# Presentation: 271248

## CHANGING TOBACCO POLICY TO REDUCE HEART DISEASE & STROKE Beverly J. May, M.P.A.Regional Director,  Western States and OhioCampaign for Tobacco-Free KidsSeptember 20, 2007

## Lets all get ALONG!! 

## Tobacco is the leading preventable cause of death, killing more than 400,000 each year
Tobacco kills more people than from AIDS, alcohol, car accidents, murders, suicides, and fires combined
Tobacco results in $96.7 billion in annual health care costs
Nearly 90% of lung cancer cases, 1/3 of total cancer deaths, and 1 in 5 deaths from heart disease are tobacco related

**Tobacco kills more people than from AIDS, alcohol, car accidents, murders, suicides, and fires combined**
**Tobacco results in $96.7 billion in annual health care costs**
**Nearly 90% of lung cancer cases, 1/3 of total cancer deaths, and **_**1 in 5 deaths from heart disease are tobacco related**_

**Tobacco’s Toll in U.S.**

## 
4,000 kids try their first cigarette every day
More than 1,000 kids become regular daily smokers every day; one-third will die from smoking-related diseases
23% of high school students smoke, according to CDC
28.4% used some tobacco product in the last month

**4,000 kids try their first cigarette every day**
**More than 1,000 kids become regular daily smokers every day; one-third will die from smoking-related diseases**
**23% of high school students smoke, according to CDC**
**28.4% used some tobacco product in the last month**

**Tobacco’s Toll in U.S.**

## Tobacco-Related Deaths

## Tobacco & Heart Disease

- 1 in 5 cardiovascular deaths are caused by smoking.
- Cigarette smokers are 2-4 times more likely to develop coronary heart disease than nonsmokers.
- Cigarette smokers’ risk of dying from heart disease is 2-3 times higher than nonsmokers’ risks.
- Smokers’ risk of having a stroke is about 2 times higher than nonsmokers’ risk.
- The risk for developing cardiovascular disease, the number 1 killer of women, is greatly increased in women who smoke.

- Sources: CDC, AHA

## Secondhand Smoke& Heart Disease

- More than 35,000 people die each year from coronary heart disease due to exposure to secondhand smoke.
- Nonsmokers who are exposed to secondhand smoke increase their risk of developing heart disease by 25-30%.

- Source: CDC; Barnoya & Glantz, 2005

## Domestic Cigarette Advertising and Promotional Expenditures 1998 - 2005(thousands of dollars)

- Source: Federal Trade Commission Cigarette Report for 2004 and 2005

**$11.22**
**Billion**

**$9.59**
**Billion**

**$8.24**
**Billion**

**$6.73**
**Billion**

**$12.47**
**Billion**

**$9.8b price discounts**

**$15.15**
**Billion**

**$14.15**
**Billion**

**$10.9b price discount**

**$13.11**
**Billion**

**$10.8b price discount**

**$7.9b price discount**

## EVIDENCE BASED SOLUTIONS

## Key Components of FDA Regulation

**Regulating the marketing of tobacco products**
**Regulating the product itself**
**Using a “Public Health” standard, which takes into account not just the impact on the individual smoker but on encouraging initiation and discouraging cessation**

## Effects of a 10% Increase in Price

**Nearly 7% decline in youth prevalence**
**A 2% decline in adult prevalence**
**A 4% decline in overall consumption**

**Notes:**
Show tax ads from Pete -- transparencies

How can we influence price.  We do it by supporting public policies (i.e. excise tax increases) that effectively raise the price of cigarettes and other tobacco products.  Economic research shows that price influences consumption – particularly for kids.

We have supported tax increases at the federal and state level through:

Advertising in support of the tax increases
Direct lobbying
Grassroots organizing – letter writing, visits, etc.

In 1997, we saw state excise tax increases in 8 states.  In Alaska, the increase was from 29 cents to a full dollar, now the highest cigarette tax in the country.

We’ve also supported the Hatch - Kennedy proposal to increase the federal excise tax to fund health insurance for uninsured kids.

