Reduce Tobacco Use and Improve Public Health?
In July 2006, way ahead of HP2020, a new state-wide law was enacted called the Colorado Clean Indoor Air Act (Colorado Office of Legislative Legal Services, 2006). Colorado went smoke free, and no longer allowed smoking in most indoor public places. Gone are the days when you could go smoke in a restaurant, bar, movie theater, lobbies, elevators, and the list goes on and on (Colorado Office of Legislative Legal Services, 2006). Smoking is also not allowed within 15 feet of a main entryway (Colorado Office of Legislative Legal Services, 2006). Now there are exemptions, but this rule is meant to reduce the exposure of the public to second hand smoke.
In the Fall of 2010, the Colorado Department of Public Health and Environment launched the Colorado Quitline (1-800-QUIT-NOW) (Colorado Department of Public Health and Environment, 2013). The line is available 7 days a week, and is a free service available to residents 15 years and older (Colorado Department of Public Health and Environment, 2013). There are ads for this service played quite frequently on television. When you make the call, you meet a tobacco cessation coach who helps counsel you through your quitting process. And you will also get enrolled in a program that shows you a coaching program for your successful quitting, a free supply of nicotine patches, and referrals for healthcare providers in your area to help you on your way. Many people probably think that quitting might be too expensive and/or too hard, and are afraid to start, but having this resource freely available makes starting the process much easier. And there is even a special program for pregnant women who enroll during pregnancy and will help them stay smoke-free after birth! They can have up to 9 free personal coaching calls from the start of their pregnancy through the post-partum period, the same coach throughout their path, text messages for support, and rewards for completed calls to help purchase items for herself or her baby ($5 up to $25 during pregnancy, and $10 up to $40 after the baby is born) (Colorado Department of Public Health and Environment, 2013).
Outreach and education is also very important to help get the word out about the dangers of tobacco use, and there is a Tobacco Education, Prevention, and Cessation grant program that can be applied for. The goals of the program are to prevent youth from starting to use tobacco; help people who use tobacco to quit; assist in the reduction of and protection from secondhand smoke; and reduce tobacco use among groups that are disproportionately affected and/or at high risk (Colorado Department of Public Health and Environment {II}, 2013). There are also ten priority populations that have been identified, and eliminating these health disparities is a challenge. They are: African-Americans, Latinos/Latinas, Asian-Americans/Pacific Islanders, Native Americans, people in treatment for substance abuse, people in treatment for mental illness, people with disabilities, spit tobacco users, the gay, lesbian, bisexual, transgender community, and persons with low socioeconomic status (Colorado Department of Public Health and Environment{II}, 2013). So if you think you have a great idea or project to address these, apply for the grant!
The Family Smoking, Prevention, and Tobacco Control Act became law on June 22nd, 2009 (FDA, 2013). It gives the FDA the authority to regulate the manufacture, distribution, and marketing of tobacco products (FDA, 2013). In 2010, the Colorado Dept. of Public Health and Environment described a new $1 Million contract with the FDA to improve the enforcement and stop illegal sales of tobacco to minors (CoPrevent, 2013). In Denver, a license is not needed to sell tobacco products, but many Colorado communities have adopted laws to help reduce the sale of tobacco to minors (Licensed to Sell Tobacco, 2013).
Other organizations also do their part. An example of this is the Colorado Tobacco Education and Prevention Alliance (CTEPA, 2010). They were founded in 1963, and are the oldest statewide tobacco control coalition in the United States(CTEPA, 2010). They have many member organizations, including the American Heart Association, the American Lung Association of Colorado, and the American Cancer Society(CTEPA, 2010). They continue to work to change laws and help communities make their voice heard to government, as well as holding public information events (CoPrevent{II}, 2013).
Future Ideas for Healthy People 2020?
I’ll leave it up to the reader to think about what solutions they might have to a couple highlighted issues related to teen smoking.
You can’t ignore that teenagers are influenced by the cultures around them to smoke - if they see a lot of people giving into a certain behavior and they are perceived as being socially acceptable, they are more likely to engage in that behavior. Let’s take a quick look at TV shows. In 1970, after two decades of concern over how cigarettes were being advertised of TV Shows, Congress passed the Public Health Cigarette Smoking Act, which banned the advertising of cigarettes on TV and radio (Centers for Disease Control and Prevention, 2012) and it went into effect on January 2nd, 1971. But even after this, tobacco companies found other ways to appeal to youth, mainly in how smoking is culturally depicted in the media. The most recent study of these depictions was published in 2011 from researchers at Columbia University, in association with the American Legacy Foundation. They looked at the top-rated TV shows for youth aged 12-17 that aired during the Fall 2007 season. They found that 40% of these shows had at least 1 depiction of tobacco use, and 89% of them were of cigarettes (Cullen, Sokol, Slawek, et al., 2011). Briefly, the network with the most depictions was FOX (with 44%), and the second biggest was the CW (with 41%) (Cullen, Sokol, Slawek, et al., 2011). The top 3 TV shows that season with the most tobacco depictions that season were the CW’s America’s Next Top Model (with 157 depictions in 13 episodes), Fox’s American Dad (57 in 8 episodes), and The Simpsons (29 in 7 episodes) (Cullen, Sokol, Slawek, et al., 2011). The study called for better ratings on TV shows, and for health practitioners and policy makers to discourage tobacco use in programming (Cullen, Sokol, Slawek, et al., 2011). Do the cool people really need to be smoking a cigarette? Can villains or powerful characters just be powerful in their actions and not need to do it while smoking? If the entertainment industry could come together and reduce smoking in TV shows, just think about what this could do for the HP2020 goal of reducing tobacco advertising and promotion, as well as Areas 1 and 3.
Another example that also ties into health disparities is the high smoking rate of Native American teenagers. Culturally, Native Americans value tobacco as a significant symbol. Leaves are traditionally offered to spirits to give thanks for blessings or during prayer, or at the graves of the departed (Milwaukee Public Museum). Smoking a small amount, sometimes mixed with other plant products, carried ceremonial significance at the coming together of Elders, conflict resolution, or to give thanks or pray (Milwaukee Public Museum). This tobacco was never processed, unlike the cigarettes of the modern age. Native Americans themselves have the highest smoking rate of all race and ethnic groups (American Lung Association, 2010). 32.4% of all Native American adults smoke, and 23.1% of Native American youth smoke (American Lung Association, 2010). 17.8% of women smoke during pregnancy, and this also one of the highest rates among race and ethnic groups in the country (American Lung Association, 2010). These statistics are alarming if you think about how the youth demographic grows up from adolescence to adulthood. And this presents a unique challenge - how do we work with this group to keep the cultural significance of tobacco but also improve their overall health? Many stop smoking initiatives have programs specifically aimed for Native American youth at both the grassroots and the government level, but what else could be done to encourage dialogue within homes and communities? What could we also learn from working with these youth and could we apply it to other youth communities?
PUBH 6600 in Action?!
Through researching these initiatives, one can see that these are concepts we learned in our class being put into action.
