1. Campaign for Tobacco-Free Kids www.tobaccofreekids.org CHANGING TOBACCO POLICY TO REDUCE HEART DISEASE & STROKE Nichole Veatch, Vice-President, Research Campaign for Tobacco-Free Kids Washington, DC October 21, 2015

2. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Tobacco is the leading preventable cause of death, killing more than 480,000 Americans each year – Nearly 150,000 of these deaths are from heart disease and stroke Tobacco causes nearly 90% of lung cancer deaths, 30% of all cancer deaths, and nearly 1/3 of deaths from heart disease More than 2,500 kids try their first cigarette every day – Another 580 kids become regular daily smokers every day; one-third will die from smoking-related diseases Tobacco use costs the U.S. approximately $170 billion in health care expenditures annually Tobacco’s Toll in U.S.

3. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Secondhand Smoke Causes Heart Disease & Stroke CDC: “Exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and can cause coronary heart disease and stroke.” Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25–30%. Secondhand smoke increases the risk for stroke by 20−30%. Secondhand smoke causes nearly 34,000 premature deaths from heart disease each year in the United States among nonsmokers. Secondhand smoke exposure causes more than 8,000 deaths from stroke annually. Source: CDC, Health Effects of Secondhand Smoke

4. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Source: CDC, Health Effects of Cigarette Smoking Just 1 year after quitting smoking, risk for a heart attack drops sharply. Within 5 years after quitting smoking, risk for stroke could fall to about the same as a nonsmoker’s. Quitting Smoking Cuts Cardiovascular Risks

5. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Evidence Based Policy Solutions Public Policies That Protect Children, Help Smokers Quit, and Restrain the Tobacco Industry – Tobacco Taxes – Smoke-Free Laws – Media Campaigns – Comprehensive Tobacco Prevention and Cessation Programs – FDA Regulation of Tobacco

6. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Tobacco Excise Taxes “Raising prices on cigarettes is one of the most effec­tive tobacco control interventions.” “The evidence is sufficient to conclude that increases in the prices of tobacco products, including those resulting from excise tax increases, prevent initiation of tobacco use, promote cessation, and reduce the prevalence and intensity of tobacco use among youth and adults.” — 2014 Surgeon General’s Report, The Health Consequences of Smoking: 50 Years of Progress 6

7. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Federal Cigarette Excise Tax + Average State Cigarette Tax federal rate ($1.01) + current state average ($1.60 * ): $2.61 per pack 1996 federal rate (24¢) + state average (33¢): 57¢ per pack 2001 federal rate (34¢) + state average (43¢): 77¢ per pack October 2015 * Includes state cigarette tax rates in effect as of October 1, 2015.

8. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Smoke-Free Laws “... smokefree legislation at the state and local levels is a key component of a comprehensive tobacco control strategy.” (2014 Surgeon General’s Report) The Surgeon General’s Report calls for “complete protection of the entire U.S. population from exposure to tobacco smoke through comprehensive smokefree indoor air policies.” (2014 Surgeon General’s Report) 8

9. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Source: American Nonsmokers’ Rights Foundation Percent of Population Covered By Smoke-Free Laws (Workplaces, Restaurants & Bars) 2015: 49.5% 24 states and hundreds of communities are smoke-free 1996: < 1% Comprehensive smoke-free laws in 7 communities nationwide 11/27/2002: 3% DE becomes 1 st smoke-free state in all workplaces, restaurants and bars

10. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Statewide ban motivating Minnesota smokers to quit By JOSEPHINE MARCOTTY, Star Tribune December 11, 2007 The state-wide smoking ban is having an unadvertised consequence: More smokers are trying to quit. Since the ban went into effect Oct. 1, the state's two largest health plans and the anti-tobacco organization ClearWay have seen a sharp spike in the number of people using nicotine replacement products and smoking cessation counseling programs. Blue Cross and Blue Shield of Minnesota said that between September and October the number of people who enrolled for its telephone hotline counseling service jumped to 525, an increase of 43 percent. Compared to October 2006, the number of over-the-counter products like the patch and nicotine gum that it provided to members tripled to a total of 10,000 claims. "It's doing what we like it to do," said Marc Manley, medical director for population health at Blue Cross. "Helping people decide to quit." Medica, Minnesota's second-largest health plan, said it has also seen a 40 percent increase in the number of members seeking counseling.

11. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Institute of Medicine Report (2009) Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence IOM reviewed 11 publications looking at the relationship between smoke-free laws and cardiovascular events. Data consistently demonstrate that secondhand smoke exposure increases the risk of coronary heart disease and heart attacks. Based on the evidence, IOM concluded that smoke-free laws, “do, in fact, decrease the rate of heart attacks.” Source: IOM Report Brief: Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence

12. Campaign for Tobacco-Free Kids www.tobaccofreekids.org These findings suggest that tens of thousands of heart attacks could be prevented each year, and that states and communities that do not have comprehensive smoke–free laws could have significant cardiovascular health benefits by doing so. There’s no time to waste with this many lives at stake. It is time to mount a full- scale assault on the tobacco epidemic and eliminate all exposure to secondhand smoke. Smoke-free laws are one of the most readily available and cost-effective methods for preventing heart attacks, heart-disease related illnesses and deaths, and reducing health care costs. CDC Statement on IOM Report

13. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Mass Media Campaigns Reduce Tobacco Use To accelerate progress in tobacco control, 2014 Surgeon General’s Report calls for specific actions, including: “Counteracting industry marketing by sustaining high impact national media campaigns like the CDC’s Tips from Former Smokers campaign and FDA’s youth prevention campaigns at a high frequency level and exposure for 12 months a year for a decade or more.” — 2014 Surgeon General’s Report, The Health Consequences of Smoking: 50 Years of Progress

14. Campaign for Tobacco-Free Kids www.tobaccofreekids.org CDC’s “Tips from Former Smokers” First-ever government funded national tobacco education campaign, launched March 2012 Features real people dealing with serious long-term health effects from smoking and SHS 2012 Tips campaign motivated 1.6 million smokers to make a quit attempt 2012 Tips campaign helped more than 100,000 U.S. smokers quit for good and saved 17,000 from premature death Cost-effective 14 cdc.gov/tips

15. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Comprehensive State Prevention and Cessation Programs State and Community Interventions Public Education Campaigns Cessation Services including Quitlines Three Core Elements Help Prevent Initiation and Encourage and Help People to Quit

16. Campaign for Tobacco-Free Kids www.tobaccofreekids.org NYC Adult Smoking, 2002-2014 NYS tax increase Federal tax increase NYS tax increase Hard-hitting media campaigns Smoke-free Workplaces Free patch programs start NYC and NYS tax increases Ad Campaign/ Patch Give-away National TIPS Campaign Age of sale increase (21); comprehensive pricing & enforcement policies Source: NYC Community Health Survey, 2002-2014

17. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Emerging Issues Raising Tobacco Sale Age to 21 Electronic Cigarettes

18. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Raising the Tobacco Sale Age to 21 Why Raise Age? 95% of smokers start before age 21 Nicotine is addictive Older kids/young adults are source of cigarettes Tobacco companies target young adults IOM report released this year concludes that raising the tobacco sale age to 21 will improve public health and save lives. One state and at least 90 localities in 8 states have raised the tobacco sale age to 21.

19. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Growing World of E-Cigarettes (images not to scale)

20. Campaign for Tobacco-Free Kids www.tobaccofreekids.org E-Cigarettes Marketing Mimics the Worst of Cigarette Marketing TV Ads Celebrity Endorsements Cartoons Kid-Friendly Flavors Music Sponsorships NASCAR Car Sponsorships Branded Items “Cigarette Girls” Countertop Displays

21. Campaign for Tobacco-Free Kids www.tobaccofreekids.org High School E-Cigarette Use vs. Cigarette Smoking (past 30 day use) Source: CDC, National Youth Tobacco Survey (NYTS)

22. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Potential of E-Cigarettes to Benefit Public Health Hinges on Unanswered Questions 1.What are the long-term health effects? 2.Will they draw in youth users? How will that impact use of other tobacco products? 3.Can e-cigarettes help smokers quit completely? Effective regulation is needed to minimize the potential harms of e-cigarettes and maximize any potential benefits

23. Campaign for Tobacco-Free Kids www.tobaccofreekids.org Federal Regulation and State Activity on E-cigarettes FDA’s Proposed “Deeming Rule” issued April 25, 2014  Unsure when will be finalized States and localities can take their own action, but should not lose focus on policies that reduce use of traditional tobacco products States and Localities Are Taking Policy Action on Electronic Cigarettes  Prohibit sales to youth: 48 states  Smoke-free: 8 states and 400+ localities  Tax: 4 states, Washington, DC and 5 localities  Child-proof packaging: 17 states  Flavor restrictions: 3 localities (Laws passed as of October 2, 2015)

24. Campaign for Tobacco-Free Kids www.tobaccofreekids.org You Can Help Get Involved with State or Local Tobacco Control Coalition Learn more at our website: www.tobaccofreekids.org www.tobaccofreekids.org – Join our email list: tfk.org/join – Like us on Facebook: facebook.com/tobaccofreekids – Follow us on Twitter: @tobaccofreekids