1. TOBACCO PREVENTION AND CONTROL PROGRAM Mike Maples, Assistant Commissioner Mental Health and Substance Abuse Services

2. Each Day in the United States The tobacco industry spends nearly $36 million to market and promote its products. Almost 4,000 adolescents start smoking. Approximately 1,200 current and former smokers die prematurely from tobacco-related diseases. The nation spends more than $260 million in direct medical costs related to smoking. The nation experiences nearly $270 million in lost productivity due to premature deaths from tobacco- related diseases. Page 2

3. Texas Tobacco Facts 3,257,000 adults age 18+ are smokers Approximately 24,200 adults die annually from a smoking-attributable illness $5.83 billion annual medical costs due to smoking $1.62 billion annual Medicaid costs due to smoking $6.445 billion lost productivity annually due to premature death from smoking $622.4 million spent by the tobacco industry marketing tobacco products in 2008 Page 3

4. Actual Causes of Death in Texas 2001 Page 4

5. Page 5 Trends in Lung Cancer – Incidence & Smoking: United States, 1999-2008 Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in the United States. Most deaths from lung cancer are caused by cigarette smoking and exposure to secondhand smoke. Effective tobacco control policies can decrease smoking prevalence, ultimately leading to decreases in lung cancer.

6. Smoke-Free Texas Municipalities Page 6

7. Page 7 Core Programs Tobacco Prevention and Control Coalitions (TPCC) Prevent tobacco use among youth, ensure compliance with state and local laws, increase cessation among youth and adults, eliminate exposure to secondhand smoke, reduce use in populations with the highest burden of tobacco-related health disparities Quitline – Counseling Services for TPCC Communities and uninsured individuals, pregnant women, and Medicaid recipients statewide. Free Nicotine Replacement Therapy statewide to uninsured and pregnant women.

8. Page 8 Core Programs, Cont’d. Reducing Minors’ Access to Tobacco – Synar (DSHS Enforcement Contract), Texas Youth Tobacco Awareness Program, FDA State Enforcement Contract, Tobacco Hotline Youth Engagement – Teen Ambassadors, Youth Leadership, Regional Summits, Mini-Grants to Schools and Community Groups Media – Focuses on TPCC Communities, Stresses Prevention and Youth Access to Tobacco Products

9. Page 9 Tobacco Budget

10. Page 10 Impact to Personnel FTE Reductions 22.4 FTEs in FY11 to 10.11 FTEs in FY12 Approximately 4.5 FTE Reduction in Central Office Approximately 7.5 FTE Reduction in Regions Staff whose positions were no longer funded by tobacco were transferred to positions and duties funded by other sources Regional Coordinators remain in 7 of the 8 DSHS regional health offices across the state.

11. Page 11 Program & Participant Impact TEA Tobacco Prevention Education Interagency Contract eliminated ($3 million annually) – Served 628 School Districts; 15,230 Teachers; 450,920 Students through 20 regional educational service centers and curriculum for two programs Smokeless Tobacco Prevention Program eliminated ($1 million annually) – 18,957 youth received curriculum; 31,393 students received prevention materials; 608,842 youth reached through media TPCC Program reduced by 35%

12. Page 12 Program & Participant Impact, Cont’d. Media Campaign reduced by 45% Texas Quitline reduced by 39% (FY 2011 average between 2,000-2,500 calls per month) Comptroller Tobacco Law Enforcement Funds eliminated ($1 million of DSHS tobacco funds diverted to maintain program for Synar compliance) Youth Engagement Prevention Program increased by 35% – 20 teen ambassadors, 7 college age consultants, 11 regional youth summits, statewide teen leadership summit, Texas Tobacco-Free Kids Day

13. Page 13 Texas Adult Smoking Rates

14. Page 14 Texas Youth Tobacco Use Lifetime and Past-Month Tobacco Use – G7 - 12 Texas School Survey (1990 - 2010)

15. Page 15 Texas Synar Rates

16. Page 16 Tobacco Initiatives FDA State Enforcement Contract ($1 million per year for three years) – Undercover Buys, Advertising and Labeling Inspections, Targets High Risk Areas (Ethnic & Minority Communities, Near Schools and Recreation Centers), Undercover Buys supplement Synar activities Cancer Prevention Research Institute (CPRIT) – DSHS applied for 3 year grant at $1 million per year to increase Quitline Services to cover uninsured persons statewide, persons receiving treatment for addictions to alcohol or illicit drugs, and persons referred by a clinician (targeting Federally Qualified Health Centers)

17. Page 17 Tobacco Initiatives, Cont’d. Community Transformation Grant (CTG) (Division of Prevention and Preparedness Services) – $10 million per year for five years, includes target of a 5% statewide reduction in morbidity rates due to tobacco Cessation Medication and Nicotine Replacement Therapy (NRT) exempted from three script limit for Medicaid recipients (Additional Rx benefit) Quitline Services approved by CMS for reimbursement at 50% administrative cost for all Medicaid callers