In Chapter 13, we learned that it can be hard to change a patient’s behavior to encourage a healthier lifestyle, but we also learned of some creative ways like the “Just Say No” campaign that have been used to reach the public (Schneider, 2011). Health promotion is also more effective when individuals are targeted at many different levels (Schneider, 2011), and one can consider opportunities outside of education - such as advertising. The Family Smoking, Prevention, and Tobacco Control Act is actually in the midst of an exciting change. Following the lead of other countries, the Act mandated more graphic labels to be used on tobacco products. To make a long story short, there were a lot of court battles back and forth between the FDA, smoking companies, and the Government between 2009 and 2013 (Morran, 2013) . But, as of right now, those graphics are back on the table and are currently being worked on (Morran, 2013). The older planned designs leave a lot to be desired, but measures like this have been pretty effective in other countries in motivating smokers to quit (Campaign for Tobacco Free Kids, 2013). In Colorado, organizations like CTEPA, as well as the Tobacco Education, Prevention and Cessation program are working in communities locally.
In Chapter 14, we learned of a theory that has proven useful in health education, known as the transtheoretical model (Schneider, 2011). This model sees change as a process involving progress through a series of five stages: precontemplation, contemplation, preparation, action, and maintenance (Schneider, 2011). We can see this in action from the hints of what we know of the Colorado Quitline, especially with respect to maternal health. There are coaches there to help a patient every step of the way, and new mothers have initiatives to keep up with their program to help purchase things for their babies. And while the state recognizes it may not have all the answers to improve health education and outreach, there are grants that are available from the Tobacco Education, Prevention, and Cessation grant program to help others that have ideas that could be effective in Colorado communities.
Why Should You Quit?
Quitting smoking is the single most important step a smoker can take to improve the length and quality of his or her life. As soon as you quit, your body begins to repair the damage caused by smoking. Smoking harms nearly every organ of the body. In little as 20 minute after your last cigarette you heart rate start to drop towards normal level, in 12 hours after quitting the carbon monoxide level in blood drops to normal and in less than 3 months your chances of getting heart attack begins to drop. (k.George, 2013)
http://www.youtube.com/watch?v=fLbQfMmrISE
The following video by Dr Mike Evans founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael's Hospital provides a very good reason why to quit smoking and why it is the single best thing you can do to your body. In this video Dr Mike Evans talks about the challenges of quitting smoking. And what are some things which people can do to support those who want to quit. Quitting smoking can be a long and hard process but each day you don’t smoke is a huge victory and one step closer to healthy life.
http://www.youtube.com/watch?v=z16vhtjWKL0
Teen Smoking:
Most people start smoking in their teenage years. There are number of reasons why teenagers start smoking and the three main reasons are peer pressure as teens often seek approval and acceptance from their peers and want to fit in the cool group, advertising as they make smoking look glamorous and are designed to have strong influence on teenagers and a family member that smokes as kids start perceiving smoking as a normal behavior. (N. Rachel, 2010)
Here in this video teens are discussing their reasons to smoke and most of them said that part of the reason they smoke is watching actors smoke in movies.
http://abcnews.go.com/Health/video?id=9127767
What's in a Smoke?
The major forms of smoking tobacco these days involve cigarettes, cigars, cigarillos, and smoking pipes. Usually, tobacco from many different kinds of plants are shredded, dried and blended into a mix. Many of the smoking corporations also spend quite a bit of time in plant development, finding breeds and concocting hybrids for flavor and higher concentrations of naturally occurring addictive substances. But, leaves are not the only things included in these mixes. Many additives are added to the mixes, and they function to aid in the mix's moistness, preservation, flavor, to enhance addictive properties, to appeal to all senses, and other enhancements. There have been almost 600 additives provided by the cigarette companies submitted the Department of Health and Human Services. Unfortunately, none of these chemicals are ever listed on a package. So when you are smoking tobacco, you are smoking more than just leaves. Cigars, cigarettes, and cigarillos are all defined by their size (large to small), but cigarillos have presented a new problem as of late. They are short, narrow and described by some as "cute". These are very popular among teenagers simply because, they come in "fun flavors". A few examples of these are vanilla, chocolate, strawberry, grape, orange, and watermelon. These flavors are very appealing to young people (watch this old commercial from the American Legacy Foundation's The Truth Campaign). A flavor ban was included in President Obama's 2009 Family Smoking Prevention and Tobacco Control Act, however because the type of cigarettes included in this flavor ban were not explicitly defined, these are still available in stores. You can walk into your store that sells cigarettes and notice them immediately, with their bright colors and sweet-sounding flavors.
Other Forms: Hookah:
There is an emerging alarming new trend in smoking among young people. It's not cigarettes but hookahs, also known as water pipes. It has become increasingly popular, and it's more dangerous than many young people think. There is perception among general public that hookahs are less hazardous form of tobacco and a safer alternative to cigarettes. According to CDC Hookah smokers are at risk for the same kinds of diseases as are caused by cigarette smoking, including oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function, and decreased fertility(CDC,2012).
The following video discusses how this new trend is on rise among college students and is being viewed as social event. Hookah bars have also popped up, many of them in college towns to take advantage of young adults http://www.youtube.com/watch?v=wKWh-nDxEqc
Other Forms: Tobacco Chewing:
With the decline in the sales of cigarettes over the past few years the large tobacco companies are now aggressively promoting and marketing the smokeless tobacco. Smokeless tobacco products consist of chewing tobacco and snuff. Chewing tobacco is sold as leaf tobacco or plug tobacco. The tobacco is placed in the mouth between the cheeks and gum and is kept there for long hours to get continuous high from nicotine. Snuff is in powdered form and is placed between lower lip and gum, which is then quickly absorbed by the bloodstream. The tobacco products are cleverly packaged and flavored to especially target the youth. It is also being marketed as a safer option to smoking cigarettes and as an effective method to quit smoking. This 5 minute video on CDC website looks at the clever and deceptive tactics used by the tobacco industry to sell smoke less tobacco. http://www.cdc.gov/tobacco/basic_information/smokeless/ While the use of cigarette smoking is on decline in teens this new trend of chewing tobacco is on rise. There are fewer government restrictions on the sale of smokeless tobacco products, so tobacco companies are spending record amount of money for promotion of smokeless tobacco. This short abc news video sheds light on this emerging trend and how it is having big impact on individuals health. Smokeless tobacco users are 2 times as likely to get oral cancer and 60% more likely to get pancreatic or cancer of esophagus. http://abcnews.go.com/Health/video/smokeless-tobacco-rise-5305055
Our Groups Suggestions for Meeting the CDC's Winnable Battles Goals:
1) Creating smoke free environments in education institutions around the country, and other common spaces, cities, recreational areas, bars, restaurants, and any public place, these prohibitions create healthier spaces for the community and protect them from second hand smoke, they also interact with physiological behavioral and social aspects of smoking. Lobbying efforts against these spaces will be strong in many cases, it will be important for public health officials to understand their political system, political leaders, in order to defeat the powerful Tobacco industry that still exists.
2) Increased funding and support to the FDA’s power to regulate mis-leading flavored cigarette packaging under the 2009 Tobacco Control Act.
3) Creative and support public health campaigns to research at risk populations for smoking and secondhand smoke. For example reaching women who may smoke around young children.
4) Support and fund practiced based quitting campaigns and integrate healthcare providers to help identify smokers and help them through the quitting journey. Provide incentives for health care providers and insurance companies with less smoking patients; provide incentives for patients who successfully complete quitting programs.
5) Continually provide and create creative campaigns that help educate and protect young adults against advertising and cultural influences that may lead them to become smokers. Make the links between smoking and cardiovascular disease, cancer, and respiratory diseases for smokers.
