1. Continuing the Journey to a Tobacco-Free Kansas Jeffrey Willett, Ph.D. Vice President for Programs

2. Infertility, impotence and pregnancy complications placenta previa, placental abruption, premature birth, low-birth-weight infants, stillbirth, and infant death Peptic ulcers Periodontitis Lower survival rate after surgery Delayed wound healing, reduced immune response, infections, postoperative pneumonia Smoking and Disease Cancers Oral cavity, pharynx, larynx, esophagus, lung, bladder, stomach, cervix, kidney, pancreas, acute myeloid leukemia Vascular disease Coronary heart disease and stroke, atherosclerosis, abdominal aortic aneurysm Respiratory disease chronic obstructive pulmonary disease, chronic coughing and wheezing, upper and lower respiratory tract infections, reduced lung function

3. Secondhand Smoke and Disease Causes 53,000 deaths per year – Immediate adverse effects on CVS – CHD and lung cancer No risk-free level of exposure Children at increased risk – sudden infant death syndrome (SIDS), – acute respiratory infections, – ear problems, – more severe asthma.

4. Environment Host Tobacco User Potential User Agent Tobacco Products Vector Tobacco Companies Tobacco Retailers Addiction Disease Death

5. In 2010, tobacco companies spent $8.5 billion nationally on marketing. 90% of tobacco marketing goes to the retail environment. Retail tobacco marketing includes paying retailers to prominently display tobacco products, in-store advertising, price discounts and other in- store promotions.

6. Stores are the main channel of communication for tobacco companies to reach new and current customers. Studies have identified a clear link between retail tobacco marketing and youth smoking behaviors. There are apparent discrepancies between self- reported youth purchase behaviors and retail sales to minor compliance data.

7. Tobacco companies pay retailers to put their products in the most visible location in the store: at the point of sale where they are prominently displayed. Contracts with retailers give the tobacco industry direct control over how products are displayed and promoted at the point of sale.

8. Copyright ©2010 American Public Health Association Frieden, T. R. Am J Public Health 2010;100:590-595 The health impact pyramid fluoridated water immunizations treatment of hypertension dietary counseling

9. Tobacco control - health impact pyramid Prevention and cessation education. Health provider 5As, EHR that document tobacco screening and interventions. Mass media campaigns. Smoke-free policies, high prices for tobacco, restricting tobacco marketing, establishing and reinforcing tobacco-free social norms. Tobacco industry targeting of low-SES, racial/ethnic minorities, LGBT. Tobacco use to self-medicate for depression/stress caused by social disadvantage. Family and social networks supportive of tobacco use. Increasing Population Impact Increasing Individual Effort Needed

10. Percentage of U.S. Adults Who Currently Smoke, NHIS 1999-2010 Best Practices Period Tobacco Master Settlement Agreement Quitline Established in Every State 48.6% of U.S. Covered by Smoke-Free Laws 1 47 States Raise Cigarette Taxes 2 States Invest $8 Billion in Tobacco Prevention Programs 2 Sources: 1 – American Nonsmokers Rights Foundation; 2 – Campaign for Tobacco Free Kids Tobacco Industry Marketing Nicotine Addiction and Product Design

11. Percentage of U.S. Adults Who Currently Smoke, NHIS 1999-2010 Best Practices Period Tobacco Master Settlement Agreement Quitline Established in Every State 48.6% of U.S. Covered by Smoke-Free Laws 1 47 States Raise Cigarette Taxes 2 States Invest $8 Billion in Tobacco Prevention Programs 2 Sources: 1 – American Nonsmokers Rights Foundation; 2 – Campaign for Tobacco Free Kids Tobacco Industry Marketing Nicotine Addiction and Product Design Healthy People 2020 Goal – 12%

13. Tobacco Use in Kansas

14. 3,800 Kansas adults die each year from their own smoking 54,000 Kansas kids now under 18 will ultimately die prematurely from smoking $927 million in annual health care costs in Kansas are directly caused by smoking of which $196 million is covered by the state Medicaid program Health and Economic Impact

15. Current Smoking – Kansas and US* (2011) Source: Behavioral Risk Factor Surveillance System *Median for 50 states and D.C. Healthy People 2020 Goal – 12%

16. Current Smoking – Kansas and US* (2011) Source: Behavioral Risk Factor Surveillance System *Median for 50 states and D.C.

17. Current Smoking – Kansas and US* (2011) Source: Behavioral Risk Factor Surveillance System *Median for 50 states and D.C.

18. Percentage of Kansas HS Students Who Currently Smoke, 2000-2010 Youth Tobacco Survey: 2000, 2002, 2010; Youth Risk Behavior Surveillance System: 2005, 2007, 2009

19. Current Tobacco Use by Gender Kansas High School Students Source: 2010 Kansas Youth Tobacco Survey

20. 1.Clear public health threat 2.Evidence-based interventions 3.Tobacco-related revenue Tobacco Use – A Winnable Battle

21. Comprehensive Smoke-Free Air Laws 2010 Kansas Indoor Clean Air Act Raising the Retail Price of Tobacco Products KS cigarette excise tax = $0.79 (36 th in nation) National average = $1.49 Funding Comprehensive Tobacco Control Programs KS state funding = $1.0 million (37 th in nation) CDC recommendation = $32 million Tobacco revenues = $60 million MSA / $100 million tobacco taxes Tobacco Cessation Limited Medicaid coverage American Lung Association gave KS an F Core Tobacco Control Strategies

22. Statewide efforts should include implementing evidence-based policy interventions to decrease tobacco use initiation, increase cessation, and protect people from exposure to secondhand smoke.

23. Community programs are essential for advancing and implementing powerful tobacco control interventions.

24. Community Supportive of Tobacco Control Community Education Decision Maker Education Community Mobilization Community Change

25. Thank you Contact Information: Jeffrey Willett jwillett@khf.org