Our support for package 

## Recent Cigarette Tax Increases

**CALIFORNIA**

**NEVADA**
**    ****80**

**OREGON**
**118**

**WASHINGTON**
**202.5**

**ARIZONA**
**   ****200**

**NEW MEXICO**
**91**

**TEXAS**
**141**

**OKLAHOMA**
**103**

**UTAH**
**69.5**

**COLORADO**
**84**

**KANSAS**
**79**

**NEBRASKA**
**64**

**IDAHO**
**57**

**MONTANA**
**170**

**NORTH DAKOTA**
**44**

**SOUTH DAKOTA**
**153**

**MINNESOTA**
**149.3**

**IOWA**
**136**

**MISSOURI**
**17**

**ARKANSAS**
**59**

**       ****36**
**LOUISIANA**

**MS**
**18**

**ALABAMA**
**42.5**

**GEORGIA**
**37**

**FLORIDA**
**33.9**

**SOUTH CAROLINA**
**7**

**NORTH CAROLINA**
**35**

**TENNESSEE**
**20**

**KENTUCKY**
**30**

**ILLINOIS**
**98**

**WISCONSIN**
**   ****77**

**MICHIGAN**
**200**

**IN**
**55.5**

**OHIO**
**125**

**WV**
**55**

**30**
**VIRGINIA**

**PENNSYLVANIA**
**135**

**NEW YORK**
**150**

**MAINE**
**200**

**VT**

**NH: ****80**

**MA**

**CT:****151**

**RI:****246**

**NJ:****258**

**DELAWARE:****55**

**MARYLAND:****100**

**DC:****100**

**HAWAII**
**160**

**ALASKA**
**180**

**States that have recently passed or implemented a cigarette tax increase ****(since 1/1/2002)**

**WYOMING**
**60**

***               ******March 2007***

**Recent Cigarette Tax Increases**

**CT**

**MA:****151**

**87**

**VT:****179**

- AZ’s tax rate is effective 5/1/07.  Upcoming increases:  AK increase to 200 cents per pack on 7/1/07; HI’s increase to 180 cents per pack on 9/30/07; VT increase to 199 cents per pack on 7/1/07.

**States that have not passed tax increases since before 2001**

## Effects of Smoke-free Laws

- Protect everyone from secondhand smoke
- Prompt more smokers to try to quit
- Increase the number of successful quit attempts
- Reduce the number of cigarettes that  smokers consume
- Discourage kids from starting
- Do NOT hurt business

## Smoke-Free Laws

- In Helena, MT, during the 6 months that a local law that prohibited smoking in most workplaces, including restaurants and bars, was enforced, the number of hospital admissions for acute myocardial infarction fell significantly, from an average of 40 admissions during the same months in the years before and after the law to a total of 24 admissions during the six months the law was in effect. [Sargent et al., 2004]
- In part, due to the Helena study, along with a “growing body of scientific data,” experts at the CDC advised all clinicians to tell their patients who have a history of coronary heart disease, “to avoid all indoor environments that permit smoking.” [Pechacek & Babb, 2004]

## Smoke-Free Laws

- If all workplaces went smoke-free, an estimated “6250 myocardial infarctions and 1270 strokes would be prevented, and $279...million would be saved in direct medical costs annually.”
- 	[Ong & Glantz, 2004, 2005]

## Smoke-Free Laws

**Smoke-Free Laws**

***March 2007***

*** The Montana and Utah laws extend to bars in 2009. **

*** Arizona law effective 5/1/07; New Mexico law effective 6/15/07**

**Restaurants**

**Restaurants & Bars**

**Notes:**
Includes Columbus, OH, Lawrence, KS, Lincoln, NE, Roswell NM, copperas Cove, TX

Wilmette, IL
Madison WI
Burlington VT
Minneapolis
Bloomington
Powell OH
Worthington OH
Fargo ND
Wauseon OH
Winooski, VT

