# Presentation: 682110

## Tobacco Progress Review
May 14, 2003

**Tobacco Progress Review**
**May 14, 2003**

## Tobacco Impact and Public Health Challenges

**Tobacco Impact and Public Health Challenges**

**Current Smokers**

**Environmental**
** ****Tobacco Smoke**

**Annual Impact**

**~440,000**
** ****Premature**
**Deaths**

**Lung / Other Cancers**
**Chronic Respiratory Disease**
**Cardiovascular Disease**

**14% of Medicaid Expenditures**
**Direct and Indirect Costs:**
**	****$157 Billion **

## Tobacco Impact and Public Health Challenges

**Tobacco Impact and Public Health Challenges**

**Current Smokers**

**Environmental**
** ****Tobacco Smoke**

**Annual Impact**

**~440,000**
** ****Premature**
**Deaths**

**Lung / Other Cancers**
**Chronic Respiratory Disease**
**Cardiovascular Disease**

**14% of Medicaid Expenditures**
**Direct and Indirect Costs:**
**	****$157 Billion **

**Future Smokers**

## Smoking-Attributable Mortality, 1995-1999

**Number of average annual deaths **

- Sources: CDC. Annual Smoking –Attributable Mortality, Years of Potential Life Lost, and Economic Costs—United States, 1995-1999.  MMWR 2002 51;300-3.  Burn deaths from: Hall JR.  The U.S. smoking-material fire problem.  Quincy, Massachusetts: National Fire Protection Association, Fire Analysis and Research Division, 2001.  Environmental tobacco smoke deaths from: National Cancer Institute. Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protection Agency. Smoking and tobacco control monograph 10. Bethesda, Maryland: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 1999.  Total does not equal sum due to rounding.

**Neoplasms**

**Cardiovascular diseases**

**Respiratory disease **

**Total**

**Perinatal conditions**

**Burn**
** ****deaths **

**Total**

**Lung**
**cancer**

**Ischemic**
** ****heart disease**

**    ****Environmental Tobacco **
**Smoke**

**All Deaths**

**Smoking-attributable**
**(19%)**

**Other**

## 3-2. Lung Cancer Death Rates

**Age-adjusted death rate per 100,000 standard population**

**Black male**

**Total population**

**White male**

**White female **

**Black female **

- Notes: Data are age adjusted to the 2000 standard population.
- Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC.

**2010 Target**

**Total male**

**Total female**

## 27-1a. Current Cigarette Smoking: Adults 18 Years and Older

**Age-adjusted percent**

**2010 Target**

**Black male**

**1975**

**1965**

**1975**

**1995**

**2001**

**1985**

**White male**

**White female**

**Black  female**

- Notes: Data are age adjusted to the 2000 standard population.  Survey redesigned in 1997 and data for 1998 and subsequent years may not be directly comparable to earlier years.  Source: National Health Interview Survey (NHIS), NCHS, CDC.

## 3.2  Lung Cancer Death Rates

**Age-adjusted death rate**
** ****per 100,000 standard population**

**Black male**

**Total population**

**White male**

**White female **

**Black female **

**Total male**

**Total female**

**Age-adjusted percent**

** ****27-1a. Current Cigarette Smoking:**
_** **__**Adults 18 Years and Older**_

**3.2  **_**Lung Cancer Death Rates**_

**1950**

**1960**

**1970**

**1980**

**1990**

**2000**

**Black male**

**White male**

**Black female **

**White female **

**1965**

**1985**

**1995**

**2001**

**1975**

**60**

**40**

**20**

**0**

- Sources/Notes: Same as previous slides for objectives 3-2 and 27-1a.

## Annual Adult Per Capita Cigarette Consumption

- <date/time>

- Sources: Centers for Disease Control and Prevention and the United States Department of Agriculture.