6) Mandatory smoking cessation courses for students entering medicine, nursing, pharmacy and dentistry fields to give healthcare providers creative and useful tools to help their patients quit smoking.
7) Effective age and demographic appropriate advertising campaigns for children and adults addressing smoking and secondhand smoking awareness. Sharing stories like Heather Crowe’s message here: https://www.youtube.com/watch?v=W4fzTdjqvt0
8) Instate restrictions that place cigarettes and tobacco products out of sight, behind curtains or cupboard doors, similar curtain laws exist in Canada.
9) Being informed is the single most important thing to catch this problem while in bud. 90 percent of smokers begin smoking before 21 years of age. Communicate with your teen don’t assume that your kid knows smoking is bad. It is important that kids get the information from parents. Set an example yourself by not smoking so that children do not associate smoking as a normal behavior. Most teenagers think they are invincible so making them aware of the health implication associated with smoking can put things in perspective for them.
10) According to CDC kids are more likely to smoke brands heavily advertised so educate kids about the deceptive and clever tactics used by tobacco companies to allure the kids into smoking. Peer pressure is also one of the major factors associated with smoking so discuss ways with them to respond to peer pressure. Encourage kids to get involved in activities that prohibit smoking, such as sports and be more involved in the kid’s life.
11) Things that we all can do to help are joining with the active groups to stop sale of cigarettes to children and teenagers. Asking schools to teach kids the dangers of smoking and organizing community programs to educate on dangers of tobacco.
Additional Reading:
Stop smoking resources for patients and health professionals: http://www.ash.org.uk/stopping-smoking
Public Health and Tobacco Regulation- “Tobacco Product Regulation-A Public Health Approach” http://www.nejm.org/doi/full/10.1056/NEJMp1004152
HealthyPeople.gov-Framework for ending Tobacco Use http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=41
American Cancer Society. (2012).Smokeless Tobacco. Retrieved from http://www.cancer.org/cancer/cancercauses/tobaccocancer/smokeless-tobacco
American Cancer Society. (2013).Guide to quit smoking. Retrieved from http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-toc
Colorado Quit line be Tobacco free. (2013). My Quit Path. Retrieved from http://www.myquitpath.org/ Web MD.(2013).
News and features related to Lung cancer. Retrieved from http://www.webmd.com/lung-cancer/news-features
Depictions of Tobacco Use in 2007 Broadcast Television Programming Popular Among US Youth. http://archpedi.jamanetwork.com/article.aspx?articleid=384271
Old Truth Whudafxup Campaign. http://truthv18.arn.com/
The Truth.http://www.thetruth.com/
American Legacy Foundation: http://www.legacyforhealth.org/
Heather Crowe. http://www.smoke-free.ca/heathercrowe/ and http://www.canada.com/nationalpost/story.html?id=16546d57-7857-4fbb-8586-77c9c6fb5e3a&k=73829
Concerned Children's Advertisers. http://cca-arpe.ca/psas/substance_abuse_prevention.html and http://cca-arpe.ca/psas/smart_choices.html and http://cca-arpe.ca/psas/role_models_mentoring.html and http://www.youtube.com/watch?v=Mrhuaj540Aw
Colorado Quitline. https://www.coquitline.org/
Colorado Tobacco Education Prevention and Cessation Grant Program. http://www.colorado.gov/cs/Satellite/CDPHE-PSD/CBON/1251617593490
COPrevent. http://www.coprevent.org/
World Health Organization Tobacco Free Initiative. http://www.who.int/tobacco/mpower/warn/en/
National Institute of Health. http://www.drugabuse.gov/publications/drugfacts/cigarettes-other-tobacco-products
FDA Tobacco Products. http://www.drugabuse.gov/publications/drugfacts/cigarettes-other-tobacco-products
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Schneider, M. (2011). Public Health Enemy Number One: Tobacco.(Third Edition). Introduction to Public Health (241-266). Sudbury: Jones and Bartlett Publishers.
Centers for disease control and prevention. (2011).Smoking & Tobacco Use. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/
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Centers for disease control and prevention. Youth and Tobacco Use. (2012) Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/
Centers for disease control and prevention .Secondhand Smoke (2007) Retrieved from http://www.cdc.gov/datastatistics/archive/second-hand-smoke.html
Secondhand Smoke and Lung Cancer E, Lynne.(2012) Retrieved from http://lungcancer.about.com/od/causesoflungcance1/a/secondhandsmokelungcancer.htm
American lung association.(2012) Lung Cancer Health Center Retrieved from http://www.webmd.com/lung-cancer/lung-cancer-survival-rates
American lung association.(2012).Lung cancer fact sheet. Retrieved from http://www.lung.org/lung-disease/lung-cancer/resources/facts-figures/lung-cancer-fact-sheet.html#1
Seattle cancer care alliance. (2012).Winning the Battle against Lung Cancer, Retrieved from http://www.seattlecca.org/diseases/lung-cancer-survival-rates.cfm
American Lung Association. (2010). American Indians/Alaska Natives. Retrieved From: http://www.lung.org/stop-smoking/about-smoking/facts-figures/american-indians-tobacco.html
Campaign for Tobacco Free Kids. (2013). Tobacco Warning Labels: Evidence of Effectivenes Factsheet. Retrieved from: http://www.tobaccofreekids.org/research/factsheets/pdf/0325.pdf
Centers for Disease Control and Prevention. (2012). Smoking and Tobacco Use: Legislation. Retrieved From: http://www.cdc.gov/tobacco/data_statistics/by_topic/policy/legislation/
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Colorado Department of Public Health and Environment{II}. (2013). Tobacco Education Prevention and Cessation Grant Program. Retrieved From: http://www.colorado.gov/cs/Satellite/CDPHE-PSD/CBON/1251617593490
Colorado Office of Legislative Legal Services. (2006). Session Laws of Colorado 2006 Second Regular Session, 65th General Assembly CHAPTER 22 HEALTH AND ENVIRONMENT. Retrieved From: http://www.state.co.us/gov_dir/leg_dir/olls/sl2006a/sl_22.htm
Colorado Tobacco Education and Prevention Alliance. (2010). History. Retrieved From: http://www.ctepa.org/gtku_history.htm
CoPrevent. (2013). Tobacco Projects, Initiatives and Talking Points. Retrieved From: https://docs.google.com/document/d/19nKOcPHvWm5HHGT10qFcXTm2OGkGPByad6a9fUQB6Y4/edit?hl=en_US
CoPrevent {II}. (2013). Weld County Public Symposium Looks at Youth Marijuana and Tobacco Trends. Retrieved From:
http://www.coprevent.org/2013/04/weld-county-public-symposium-looks-at.html
Cullen, Jennifer, Sokol, Natasha A., Slawek, Deepika, Allen, Jane A. , Vallone, Donna, and Healton, Cheryl. (2011). Depictions of Tobacco Use in 2007 Broadcast Television Programming Popular Among US Youth. Archives of Pediatrics and Adolescent Medicine,Vol. 165 (Issue 2), 147-151. http://archpedi.jamanetwork.com/article.aspx?articleid=384271 .
FDA. (2013). Overview of the Family Smoking Prevention and Tobacco Control Act: Consumer Fact Sheet.
