1. Protecting Children and Families from Tobacco: Leadership Advocacy Training Susanne E. Tanski, MD, MPH, FAAP Assistant Professor Geisel School of Medicine at Dartmouth

2. Sponsoring Partners: the Five A’s Collaborative American Academy of Pediatrics American Academy of Pediatrics American Medical Association American Medical Association American Academy of Family Physicians American Academy of Family Physicians American College of Obstetrics and Gynecology American College of Obstetrics and Gynecology American College of Physicians American College of Physicians

3. Funders Grant support to the American Academy of Pediatrics from: Flight Attendant Medical Research Institute (FAMRI) Legacy Unrestricted education contribution from: Pfizer, Inc.

4. Artwork by Julie L.. © 2009 American Academy of Pediatrics (AAP) Children's Art Contest. Support for the 2009 and 2010 AAP Children's Art Contest was from the Flight Attendant Medical Research Institute.

5. …dedicated to eliminating children’s exposure to secondhand smoke and tobacco.

7. US Tobacco Control Tobacco is the leading cause of preventable death and disease in the United States, too Approximately 443,000 die each year 19.3% of adults >18 years smoked in 2010 (45 million)

8. Secondhand Smoke Exposure An estimated 88 million nonsmokers were exposed in the United States in 2007-2008 Children are at particular risk for exposure Only 5.4% of adult nonsmokers live with a smoker Among children: –41.1% exposed to SHS at home –54.9% exposed to SHS in public places Global Youth Tobacco Surveillance, 2000—2007 cdc.gov/preview/mmwrhtml/ss5701a1.htm cdc.gov/preview/mmwrhtml/ss5701a1.htm

9. Secondhand Smoke Children exposed to SHTS have greater risk/rates of:Children exposed to SHTS have greater risk/rates of: Decreased lung functionDecreased lung function AsthmaAsthma Sudden Infant Death SyndromeSudden Infant Death Syndrome Upper and lower respiratory track infections; pneumonia and bronchitisUpper and lower respiratory track infections; pneumonia and bronchitis Ear infectionsEar infections Neuro-cognitive delay and behavior problemsNeuro-cognitive delay and behavior problems Increased adult risk of:Increased adult risk of: LLung cancer and leukemias HHeart disease, lipid disorders, and metabolic syndrome Smoking themselvesSmoking themselves

10. Screening Are we asking the right questions?

11. HHS Strategic Plan Ending the Tobacco Epidemic Accelerate progress for four Healthy People 2020 goals: Reduce tobacco use by adults and adolescents Reduce initiation of tobacco use among children, adolescents, and young adults Increase successful cessation by smokers Reduce nonsmokers exposure to secondhand smoke Support FDA regulation of manufacture, marketing, and distribution of tobacco products

12. Global State of Tobacco Control 2011 WHO Report on the Global Tobacco Epidemic: Tobacco use continues to be the leading preventable cause of premature death and disease worldwide 6 million people die each year due to tobacco related illnesses, most of these in low- and middle-income countries This disparity is expected to widen, with deaths expected to increase to > 8 million a year by 2030 700 million children – almost half of the world’s children - are exposed to secondhand smoke

13. WHO MPOWER Package Monitor tobacco use and prevention policies Protect people from tobacco smoke Offer help to quit tobacco use Warn about the dangers of tobacco Enforce bans on tobacco advertising, promotion and sponsorship Raise taxes on tobacco.

14. Why Physicians? Tobacco use and smoke exposure result in adverse health outcomes for both adults and children 70% of smokers see a primary care physician annually –Only 17.3% of adults report being asked about secondhand smoke exposure by their physician –27.2% of parents report being asked about secondhand smoke exposure by children’s physician –63% of physicians assess patients’ willingness to quit –13% of physicians refer to appropriate treatment –17% of physicians arrange a follow-up visit to address smoking issues

15. Why Physicians? 5 As Collaborative represents over 560,000 physician members Physicians are the first line in any patient interaction and provide the majority of medical interventions on tobacco use and secondhand smoke exposure Physicians provide a credible voice for tobacco control issues to decision makers, elected officials, and communities Physicians can often put a “personal” face on an issue

16. Conference Goals To improve the effectiveness of tobacco control education and advocacy by physician leaders. To provide physician tobacco control advocates with knowledge and tools to collaborate with state chapters, state sections, other medical societies, and local tobacco control organizations to create lasting positive changes in tobacco control and secondhand smoke exposure.

17. Overall Training Objectives Identify at least two qualities physicians bring to strengthen advocacy campaigns and partnerships. Describe trends associated with cigarette & other tobacco product use & cessation. Identify risk factors for tobacco initiation & barriers to tobacco cessation & SHS reduction for children & other non-smokers. Describe the role of state/local governments & health plans in increasing access to tobacco cessation & pharmacotherapy coverage. Explain how tobacco cessation & pharmacotherapy coverage efforts are affected by the Affordable Care Act. Articulate 2 policies that can help promote reduction or elimination of youth initiation & SHS exposure, and improve quit attempts. Identify state, organizational, and community channels that will allow them to get more actively involved in tobacco control advocacy. Identify emerging non-traditional nicotine delivery products that may pose new risks to consumers.

18. 2011 Training Results: One Year Later Physicians continue to share local successes: –Integration of tobacco cessation curriculum into medical school training and residency programs –Reached out to state leaders to express support for clean air laws in state –Worked with hospital leadership to have ashtrays removed from in front of hospital –Arranged Grand Rounds and noon conference sessions in hospital about tobacco control –Received grant for continued smoke-free multiunit housing advocacy and awareness –Conducted tobacco cessation training for physicians, mid-level providers, and nurses in clinic

19. Future Efforts Training model replicated internationally –Malaysia (September 2012) 26 physicians and tobacco control advocates from 13 countries in the Asia Pacific region –Colombia (November 2012) 30+ physicians from 12+ countries on Latin and South America –Melbourne, Australia (August 2013) International Pediatric Association Enrollment underway US training : Today!

20. Artwork by Elizabeth G. © 2010 American Academy of Pediatrics (AAP) Children's Art Contest. Support for the 2009 and 2010 AAP Children's Art Contest was from the Flight Attendant Medical Research Institute.