Making Progress in Tobacco Control: The Good, Bad, and Ugly

1
Making Progress in Tobacco Control The Good,
Bad, and Ugly

• Michael Kretz, M.D.
• 7/22/05
• President
• Pierce-St. Croix Tobacco Free Coalition

2
(No Transcript)
3
Corporate Tobacco

• Spends 23 in marketing for every 1 we spend on
  prevention and helping people quit.
• In 2004, spent 12.7 billion in marketing and
  promotion.
• Spent 247 million in Wisconsin in 2004.
• They market to the less affluent, lesser
  educated, certain racial/ethnic groups, and kids.
• (www.tobaccofreekids.org)

4
Plasma Nicotine Levels after a Smoker Has Smoked
a Cigarette, Received Nicotine Nasal Spray, Begun
Chewing Nicotine Gum, or Applied a Nicotine
Patch. The amount of nicotine in each product
is given in parentheses. The pattern produced
by the use of the nicotine inhaler (not shown) is
similar to that of nicotine gum. (Garret, 2001)
5
Annual Smoking Deaths
Average Annual Number of U.S. Deaths Attributable
to Cigarette Smoking, 1995-99 (Total average
number, 442,532) (CDC)
6
Morbidity and Mortality 2005
7
Doubly Ugly

• Wisconsin spends about 2.4 of the 423.6
  million in tobacco-generated revenues on tobacco
  prevention (Rank 24th).
• (www.tobaccofreekids.org)

• 46 of Wisconsin smokers tried to quit in the
  past 12 months (421,000 smokers)!
• 2. 80 tried to quit on their own (337,000) at
  a success rate of 5.
• (www.ctri.wisc.edu) Insights Smoking in
  Wisconsin 2002

8
State Snapshot 2004 from the National Healthcare
Quality Report
9
(No Transcript)
10
(No Transcript)
11
2003 St. Croix County Community Health Needs
Assessment

• 3 Focus Groups
• Lack of access to care (affordable health
  insurance)
• Poor diet/exercise
• Tobacco, alcohol, drugs

• Health Survey (683)
• Health insurance cost
• Cost of prescriptions
• 5. Health care cost

12
Smoking-caused lung diseases(Department of
Health and Family services, 2002)

• Lung cancer
• Cost 23,247
• Number 2,325
• Smoking 88
• Total hospital cost due to smoking
• 47.5 million

• COPD (emphysema)
• Cost 11,116
• Number 7,277
• Smoking 83
• Total hospital cost due to smoking
• 67.4 million

13
Heads-Up on Health Costs

• Average 65-year-old couple
• (first 15 to 20 years of retirement)
• Medicare Premiums 58,900
• Prescription Drugs 62,700
• Other health-care needs 68,400
• 
  190,000
• (Study by Fidelity Investments)

14
National Report CardState of Tobacco Control 2004

• Grades
• Cessation F
• Framework Convention D
• on Tobacco Control
• FDA Tobacco Regulation F
• Cigarette tax F
• (www.lungusa.org)

15
Wisconsin Report Card State of Tobacco Control
2004

• Grades
• Smokefree Air F
• Youth Access D
• Tobacco Prevention and
• Control Spending F
• Cigarette Tax D
• (www.lungusa.org)

16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
Building Infrastructurethe Tobacco Control System

• Wisconsin Tobacco Quit Line (36,000 calls)
• 230 Wisconsin Referral Resources
• Fax-to-Quit Sites (522)
• 384 Clinics
• 110 First Breath Sites
• 28 Employer Sites
• Center for Tobacco Research and Intervention
  (CTRI)
• Outreach
• Research
• Presentations to health care providers (gt10,000)
• FACT (6,000)
• Tobacco Free Coalitions (77?44)
• Wisconsin Wins (33.7?8.3)
• First Breath Sites (111)
• Information distribution (www.tobwis.org)

22
Wisconsin Tobacco Quit Line

• 44,000 calls
• 7,500 smokers quit
• Quit Rate 4 X greater than cold turkey
• 24 million in health care costs saved
• 1,623 saved annually
• 61 return on investment