**Great Depression**

**End of WW II**

**Nonsmokers’**
**Rights Movement Begins**

**1st Surgeon**
**General’s Report**

**Fairness Doctrine**
**Messages on TV and Radio**

**Federal Cigarette**
**Tax Doubles**

**Broadcast**
**Ad Ban**

**Annual Adult Per Capita Cigarette Consumption**

**Master**
**Settlement**
**Agreement**

**Nicotine**
**Medications Available Over ****the Counter**

**1st Smoking-**
**Cancer Concern**

**1st World Conference**
**on Smoking and Health**

**Surgeon General’s**
**Report on Environmental**
**Tobacco Smoke**

**1st Great American Smokeout**

## 27-1a. Current Cigarette Smoking for Adults 

**American Indian/**
**Alaska Native only**

**Asian only**

**Hispanic***

**Black only, **
**not Hispanic***

**White only,**
** ****not Hispanic***

**Total***

**Males***

**9-11 years**

**High school**
**graduate**

**13-15 years**

**16 years **
**or more**

**Females***

**Age-adjusted percent**

**Education level**

- *Preliminary data: January-September 2002, current data year for other groups is 2001.
- Notes: Current smokers report smoking everyday/some days and have smoked at least 100 cigarettes.  Data are age adjusted to the 2000 standard population.  American Indians/Alaska Natives or Asians/Pacific Islanders may be of Hispanic origin.  Hispanics may be of any race.  For 1998 and 2002, persons reported only one race or reported more than one race and identified one race as best representing their race.  Adults: 18 years and older.

- Source: National Health Interview Survey (NHIS), NCHS, CDC.

- test

## 27-5. Current Adult Smokers Who Attempted and Failed to Quit in the Past Year, 2001

**American Indian/**
**Alaska Native only**

**Asian only **

**Hispanic **

**Black only,**
** ****not Hispanic**

**White only,**
** ****not Hispanic**

**2010 Target**

- I 95% confidence interval
- *Current smokers (everyday/some days and have smoked at least 100 cigarettes) who have quit smoking one day or longer in the year prior to interview.
- Notes:  American Indians/Alaska Natives or Asians may be of Hispanic origin.  Hispanics may be of any race.  Data are age adjusted to the
- 2000 standard population.  Adults: 18 years and older.

**Age-adjusted percent**

**Total**

- Source: National Health Interview Survey (NHIS),  NCHS, CDC.

## 27-1a, 27-2b. Current Cigarette Smoking   

**Percent**

**2010 Target: Students**

**Students (grades 9-12)**

**Adults (18 and older)**

**2010 Target: Adults**

**1970**

**1975**

**1980**

**2000**

**1965**

**1985**

**1990**

**1995**

***Preliminary data, January-September 2002.**
**Notes: Adults, age adjusted to the 2000 standard population.  Current Smoking: Adults-every/some days (and have smoked at least 100 cigarettes), Students-1+ day/past month.**

**2002***

- Sources: Adults, National Health Interview Survey (NHIS), NCHS, CDC.  Students, Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

## Healthy People 2010 Objectives Past Month* Tobacco Users: Students (Grades 9-12), 2001

| Tobacco Product | Any 
Tobacco
Product | Cigarettes
 | Spit Tobacco | Cigars
 |
| --- | --- | --- | --- | --- |
| Current
Rate | 34% (total)

30% (females)
39% (males) | 28% (total)

28% (females)
29% (males) |    8% (total)

2% (females)
15% (males) | 15% (total)

9% (females)
22% (males) |
| 2010
Target | 
21% | 
16% | 
1% | 
8% |
| Objective Number | 27-2a. | 27-2b. | 27-2c. | 27-2d. |

- *Tobacco use on one or more days in the 30 days preceding the survey.
- Note: Tobacco users may have used more than one tobacco product.

- Source: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

## 27-2b. Cigarette Use in Past Month*:Students (grades 9-12)

**Males**

**Hispanic **

**Black, not Hispanic**

**White, not Hispanic**

**Percent**

**Total**

**Females**

- Sources: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC and **National Youth Tobacco Survey, OSH, CDC and The American Legacy Foundation.

