1. 1 The Impact of Smoking in Los Angeles County March 25, 2010 Jonathan Fielding, M.D., M.P.H., M.B.A Director of Public Health and Health Officer L.A. County Department of Public Health Professor of Health Services and Pediatrics Schools of Public Health and Medicine, UCLA

2. Los Angeles County Overview Unique geographic and demographic characteristics of Los Angeles that impact tobacco control efforts: 4,300 square miles 88 incorporated cities, 2 islands, and large un-incorporated areas 10.3 million residents (more than 42 states) 46% Latino, 32% White, 13% Asian/Pacific Islander, 10% African American, 0.3% American Indian Over 100 different languages Source: Department of Public Health – Strategic Plan 2008-11 2

3. 3 Tobacco Control Efforts in Los Angeles County Tobacco control & prevention efforts in Los Angeles County focuses on four major areas: Preventing youth initiation Promoting cessation resources Reducing secondhand smoke exposure Countering pro-tobacco influences Approach designed to change the social norms of communities (create a social and legal climate where tobacco is less desirable, less acceptable, and less accessible).

4. Tobacco Use in Los Angeles County Among Adults 4 Source: 2007 LACHS

5. Wide Variation in Tobacco Use Among Sub-populations Source: 2007 LACHS 5

6. 6 Impact of Tobacco Use in Los Angeles County Over 1 million adults still smoke.* 1 out of every 7 deaths is caused by cigarette smoking.** Top 5 causes of death are associated with tobacco use: lung cancer, coronary heart disease, chronic airway obstruction, cardiovascular disease, other cancers.** Approximately 336,000 children and 585,000 non-smoking adults in the County are regularly exposed in their homes.* *Source: LACHS, 2007 **Source: OHAE: Smoking Prevalence Among Los Angeles County Adults, LA Health Trends; August 2006

7. 7 Impact of Tobacco Use in Los Angels County Source: TCPP, 2006

8. 8 Impact of Tobacco Use in Los Angels County Source: TCPP, 2006

9. Cost to Employers Reduced Productivity On average male smokers miss 4 days and female smokers miss 2 more days of work a year than non-smokers.* The average smoker spends a total of 18 days a year on smoking breaks.* In Los Angeles County, total costs in lost productivity from tobacco use is more than $2.0 billion dollars per year.** Adult smokers cost employers at least $1,760 per year in lost productivity.* *Source: Pacific Business Group on Health: Tobacco Cessation Benefit Coverage and Consumer Engagement Strategies, 2008 ** Source: Max et al, 2002 9

10. Cost to Employers Increased Medical Expenditures Smoking costs Los Angeles County more than $2.3 billion in direct medical costs.** Adult smokers cost employers $1,623 per year in excess medical expenses.* Neonatal health care costs related to smoking are equivalent to $704 for each maternal smoker.* On average, tobacco users cost company drug plans twice as much as non-tobacco users.* *Source: Pacific Business Group on Health: Tobacco Cessation Benefit Coverage and Consumer Engagement Strategies, 2008 ** Source: Max et al, 2002 10

11. Smokers Want to Quit Approximately 70% of smokers reported wanting to quit smoking.* Overall, 56.7% of smokers attempted to quit smoking in 2007.* Of those who made a quit attempt, 81% reported trying to quit “cold turkey” or without using a cessation aid.* Only 5% or fewer are successful with each attempt because most try without tobacco counseling or medications.** *Source: LACHS, 2007 ** Source: Fiore MC, et al. Treating Tobacco Use and Dependence: 2008 Clinical Practice Guideline 11

12. Employers Can Help Further Reduce Tobacco Use Nearly 1.8 million smokers in California receive their health insurance benefits through their employer. 57% of workers in private businesses offered employer-sponsored health insurance were offered benefits that included at least one form of tobacco-dependence treatment: nicotine replacement therapy Zyban ® smoking-cessation counseling Only 22% of these employees have coverage for all three types of treatment. Source: McMenamin SB, et al: Trends in Employer-Sponsored Health Insurance Coverage for Tobacco-Dependence Treatments, Am J Prev Med 2008;35(4) 12

13. Effective Treatments Tobacco-dependence treatment is more cost effective than most other common and covered disease prevention interventions, such as the treatment for hypertension and high blood cholesterol.* Proven cessation strategies — such as counseling, telephone quitlines, and FDA-approved smoking medications (nicotine gum, inhaler, lozenge, nasal spray, patch, Zyban, and Chantix) — can double or even triple a smoker’s chance of quitting.** Tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit.** *Source: Cummings SR, et al. The cost-effectiveness of counseling smokers to quit. JAMA 1989;261(1):75–79. **Source: Fiore MC, et al. Treating Tobacco Use and Dependence: 2008 Clinical Practice Guideline, 2008 13

14. Coverage Recommendations Tobacco-use screening is covered at every clinical encounter. Eligible patients may access two courses of six counseling sessions per calendar year, for a total of 12 sessions per calendar year.. FDA-approved nicotine replacement products and tobacco cessation medications are covered as prescribed by a clinician and are not subject to copayments or deductible. Counseling sessions should last at least 30 minutes each. A course of treatment should support up to 300 minutes of counseling. Source: Purchaser’s Guide to Clinical Preventive Services: Moving Science to Coverage, 2008 14

15. What Can Employers Do? Learn more about smoking behavior among employees. Know what tobacco-use treatments your current health plan provides. Ask for coverage that provides effective treatments, including counseling and all FDA-approved medications. Promote effective tobacco cessation services, including the California Smokers’ Helpline (1-800 NO BUTTS). Include tobacco cessation services in worksite wellness programs. Strengthen existing smoke-free work policies. 15

16. Benefits of Tobacco-Use Cessation Over time, tobacco-use cessation benefits generate financial returns for employers in four ways: Reduced health care costs Reduced absenteeism Increased on–the–job productivity Reduced life insurance costs Benefits realized more immediately include: Increases in employee productivity Reductions in smoking–attributed neonatal health care costs Smoke-free workplace policies may also realize savings on fire insurance and costs related to property repair and upkeep. Source: CDC. Coverage for Tobacco Use Cessation Treatments, 2008 16

17. Resources Centers for Disease Control and Prevention http://www.cdc.gov/tobacco/ A Purchaser's Guide to Clinical Preventive Services: Translating Science into Coverage http://www.businessgrouphealth.org/benefitstopics/topics/purchasers/fullguide.pdf America’s Health Insurance Plans-Online ROI Calculator www.businesscaseroi.org 17