Retrieved From: http://www.fda.gov/tobaccoproducts/guidancecomplianceregulatoryinformation/ucm246129.htm
Licensed to Sell Tobacco. (2013). Licensed to Sell Tobacco Fact Sheet. Retrieved From: http://licensed2selltobacco.com/wp-content/themes/licensedtosell/inc/Licensed_to_Sell_Tobacco_Fact_Sheet.pdf
Morran, Chris. (2013). Supreme Court Agrees: Cigarette Warning Labels Don’t Violate Big Tobacco’s Free Speech. The Consumerist. Retrieved From: http://consumerist.com/2013/04/22/supreme-court-agrees-cigarette-warning-labels-dont-violate-big-tobaccos-free-speech/
Milwaukee Public Museum. No Date Published. Ceremonial Use of Tobacco. Retrieved From: http://www.mpm.edu/wirp/icw-166.html
Schneider, Mary-Jo. (2011). Introduction to Public Health (3rd Ed.). Jones and Bartlett Publishers, Sudbury, MA.
U.S. Department of Health and Human Services. (2012). About Healthy People. Retrieved From: http://healthypeople.gov/2020/about/default.aspx
U.S. Department of Health and Human Services. (2013). Tobacco Use. Retrieved From: http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=41
Some Statistics:
Mortality:
 |
| Image Credit: http://www.lung.org/lung-disease/lung-cancer/resources/facts-figures/lung-cancer-fact-sheet.html |
Smokeless tobacco is part of this statistics
♨ 443,000 deaths annually including deaths from secondhand smoke and smokeless tobacco.
(CDC ,2012)
♨ 49,400 deaths per year from secondhand smoke exposure(CDC,2012)
♨ 269,655 deaths annually among men (CDC,2012)
♨ 173,940 deaths annually among women (CDC,2012)
♨ Approximately 373,489 Americans are living with lung cancer today.(American cancer
society,2012)
♨ During 2012, an estimated 226,160 new cases of lung cancer were expected to be
diagnosed, representing almost 14 percent of all cancer diagnoses. (American cancer
society,2012)
♨ On average, smokers die 13 to 14 years earlier than nonsmokers (CDC,2012)
Annual Cigarette Smoking-Related Mortality in the United States:
| Disease/Malignant Neoplasm's | Male | Female | Total |
| Lip, Oral Cavity, Pharynx | 3,749 | 1,144 | 4,893 |
| Esophagus | 6,961 | 1,631 | 8,592 |
| Stomach | 1,900 | 584 | 2,484 |
| Pancreas | 3,147 | 3,536 | 6,683 |
| Larynx | 2,446 | 563 | 3,009 |
| Trachea, Lung, Bronchus | 78,680 | 46,842 | 125,522 |
| Cervix Uteri | 0 | 447 | 447 |
| Kidney and Renal Pelvis | 2,287 | 216 | 3,043 |
| Urinary Bladder | 3,907 | 1,076 | 4,983 |
| Acute Myeloid Leukemia | 855 | 337 | 1,192 |
| Subtotal | 104,472 | 56,376 | 160,858 |
Gender Difference In Tobacco Use:
 |
| Image Credit: http://www.lung.org/lung-disease/lung-cancer/resources/facts-figures/lung-cancer-fact-sheet.html |
♨ According to CDC 45.3 million people in United States smoke cigarettes. (CDC,2011)
♨ Cigarette smoking is more common among men than in women 21.5% compared to 17.3 %
(CDC, 2011).
♨ 19.3% of all adults aged 18 years or older, in the United States smoke cigarettes. (CDC,2011)
♨ Among adults age 18 and older, national data from 2010 showed 5% of men and less than
1% of women were current users of smokeless tobacco. (Cancer facts and figures, CDC,2012)
♨ Nationwide, about 13% of US male high school students and more than 2% of female high
school students were using chewing tobacco, snuff, or dip in 2011. (Cancer facts and figures,
CDC,2012)
Secondhand smoke:
 |
| Image Credit: http://www.cdc.gov/datastatistics/archive/second-hand-smoke.html |
and public places. (CDC,2007)
♨ 60% of the children in United States aged 3-11 years are exposed to second hand smoke.
(CDC,2007)
♨ Living with a smoker increases an individual’s chance of developing lung cancer by 20 to
30%.( Lynne Eldridge MD,2012)
Survival Rates:
| Stage | Tumor, node, metastasis (TNM) staging | 5-year survival rate |
| IA | T1, N0, M0 | More than 70% |
| IB | T2, N0, M0 | 60% |
| IIA | T1, N1, M0 | 50% |
| IIB | T2, N0, M0 | 30% |
| IIB | T3, N0-N1, M0 | 40% |
| IIIA | T1-T3, N2, M0 | 10%-30% |
| IIIB | Any T4, any N3, M0 | Less than 10% |
| IV | Any M1 | Less than 5% |
Table Data Source: http://www.webmd.com/lung-cancer/lung-cancer-survival-rates
♨ The five-year survival rate for lung cancer is 52.6 percent for cases detected when the
disease is still localized within the lungs.(American lung association,2012)
♨ For distant tumors (spread to other organs) the five-year survival rate is only 3.5 percent.
.(American lung association,2012)
♨ Over half of people with lung cancer die within one year of being diagnosed. .(American lung
association,2012)
 |
| Image Credit (Both): http://www.seattlecca.org/diseases/lung-cancer-survival-rates.cfm |
A Brief Historical Timeline of Tobacco:
1 B.C.-Tobacco plant is native to the Americas- Mayans smoked tobacco leaves in the first century BC (Proctor, 2001)
 |
| Image Credit: http://www.nature.com/nrc/journal/v1/n1/full/nrc1001-082a.html |
17th and 18th Centuries- Tobacco was used sparingly-there were many objections to its use and bans were enacted (Proctor, 2001)
1612- Chinese imperial edict banned the growth or smoking of the leaf (Proctor, 2001)
1723- Berlin banned smoking in the city (Proctor, 2001)
1761- John Hill suggested that “immoderate use of snuff” causes cancer in the nose (Proctor, 2001)
Cancer Causation Discoveries
 |
| Image Credit: |
1880’s- Cigarette rolling machine invented by Bonsack-helped create intensive use in the 20th century (Klaidman, 1991). Machine could make 100,000 cigarettes per day- production was given an enormous boost. (Proctor, 2001)
 |
| Image Credit: http://www.nature.com/nrc/journal/v1/n1/full/nrc1001-082a.html |
1885-Mass marketing campaigns began and the invention of the safety matches (Proctor, 2001)
1913- Camel began marketing campaigns to American public ( Klaidman, 1991)
1914-Free distribution to soldiers in WW1 and WW2, rations given returned home soliders as addicts( Klaidman, 1991)
1939- First statistically significant study that smoking’s health effects could shorten lifespan was by Dr. Raymond Pearl. (Rampton & Stauber, 2002)
After Dr. Pearl’s study ran in 1938 months later Philip Morris ran an add in a medical journal “ You may have questions on the physiological effects of smoking…If you have not already read the studies on the relative effects of cigarette smoke may we suggest that you use the request blank below? And also that you try Philip Morris Cigarettes yourself” (Tobacco science meets junk science, Rampton and Stauber)
1940-Until the late 1940’s there had been almost no coverage of health issues related to smoking. In 1950’s stories began to run in the New York Times, Business Week, Readers Digest, Nation, and U.S. News and World Report. (Rampton & Stauber, 2002)
1951- Richard Doll and A.B. Hill showed elevated mortality rates in first prospective study of smoking health effects with 40,000 British physicians (Koop & Luoto 1982).