- I 95% confidence interval
- *Smoked cigarette(s) on one or more days of the 30 days preceding the survey.
- Note: Data for American Indians/ Alaska Natives, and Asians/Pacific Islanders are unreliable.

**In 2000, 11% of students in grades 6-8 smoked****

## Current Cigarette Smoking, Price and Tax: Students (12th Grade)

**Dollars**

**Mean excise tax on a pack of cigarettes**

**Current smoking**

**Real price per pack**

**Current smoking **

**Percent**

- *Current cigarette smoking: Have smoked at least once in the past 30 days. ** Real price is Consumer Price Index-adjusted national average retail price.
- Real price and mean excise tax per pack of cigarettes adjusted for inflation.
- Sources:  Original analysis/slide prepared by the ImpacTeen Project.  Estimated prices for the period covered by the survey data are based on the 11/01 price
- for each year reported by Orzechowski and Walker, adjusted for changes in state and federal cigarette taxes and trends in the non-tax component of price.
- Price data from: Orzechowski W, Walker RC.  The tax burden on tobacco: historical compilation 2001. Arlington, Virginia: Orzechowski and Walker, 2002.
- Smoking prevalence data from:  Monitoring the Future Study, NIH, NIDA. Tax data from: The Tax Burden on Tobacco, The Tobacco Institute.

## Serum Cotinine Levels for Persons

- <date/time>

**Serum Cotinine Levels for Persons**
** ****Aged 4 Years and Older, 1988-1991**

- Serum cotinine (ng/mL)

- Percentage of the population

- 0

- 1

- 2

- 3

- 4

- 5

- 0.1

- 1.0

- 10

- 100

- 1000

**ETS exposure**
**among non-smokers**

**Smokers**

- 0.05*

***Lowest level of detection**

- Source: Pirkle et al. Exposure of the US population to Environmental Tobacco Smoke.  The Third National
- Health and Nutrition Examination Survey, 1988 to 1991.  JAMA, April 24, 1996-Vol 275, No. 16 pp.1233-1240.

## 27-10. Exposure to Environmental Tobacco Smoke: Nonsmokers* with Detectable Cotinine Levels**, Ages 4 and Older

**2010 Target**

** ****Age-adjusted percent with detectable serum cotinine**

**  ****Mexican American **

**Total**

** ****White, not Hispanic **

** ****Black, not Hispanic **

- Source: National Health and Nutrition Examination Survey (NHANES), NCHS, CDC.

- I 95% confidence interval
- * Nonsmokers defined by serum cotinine levels < 11 ng/mL.
- **Detectable serum cotinine levels: _>_ .05 ng/mL and _<_ 10 ng/mL.
- Notes: Age adjusted to the 2000 standard population.
- Data for other Hispanics, American Indians,/Alaska Natives, Asians/Pacific Islanders are unreliable.

## 27-13.  Smoke-Free Indoor Air Laws*  

**2010 Target**

**Total number of States with laws (including D.C.)**

**Workplace    **

**Transportation**

- Source: State Tobacco Activities Tracking and Evaluation System (STATE System), OSH, NCCDPHP, CDC .

- *Indoor air laws: smoking bans or limited to separately ventilated areas.

**3**

**5**

**18**

**24**

**6**

**17**

**1**

**13**

**3**

**16**

**22**

**4**

**25**

## 27-8b. Number of States With Medicaid Coverage for Treatment of Nicotine Dependency

| 
Year | No 
Coverage | Partial 
Coverage | Full
Coverage |
| --- | --- | --- | --- |
| 1998 | 25 | 25 | 1 |
| 1999 | 16 | 34 | 1 |
| 2000 | 15 | 35 | 1 |

*** ******2010 Target: 51 (50 States and D.C.)***

- Source: Health Policy Tracking Service, National Conference of State Legislators.

## Progress review data and slides

**Progress review data and slides**
**can be found on the web at:**

**http://www.cdc.gov/nchs/hphome.htm**