## Comprehensive Programs Help Adult Smokers Quit

**Comprehensive Programs Help Adult Smokers Quit**

**Massachusetts: **
**Cut adult **
**smoking by 21% **
**between **
**1993 and **
**2000**

**Arizona: Cut **
**adult smoking **
**by 21% between **
**‘****96 and ‘99**

**California: Cut **
**adult smoking by **
**32.5% between **
**1988 and 2004 **

**Maine: Cut adult smoking by 12.5% b/t 2001 and 2004**

**WA: Cut adult smoking by 20% between 1999 and 2005**

**New York: cut adult smoking by 14% between 2001 and 2004**

## Comprehensive ProgramsReduce Youth Smoking

**Comprehensive Programs****Reduce Youth Smoking**

**Maine: Cut **
**high school **
**smoking by**
** ****59% b/t **
**1997 and 2005**

**Oregon: Cut **
**smoking by**
** ****63% among **
**eighth graders **
**between ‘96 **
**and 2004**

**Mississippi: Cut **
**smoking among **
**public middle school **
**students by**
**48% in 5 years**

**Florida: Cut **
**middle school **
**smoking by **
**47% & high school **
**smoking by **
**30% b/t **
**1998 and 2001**

**Indiana: Cut high school smoking by 32.5% b/t 2000 and 2004**

**WA: Cut youth smoking by 50% b/t 2000 and 2004**

## Funding for Tobacco Prevention & Cessation

**States that have committed substantial funding for tobacco prevention programs (more than 50% of CDC minimum).**
**States that have committed modest amounts for tobacco prevention programs (25% - 50% of CDC minimum). **

**December 5, 2006**

**States that have committed minimal amounts for tobacco prevention programs (less than 25% of CDC minimum).**
**States that have committed no tobacco settlement or tobacco tax money for tobacco prevention programs.**

**Funding for Tobacco Prevention & Cessation**

**Notes:**
RED- Fifteen (15) states will spend tobacco settlement money to fund new, substantial tobacco prevention programs

ORANGE - Eleven (11) states committed modest amounts of tobacco settlement money for tobacco prevention programs (less than 45% of the minimum amount recommended by the CDC)

YELLOW - Twelve (12) states committed minimal amounts of tobacco settlement money for tobacco prevention programs (less than 25% of the minimum amount recommended by this CDC) 

GREEN - Eight states, and DC,  have not yet allocated their tobacco settlement money or have placed tobacco settlement money into a trust with no guarantee of funding for tobacco prevention programs.

GREY - Four (4) states  made decisions concerning the tobacco settlement money, but did not appropriate any of that for tobacco prevention programs.

## FY 2007 Tobacco Money for Tobacco Prevention

**$1.6 Billion**

** ****$597.5 Million**

** ****$ 21.7 Billion**

**$14.7 Billion **
**Tobacco Tax Revenues**

- $**7.0 Billion**
**Tobacco Settlement Revenues**

- FY 2007 Tobacco Money for Tobacco Prevention

*        **  ****Because everyone deserves a second chance!***

## Slide 22

## Slide 23

## Policy Success in New York City

- The city and state’s combined comprehensive approach of excise tax increases, smoke-free workplace laws and assistance for smokers who want to quit drastically reduced smoking.
- The number of adult smokers in NYC declined by 15% in just 2 years – that’s 188,000 fewer smokers.

## Policy Success in California

- By 2010, 50,000 Californians’ lives will be saved due to the state’s anti-smoking laws, including a comprehensive prevention program, higher cigarette taxes, and clean air laws.
- [Pacific Institute for Research and Evaluation, March 1, 2007]

## Impact of Reduced Smoking on Heart Disease & Stroke

- Decreasing smoking rates by one percentage point per year [Lightwood & Glantz, 1997]

|  | # Fewer Heart Attacks | # Fewer Strokes |
| --- | --- | --- |
| Year 2 | 924 | 538 |
| Year 3 | 3,022 | 1,684 |
| Year 4 | 5,725 | 3,141 |
| Year 5 | 8,736 | 4,734 |
| Year 6 | 11,896 | 6,389 |
| Year 7 | 15,122 | 8,060 |