1953- meetings at Hill and Knowlton, very famous PR firm, drafted a strategy memorandum for the tobacco industry. (Klaidman, 1991).
“The 1954 Emergency”
“Because of the grave nature of the number of recently highly publicized research reports on the effects of cigarette smoking, widespread public interest has developed, causing great concern within and without the industry. There developments have confronted the industry with serious problem of public relations. Obviously, that problem would be quickly solved if the adverse publicity would cease and people would stop talking about the whole matter.” (“Preliminary Recommendations for Cigarette Manufacturers,” memorandum prepared by the public relations firm Hill and Knowlton for the cigarette industry and disclosed as plaintiff’s exhibit 2700 during the 1988 trial in Federal District Court in Newark N.J. known as Cipollone v. Liggett Group Inc., et al. )
This report contained a proposal as to how the tobacco industry could debate and halt the studies coming out linking cigarette smoking to lung cancer, heart disease and death. (Klaidman, 1991).
1954-Tobacco Institute Research Committee later known as The Council for Tobacco Research was formed, ran advertisements for tobacco companies, citing that tobacco companies recognized a special responsibility to the public about their product, and promised independent research. Their main goal was to undermine scientific and medical communities claims. (Rampton & Stauber, 2002)
During 1950’s tobacco companies budgets went from $76 million to $122 million by 1957 (Rampton & Stauber, 2002)
1950’s- Major marketing strategies since 1950’s (Proctor, 2001)
♨ Mass advertising, billboards, television advertisement and film implants (paying actors to
smoke in movies)
smoke in movies)
♨ Sponsorship of sporting and cultural events
♨ Targeting marketing to countries with weak regulations
♨ Lobbying politically for low tax rates and to fight tobacco legislation
♨ Targeting advertising to children and teens
♨ Using sexual and adventure imagery
♨ Targeting women in “gender equality” campaigns
1961- The American Cancer Society, the American Heart Association, the National Tuberculosis Association, and the American Public Health Association submit a joint letter to President Kennedy. They suggest he establish a commission to evaluate the evidence of smoking’s health hazards (Klaidman, 1991).
1964- First Surgeon Generals report linking smoking and lung cancer. Luther L. Terry M.D. and committee’s of the Public Health Service concluded that smoking was a cause of lung cancer and laryngeal cancer in men, it was a “probable cause in women”, and stated that smoking also causes chronic bronchitis (Proctor, 2001).
A History of the CDC’s Surgeon Generals Report:
Video:
1965-Cigarette labeling and Advertising Act to enhance packaging regulations (Proctor, 2001).
1969-Public Health Cigarette Smoking Act of 1969 requires the U.S. Public Health Service to perform and provide congress with information on the health consequences of smoking. Added the phrase “Warning: The Surgeon General Has determined that cigarette smoking is dangerous to your health”, to packaging. Also banned advertising on television and radio (Proctor, 2001).
1970-World Health Organization (WHO) takes a public position against cigarette smoking (Proctor, 2011).
1984- The 1965 Federal Cigarette Labeling and Advertising Act changed to require that one of the four labels is placed on packaging and advertising. (Borio, 1993).
♨ SURGEON GENERAL'S WARNING: Smoking Causes Lung Cancer, Heart Disease, Emphysema, And May Complicate Pregnancy.
♨ SURGEON GENERAL'S WARNING: Quitting Smoking Now Greatly Reduces Serious Risks to Your Health.
♨ SURGEON GENERAL'S WARNING: Smoking By Pregnant Women May Result in Fetal Injury, Premature Birth, and Low Birth Weight.
♨ SURGEON GENERAL'S WARNING: Cigarette Smoke Contains Carbon Monoxide. (Borio, 1993)
1982- Report from the Surgeon General, C. Everett Koop, “The health consequences of smoking-cancer.” Linked smoking to lung caner, larynx, oral cavity and esophagus bladder pancreatic and kidney cancer, “Smoking harms almost every organ in the body, causing many disease and reducing the health of smokers in general.” Secondhand smoke is a serious health threat as well, especially for children and pregnant women who smoke. (Koop & Luoto, 1982)
The Full Report: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1424341/pdf/pubhealthrep00116-0028.pdf
1988-The Cipollone Case (Cipollone v. Liggett Group Inc) - The first time a cigarette company had been ordered to pay damages in a liability suit (Proctor, 2001).
Complete Supreme Court Ruling : http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=us&vol=505&invol=504
1988- White coats project created by tobacco industry to “generate a body of scientific and technical knowledge through research…and disseminate and exploit such knowledge thought specific communication programs.” (Rampton & Stauber, 2002)
1989-California Tobacco Control Program-Funded by tax increases on Cigarettes mandated mass media anti-smoking campaigns along with school and community education programs (Schneider, 2011).
1993-EPA risk assessment of second hard smoke report. Classified secondhand smoke at a “Class A carcinogen”, meaning it is known to directly cause cancer (Rampton & Stauber, 2002).
1997-Master Settlement Agreement- $206 billon to 26 states over 25 years, industry agreed to restrictions on advertising, and the American Legacy Foundation was created (1.7 Billion given), which used funding for the “truth” advertisements (Schneider, 2011).
1999- Tobacco Industry admits that smoking “causes a human health risk” (Proctor, 2001).
2009- President Obama signed Family Smoking Prevention and Tobacco Control Act. The FDA was given power to control and regulate tobacco, helped to address misleading labeling and ban flavored cigarettes ( Schneider, 2011).
Global Cigarette Consumption and Death
What is Healthy People 2020 and How Does it Relate to Tobacco Use? 
Healthy People 2020 is a United States Government initiative that provides the public with “science-based, 10-year national objectives for improving the health of all Americans.” (U.S. Department of Health and Human Services, 2012) . By the year 2020, they aim to improve the nation’s health (U.S. Department of Health and Human Services, 2012). Tobacco use is one of their topics, and their goal with this issue specifically is to “Reduce illness, disability, and death related to tobacco use and secondhand smoke exposure.” (U.S. Department of Health and Human Services, 2013). HP2020 states that tobacco use is the single most preventative cause of death and disease in the United States, and related illnesses cause 443,000 Americans to die each year (U.S. Department of Health and Human Services, 2013). Also, the Americans lost each year are not the only ones who are affected; for every one death, 20 more suffer with at least 1 serious tobacco-related illness. So roughly taking these numbers and crunching them, this brings us to 9.3 million Americans affected by tobacco-illnesses or death each year. And if the US population is estimated to be around 313 million, that works out to be almost 3% of the population that is affected, a pretty sizeable chunk. HP2020 believes that the following factors within their framework can help reduce tobacco use in America (U.S. Department of Health and Human Services, 2013):
♨ Fully funding tobacco control programs.
♨ Increasing the price of tobacco products.
♨ Enacting comprehensive smoke-free policies.
♨ Controlling access to tobacco products.
♨ Reducing tobacco advertising and promotion.
♨ Implementing anti-tobacco media campaigns.
♨ Encouraging and assisting tobacco users to quit.
They also have objectives that are organized into 3 key areas (U.S. Department of Health and Human Services, 2013):
1. Tobacco Use Prevalence: Implementing policies to reduce tobacco use and initiation among youth and adults.
2. Health System Changes: Adopting policies and strategies to increase access, affordability, and use of smoking cessation services and treatments.
3. Social and Environmental Changes: Establishing policies to reduce exposure to secondhand smoke, increase the cost of tobacco, restrict tobacco advertising, and reduce illegal sales to minors.
Also within their framework, they suggest that leadership forms initiatives to help smokers quit (U.S. Department of Health and Human Services, 2013). There is a greater benefit for people who quit at a younger age, however there are still health benefits for anyone no matter what time they quit (U.S. Department of Health and Human Services, 2013). In Colorado, there have been some great programs and initiatives to help Coloradans start meeting these goals and objectives!
What is Colorado Doing to Reduce Tobacco Use and Improve Public Health?
In July 2006, way ahead of HP2020, a new state-wide law was enacted called the Colorado Clean Indoor Air Act (Colorado Office of Legislative Legal Services, 2006). Colorado went smoke free, and no longer allowed smoking in most indoor public places. Gone are the days when you could go smoke in a restaurant, bar, movie theater, lobbies, elevators, and the list goes on and on (Colorado Office of Legislative Legal Services, 2006). Smoking is also not allowed within 15 feet of a main entryway (Colorado Office of Legislative Legal Services, 2006). Now there are exemptions, but this rule is meant to reduce the exposure of the public to second hand smoke.
In the Fall of 2010, the Colorado Department of Public Health and Environment launched the Colorado Quitline (1-800-QUIT-NOW) (Colorado Department of Public Health and Environment, 2013). The line is available 7 days a week, and is a free service available to residents 15 years and older (Colorado Department of Public Health and Environment, 2013). There are ads for this service played quite frequently on television. When you make the call, you meet a tobacco cessation coach who helps counsel you through your quitting process. And you will also get enrolled in a program that shows you a coaching program for your successful quitting, a free supply of nicotine patches, and referrals for healthcare providers in your area to help you on your way. Many people probably think that quitting might be too expensive and/or too hard, and are afraid to start, but having this resource freely available makes starting the process much easier. And there is even a special program for pregnant women who enroll during pregnancy and will help them stay smoke-free after birth! They can have up to 9 free personal coaching calls from the start of their pregnancy through the post-partum period, the same coach throughout their path, text messages for support, and rewards for completed calls to help purchase items for herself or her baby ($5 up to $25 during pregnancy, and $10 up to $40 after the baby is born) (Colorado Department of Public Health and Environment, 2013).
Outreach and education is also very important to help get the word out about the dangers of tobacco use, and there is a Tobacco Education, Prevention, and Cessation grant program that can be applied for. The goals of the program are to prevent youth from starting to use tobacco; help people who use tobacco to quit; assist in the reduction of and protection from secondhand smoke; and reduce tobacco use among groups that are disproportionately affected and/or at high risk (Colorado Department of Public Health and Environment {II}, 2013). There are also ten priority populations that have been identified, and eliminating these health disparities is a challenge. They are: African-Americans, Latinos/Latinas, Asian-Americans/Pacific Islanders, Native Americans, people in treatment for substance abuse, people in treatment for mental illness, people with disabilities, spit tobacco users, the gay, lesbian, bisexual, transgender community, and persons with low socioeconomic status (Colorado Department of Public Health and Environment{II}, 2013). So if you think you have a great idea or project to address these, apply for the grant!
The Family Smoking, Prevention, and Tobacco Control Act became law on June 22nd, 2009 (FDA, 2013). It gives the FDA the authority to regulate the manufacture, distribution, and marketing of tobacco products (FDA, 2013). In 2010, the Colorado Dept. of Public Health and Environment described a new $1 Million contract with the FDA to improve the enforcement and stop illegal sales of tobacco to minors (CoPrevent, 2013). In Denver, a license is not needed to sell tobacco products, but many Colorado communities have adopted laws to help reduce the sale of tobacco to minors (Licensed to Sell Tobacco, 2013).
Other organizations also do their part. An example of this is the Colorado Tobacco Education and Prevention Alliance (CTEPA, 2010). They were founded in 1963, and are the oldest statewide tobacco control coalition in the United States(CTEPA, 2010). They have many member organizations, including the American Heart Association, the American Lung Association of Colorado, and the American Cancer Society(CTEPA, 2010). They continue to work to change laws and help communities make their voice heard to government, as well as holding public information events (CoPrevent{II}, 2013).
Future Ideas for Healthy People 2020?
I’ll leave it up to the reader to think about what solutions they might have to a couple highlighted issues related to teen smoking.
You can’t ignore that teenagers are influenced by the cultures around them to smoke - if they see a lot of people giving into a certain behavior and they are perceived as being socially acceptable, they are more likely to engage in that behavior. Let’s take a quick look at TV shows. In 1970, after two decades of concern over how cigarettes were being advertised of TV Shows, Congress passed the Public Health Cigarette Smoking Act, which banned the advertising of cigarettes on TV and radio (Centers for Disease Control and Prevention, 2012) and it went into effect on January 2nd, 1971. But even after this, tobacco companies found other ways to appeal to youth, mainly in how smoking is culturally depicted in the media. The most recent study of these depictions was published in 2011 from researchers at Columbia University, in association with the American Legacy Foundation. They looked at the top-rated TV shows for youth aged 12-17 that aired during the Fall 2007 season. They found that 40% of these shows had at least 1 depiction of tobacco use, and 89% of them were of cigarettes (Cullen, Sokol, Slawek, et al., 2011). Briefly, the network with the most depictions was FOX (with 44%), and the second biggest was the CW (with 41%) (Cullen, Sokol, Slawek, et al., 2011). The top 3 TV shows that season with the most tobacco depictions that season were the CW’s America’s Next Top Model (with 157 depictions in 13 episodes), Fox’s American Dad (57 in 8 episodes), and The Simpsons (29 in 7 episodes) (Cullen, Sokol, Slawek, et al., 2011). The study called for better ratings on TV shows, and for health practitioners and policy makers to discourage tobacco use in programming (Cullen, Sokol, Slawek, et al., 2011). Do the cool people really need to be smoking a cigarette? Can villains or powerful characters just be powerful in their actions and not need to do it while smoking? If the entertainment industry could come together and reduce smoking in TV shows, just think about what this could do for the HP2020 goal of reducing tobacco advertising and promotion, as well as Areas 1 and 3.
Another example that also ties into health disparities is the high smoking rate of Native American teenagers. Culturally, Native Americans value tobacco as a significant symbol. Leaves are traditionally offered to spirits to give thanks for blessings or during prayer, or at the graves of the departed (Milwaukee Public Museum). Smoking a small amount, sometimes mixed with other plant products, carried ceremonial significance at the coming together of Elders, conflict resolution, or to give thanks or pray (Milwaukee Public Museum). This tobacco was never processed, unlike the cigarettes of the modern age. Native Americans themselves have the highest smoking rate of all race and ethnic groups (American Lung Association, 2010). 32.4% of all Native American adults smoke, and 23.1% of Native American youth smoke (American Lung Association, 2010). 17.8% of women smoke during pregnancy, and this also one of the highest rates among race and ethnic groups in the country (American Lung Association, 2010). These statistics are alarming if you think about how the youth demographic grows up from adolescence to adulthood. And this presents a unique challenge - how do we work with this group to keep the cultural significance of tobacco but also improve their overall health? Many stop smoking initiatives have programs specifically aimed for Native American youth at both the grassroots and the government level, but what else could be done to encourage dialogue within homes and communities? What could we also learn from working with these youth and could we apply it to other youth communities?
PUBH 6600 in Action?!
Through researching these initiatives, one can see that these are concepts we learned in our class being put into action.