## Adult Smoking Trends1992 - 2005*

-     Year

- Adult Smoking Rate

- * Data are from the National Health Interview Survey

**N/A**

## Our Role

**COMMUNICATIONS:   **Keep tobacco issue visible to public and framed as a serious public problem that requires action
**POLICY PROMOTION:  **Promote public policies that reduce tobacco use
**BUILDING THE MOVEMENT:  **Strengthen and mobilize effective support for tobacco control

## Go Forward Together!!

## 

Engage a broad coalition 
and involve them early and often

**Engage a **_**broad **_**coalition **
**and involve them **_**early **_**and **_**often**_

##      Campaign for a Healthier Colorado

_**Building the coalition**_
- Cast a wide net, identified all possible stakeholders
- Met with all potential stakeholders to learn what needs, priorities and concerns were
- Involved them early and often
- Built trust
- Had them invest early (staff time/resources, sharing in costs for research, etc.)

## Shared Challenge: Broadening the Issue Beyond Tobacco

- Some complacency with tobacco prevention issues
- Need to give the issue immediacy, urgency
- Broaden public appeal and allied support
- Healthcare is a major priority for voters
- National research shows Americans’ concern about healthcare is second only to “jobs/the economy” and equal to “national security”
- All recent successful tobacco tax ballot campaigns tied tobacco to healthcare
- WA in 2001; OR & AZ in 2002; CO in 2004
**Need a “middle class sell” beyond healthcare for the poor**

## 
Positioning Tobacco Control 
 as Part of Larger Policy Discussion 
on Healthcare

**Positioning Tobacco Control **
** ****as Part of Larger Policy Discussion **
**on Healthcare**

**Notes:**
Colorado experience – now other states

## 

Write a policy-sound, simple 
and politically viable measure

**Write a policy-sound, **_**simple **_
**and politically **_**viable measure**_

## Case Study Campaign for a Healthier Colorado

- Steering committee started with list of 17 programs
- Through facilitated discussion and using guiding principles list was reduced to 7 programs
- Policy papers ‘made the case’ for each of the 7 programs
- Program / principle matrix summarized information in policy papers into format based on guiding principles

## Guiding Principles

- 1.	Fund sound programs that benefit the health of Coloradans.  Funded programs must:
- Be cost effective
- Have evaluation and accountability mechanisms
- Have a proven track record
- 2.	Build a politically viable package.  The package must be:
- Supported by the public
- Able to attract the necessary resources to support the campaign
- Clear and concise, limited to 3 or 4 areas of funding
- Favor programs that leverage money from governmental or non-governmental agencies
- 4.	Do not duplicate or supplant existing funding

## No surprises!!!

## Campaign for a Healthier Colorado

- _Ended up with_
- Constitutional amendment increasing tobacco excise tax by 64 cents/pack and 20% on other products
- Revenue would be divided as follows:
- 46% for public health insurance expansion (CHP+/Medicaid)
- 19% for comprehensive primary care through clinics
- 16% for prevention, detection & treatment of cancer, cardiovascular and pulmonary diseases
- 16% for comprehensive tobacco control
- 3% hold-harmless provision

## So, What Happened on Election Day? 

- A35 passed with more than 61% voter support becoming Colorado’s first statewide tax increase in over 10 years
- Carried traditionally Republican and Democratic strong-holds

## PARTY PARTY!!!!

## After the Campaign

- Coalition decided to stick together through the legislative session to ensure that Amendment 35 is implemented as intended (Nov. ’04 – May ’05)
- Helped draft implementing language, found sponsors, lobbied the bill, passed it through House and Senate
- Governor signed bill into law on June 2, 2005
- And  MORE . . . .

## PARTY PARTY!!!!

## You Can Help

**Get Involved with State or Local Tobacco Control Coalition**
**Learn more at our website:  **_[www.tobaccofreekids.org](http://www.tobaccofreekids.org/)_
**Become a TFK  E-Champion**

## Slide 44

##           Western States and Ohio			

***Regional Director***
***          ******Western States and Ohio******	******	******	***

***Campaign for Tobacco-Free Kids***
**801-824-0084**
**202-481-9384**
**bmay@tobaccofreekids.org**
**www.tobaccofreekids.org**