In Chapter 13, we learned that it can be hard to change a patient’s behavior to encourage a healthier lifestyle, but we also learned of some creative ways like the “Just Say No” campaign that have been used to reach the public (Schneider, 2011). Health promotion is also more effective when individuals are targeted at many different levels (Schneider, 2011), and one can consider opportunities outside of education - such as advertising. The Family Smoking, Prevention, and Tobacco Control Act is actually in the midst of an exciting change. Following the lead of other countries, the Act mandated more graphic labels to be used on tobacco products. To make a long story short, there were a lot of court battles back and forth between the FDA, smoking companies, and the Government between 2009 and 2013 (Morran, 2013) . But, as of right now, those graphics are back on the table and are currently being worked on (Morran, 2013). The older planned designs leave a lot to be desired, but measures like this have been pretty effective in other countries in motivating smokers to quit (Campaign for Tobacco Free Kids, 2013). In Colorado, organizations like CTEPA, as well as the Tobacco Education, Prevention and Cessation program are working in communities locally.
In Chapter 14, we learned of a theory that has proven useful in health education, known as the transtheoretical model (Schneider, 2011). This model sees change as a process involving progress through a series of five stages: precontemplation, contemplation, preparation, action, and maintenance (Schneider, 2011). We can see this in action from the hints of what we know of the Colorado Quitline, especially with respect to maternal health. There are coaches there to help a patient every step of the way, and new mothers have initiatives to keep up with their program to help purchase things for their babies. And while the state recognizes it may not have all the answers to improve health education and outreach, there are grants that are available from the Tobacco Education, Prevention, and Cessation grant program to help others that have ideas that could be effective in Colorado communities.
Why Should You Quit?
Quitting smoking is the single most important step a smoker can take to improve the length and quality of his or her life. As soon as you quit, your body begins to repair the damage caused by smoking. Smoking harms nearly every organ of the body. In little as 20 minute after your last cigarette you heart rate start to drop towards normal level, in 12 hours after quitting the carbon monoxide level in blood drops to normal and in less than 3 months your chances of getting heart attack begins to drop. (k.George, 2013)
http://www.youtube.com/watch?v=fLbQfMmrISE
The following video by Dr Mike Evans founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael's Hospital provides a very good reason why to quit smoking and why it is the single best thing you can do to your body. In this video Dr Mike Evans talks about the challenges of quitting smoking. And what are some things which people can do to support those who want to quit. Quitting smoking can be a long and hard process but each day you don’t smoke is a huge victory and one step closer to healthy life.
http://www.youtube.com/watch?v=z16vhtjWKL0
Teen Smoking:
Most people start smoking in their teenage years. There are number of reasons why teenagers start smoking and the three main reasons are peer pressure as teens often seek approval and acceptance from their peers and want to fit in the cool group, advertising as they make smoking look glamorous and are designed to have strong influence on teenagers and a family member that smokes as kids start perceiving smoking as a normal behavior. (N. Rachel, 2010)
Here in this video teens are discussing their reasons to smoke and most of them said that part of the reason they smoke is watching actors smoke in movies.
http://abcnews.go.com/Health/video?id=9127767
What's in a Smoke?
The major forms of smoking tobacco these days involve cigarettes, cigars, cigarillos, and smoking pipes. Usually, tobacco from many different kinds of plants are shredded, dried and blended into a mix. Many of the smoking corporations also spend quite a bit of time in plant development, finding breeds and concocting hybrids for flavor and higher concentrations of naturally occurring addictive substances. But, leaves are not the only things included in these mixes. Many additives are added to the mixes, and they function to aid in the mix's moistness, preservation, flavor, to enhance addictive properties, to appeal to all senses, and other enhancements. There have been almost 600 additives provided by the cigarette companies submitted the Department of Health and Human Services. Unfortunately, none of these chemicals are ever listed on a package. So when you are smoking tobacco, you are smoking more than just leaves. Cigars, cigarettes, and cigarillos are all defined by their size (large to small), but cigarillos have presented a new problem as of late. They are short, narrow and described by some as "cute". These are very popular among teenagers simply because, they come in "fun flavors". A few examples of these are vanilla, chocolate, strawberry, grape, orange, and watermelon. These flavors are very appealing to young people (watch this old commercial from the American Legacy Foundation's The Truth Campaign). A flavor ban was included in President Obama's 2009 Family Smoking Prevention and Tobacco Control Act, however because the type of cigarettes included in this flavor ban were not explicitly defined, these are still available in stores. You can walk into your store that sells cigarettes and notice them immediately, with their bright colors and sweet-sounding flavors.
Other Forms: Hookah:
There is an emerging alarming new trend in smoking among young people. It's not cigarettes but hookahs, also known as water pipes. It has become increasingly popular, and it's more dangerous than many young people think. There is perception among general public that hookahs are less hazardous form of tobacco and a safer alternative to cigarettes. According to CDC Hookah smokers are at risk for the same kinds of diseases as are caused by cigarette smoking, including oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function, and decreased fertility(CDC,2012).
The following video discusses how this new trend is on rise among college students and is being viewed as social event. Hookah bars have also popped up, many of them in college towns to take advantage of young adults http://www.youtube.com/watch?v=wKWh-nDxEqc
Other Forms: Tobacco Chewing:
With the decline in the sales of cigarettes over the past few years the large tobacco companies are now aggressively promoting and marketing the smokeless tobacco. Smokeless tobacco products consist of chewing tobacco and snuff. Chewing tobacco is sold as leaf tobacco or plug tobacco. The tobacco is placed in the mouth between the cheeks and gum and is kept there for long hours to get continuous high from nicotine. Snuff is in powdered form and is placed between lower lip and gum, which is then quickly absorbed by the bloodstream. The tobacco products are cleverly packaged and flavored to especially target the youth. It is also being marketed as a safer option to smoking cigarettes and as an effective method to quit smoking. This 5 minute video on CDC website looks at the clever and deceptive tactics used by the tobacco industry to sell smoke less tobacco. http://www.cdc.gov/tobacco/basic_information/smokeless/ While the use of cigarette smoking is on decline in teens this new trend of chewing tobacco is on rise. There are fewer government restrictions on the sale of smokeless tobacco products, so tobacco companies are spending record amount of money for promotion of smokeless tobacco. This short abc news video sheds light on this emerging trend and how it is having big impact on individuals health. Smokeless tobacco users are 2 times as likely to get oral cancer and 60% more likely to get pancreatic or cancer of esophagus. http://abcnews.go.com/Health/video/smokeless-tobacco-rise-5305055
Our Groups Suggestions for Meeting the CDC's Winnable Battles Goals:
1) Creating smoke free environments in education institutions around the country, and other common spaces, cities, recreational areas, bars, restaurants, and any public place, these prohibitions create healthier spaces for the community and protect them from second hand smoke, they also interact with physiological behavioral and social aspects of smoking. Lobbying efforts against these spaces will be strong in many cases, it will be important for public health officials to understand their political system, political leaders, in order to defeat the powerful Tobacco industry that still exists.
2) Increased funding and support to the FDA’s power to regulate mis-leading flavored cigarette packaging under the 2009 Tobacco Control Act.
3) Creative and support public health campaigns to research at risk populations for smoking and secondhand smoke. For example reaching women who may smoke around young children.
4) Support and fund practiced based quitting campaigns and integrate healthcare providers to help identify smokers and help them through the quitting journey. Provide incentives for health care providers and insurance companies with less smoking patients; provide incentives for patients who successfully complete quitting programs.
5) Continually provide and create creative campaigns that help educate and protect young adults against advertising and cultural influences that may lead them to become smokers. Make the links between smoking and cardiovascular disease, cancer, and respiratory diseases for smokers.
6) Mandatory smoking cessation courses for students entering medicine, nursing, pharmacy and dentistry fields to give healthcare providers creative and useful tools to help their patients quit smoking.
7) Effective age and demographic appropriate advertising campaigns for children and adults addressing smoking and secondhand smoking awareness. Sharing stories like Heather Crowe’s message here: https://www.youtube.com/watch?v=W4fzTdjqvt0
8) Instate restrictions that place cigarettes and tobacco products out of sight, behind curtains or cupboard doors, similar curtain laws exist in Canada.
9) Being informed is the single most important thing to catch this problem while in bud. 90 percent of smokers begin smoking before 21 years of age. Communicate with your teen don’t assume that your kid knows smoking is bad. It is important that kids get the information from parents. Set an example yourself by not smoking so that children do not associate smoking as a normal behavior. Most teenagers think they are invincible so making them aware of the health implication associated with smoking can put things in perspective for them.
10) According to CDC kids are more likely to smoke brands heavily advertised so educate kids about the deceptive and clever tactics used by tobacco companies to allure the kids into smoking. Peer pressure is also one of the major factors associated with smoking so discuss ways with them to respond to peer pressure. Encourage kids to get involved in activities that prohibit smoking, such as sports and be more involved in the kid’s life.
11) Things that we all can do to help are joining with the active groups to stop sale of cigarettes to children and teenagers. Asking schools to teach kids the dangers of smoking and organizing community programs to educate on dangers of tobacco.
Additional Reading:
Stop smoking resources for patients and health professionals: http://www.ash.org.uk/stopping-smoking
Public Health and Tobacco Regulation- “Tobacco Product Regulation-A Public Health Approach” http://www.nejm.org/doi/full/10.1056/NEJMp1004152
HealthyPeople.gov-Framework for ending Tobacco Use http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=41
American Cancer Society. (2012).Smokeless Tobacco. Retrieved from http://www.cancer.org/cancer/cancercauses/tobaccocancer/smokeless-tobacco
American Cancer Society. (2013).Guide to quit smoking. Retrieved from http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-toc
Colorado Quit line be Tobacco free. (2013). My Quit Path. Retrieved from http://www.myquitpath.org/ Web MD.(2013).
News and features related to Lung cancer. Retrieved from http://www.webmd.com/lung-cancer/news-features
Depictions of Tobacco Use in 2007 Broadcast Television Programming Popular Among US Youth. http://archpedi.jamanetwork.com/article.aspx?articleid=384271
Old Truth Whudafxup Campaign. http://truthv18.arn.com/
The Truth.http://www.thetruth.com/
American Legacy Foundation: http://www.legacyforhealth.org/
Heather Crowe. http://www.smoke-free.ca/heathercrowe/ and http://www.canada.com/nationalpost/story.html?id=16546d57-7857-4fbb-8586-77c9c6fb5e3a&k=73829
Concerned Children's Advertisers. http://cca-arpe.ca/psas/substance_abuse_prevention.html and http://cca-arpe.ca/psas/smart_choices.html and http://cca-arpe.ca/psas/role_models_mentoring.html and http://www.youtube.com/watch?v=Mrhuaj540Aw
Colorado Quitline. https://www.coquitline.org/
Colorado Tobacco Education Prevention and Cessation Grant Program. http://www.colorado.gov/cs/Satellite/CDPHE-PSD/CBON/1251617593490
COPrevent. http://www.coprevent.org/
World Health Organization Tobacco Free Initiative. http://www.who.int/tobacco/mpower/warn/en/
National Institute of Health. http://www.drugabuse.gov/publications/drugfacts/cigarettes-other-tobacco-products
FDA Tobacco Products. http://www.drugabuse.gov/publications/drugfacts/cigarettes-other-tobacco-products
References:
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Schneider, M. (2011). Public Health Enemy Number One: Tobacco.(Third Edition). Introduction to Public Health (241-266). Sudbury: Jones and Bartlett Publishers.
Centers for disease control and prevention. (2011).Smoking & Tobacco Use. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/
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Secondhand Smoke and Lung Cancer E, Lynne.(2012) Retrieved from http://lungcancer.about.com/od/causesoflungcance1/a/secondhandsmokelungcancer.htm
American lung association.(2012) Lung Cancer Health Center Retrieved from http://www.webmd.com/lung-cancer/lung-cancer-survival-rates
American lung association.(2012).Lung cancer fact sheet. Retrieved from http://www.lung.org/lung-disease/lung-cancer/resources/facts-figures/lung-cancer-fact-sheet.html#1
Seattle cancer care alliance. (2012).Winning the Battle against Lung Cancer, Retrieved from http://www.seattlecca.org/diseases/lung-cancer-survival-rates.cfm
American Lung Association. (2010). American Indians/Alaska Natives. Retrieved From: http://www.lung.org/stop-smoking/about-smoking/facts-figures/american-indians-tobacco.html
Campaign for Tobacco Free Kids. (2013). Tobacco Warning Labels: Evidence of Effectivenes Factsheet. Retrieved from: http://www.tobaccofreekids.org/research/factsheets/pdf/0325.pdf
Centers for Disease Control and Prevention. (2012). Smoking and Tobacco Use: Legislation. Retrieved From: http://www.cdc.gov/tobacco/data_statistics/by_topic/policy/legislation/
Colorado Department of Public Health and Environment. (2013). Smoking and Tobacco Use. Retrieved From: http://www.colorado.gov/cs/Satellite/CDPHE-PSD/CBON/1251618783058
Colorado Department of Public Health and Environment{II}. (2013). Tobacco Education Prevention and Cessation Grant Program. Retrieved From: http://www.colorado.gov/cs/Satellite/CDPHE-PSD/CBON/1251617593490
Colorado Office of Legislative Legal Services. (2006). Session Laws of Colorado 2006 Second Regular Session, 65th General Assembly CHAPTER 22 HEALTH AND ENVIRONMENT. Retrieved From: http://www.state.co.us/gov_dir/leg_dir/olls/sl2006a/sl_22.htm
Colorado Tobacco Education and Prevention Alliance. (2010). History. Retrieved From: http://www.ctepa.org/gtku_history.htm
CoPrevent. (2013). Tobacco Projects, Initiatives and Talking Points. Retrieved From: https://docs.google.com/document/d/19nKOcPHvWm5HHGT10qFcXTm2OGkGPByad6a9fUQB6Y4/edit?hl=en_US
CoPrevent {II}. (2013). Weld County Public Symposium Looks at Youth Marijuana and Tobacco Trends. Retrieved From:
http://www.coprevent.org/2013/04/weld-county-public-symposium-looks-at.html
Cullen, Jennifer, Sokol, Natasha A., Slawek, Deepika, Allen, Jane A. , Vallone, Donna, and Healton, Cheryl. (2011). Depictions of Tobacco Use in 2007 Broadcast Television Programming Popular Among US Youth. Archives of Pediatrics and Adolescent Medicine,Vol. 165 (Issue 2), 147-151. http://archpedi.jamanetwork.com/article.aspx?articleid=384271 .
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