23
(No Transcript)
24
Key Cultural Values

• Western Cultures
• Independence (go it alone)
• Individualism (be unique)
• Competition (go for the gold)
• Involvement (them and us thinking)

• Eastern Cultures
• Interdependence (all together)
• Collectivism (blend in)
• Collaboration (team first)
• Partnership (we and ours thinking)

(Hantiuk and Gebretensae 2005)
25
Gallup Survey (1993)

• 94 feel responsibility to speak up to a friend
  or loved one about an unhealthy behavior
• 2. Only 38 felt comfortable or confident

26
Reluctance is cultural!

• If you cant say something nice, dont say
  anything at all.
• Judge not lest be judged.
• What if I make a mistake and say something
  wrong.
• I do not want to get involved in someones
  personal business.
• If you live in a glass house

27
More than QuittingProcesses of change for the
smoker

• 1) Consciousness-raising
• 2) Social Liberation
• 3) Emotional arousal
• 4) Self re-evaluation
• 5) Commitment
• 6) Countering
• 7) Environmental control
• 8) Reward
• 9) Helping relationship
• (Prochaska, James O. 1994Stages of
  Change/Transtheoretical Model)

28
Pieces of Child Development

• Physical
• Emotional
• Social
• Language
• Cognitive
• (not either/orschool is part of child
  development)

29
(No Transcript)
30
Overarching Goals

• Improve the health of the public
• 2. Reduce disparities
• 3. Transform the Public Health System

31
Keys to Successful Change

• Empathy, communication, participation
• Communication means more than telling. It
  means creating understanding.
• (Managing Change Effectively Kirkpatrick, 2001)

32
(No Transcript)
33
(No Transcript)
34
Model Capacity

• Holistic (everyone has a role)
• Ecological (all interrelated and
  interdependentno silos)
• Natural Systems (sustainability)
• Developmental
• Proactive
• upstream perspective
• Giving the work back to the people
• Approach is positive (not deficit focused)
• Individual still matters!
• Choice is informed

35
From Benjamin Franklin and Stephen Covey

• Franklin
• Teach me and I will forget
• show me and I may remember
• involve me and I will learn.
• Covey
• Involvement plus patience Commitment

36
An opportunity for

• sharing experiences and problems (successes and
  failures)
• interactive learning from each other
  (synergy/feedback)
• building trust (removing fear) and competence for
  enhanced capacity (self-efficacy)
• Integrating the work of the Public Health System
  into other systems (involvement)

37
Public Health versus Tobacco

• We represent the people.
• We advocate, treat, promote, prevent
• We offer life, liberty, pursuit of happiness.

• They represent ? (the shareholder).
• They addict the poor, young, less educated,
  ethnic/minorities
• They offer human suffering, disability, and
  death.

38
My Perspective/RelationshipsGetting Organized

• River Falls Community Partnership For Youth
• Pierce-St. Croix Tobacco Free Coalition
• Pierce County Healthy Eating and Active Living
  Coalition
• Pierce-St. Croix County Medical Society
• Health and Human Services Board Committee-St.
  Croix County
• Board of DirectorWisconsin Child Care
  Improvement Project
• University Committee on Health and Wellness

39
Breathing Secondhand Smoke Involuntary
Cigarette Smoking

• Two hours in a smoky
• bar

Two hours in a nonsmoking section of restaurant

24 hours living with a pack-a-day smoker
JAMA, July 28, 1993Vol. 270, No. 4, pp. 490-493
40
Household Contamination

• Vapor phase
• Components deposit/are absorbed onto walls,
  furniture, clothes, toys within minutes
• Re-emitted into air over hours to months
• Particulate phase
• May deposit on surfaces within hours and
  re-suspend
• Contaminates house dust, carpet, furniture for
  weeks and months
• Nicotine

(Matt, 2004)
41
(Wisconsin Tobacco Facts 2004)
42
Support for new smoking bans

• 74 favored smoking bans
• 80 go out as oftenor more often
• 13 drove at least once to other communities to
  smoke in bars and restaurants
• Most people consider secondhand smoke a health
  hazard
• (MPAAT, 2005)

43
(No Transcript)
44
Take control of your health

• 2/3rds of cancer deaths prevented by
• Not using tobacco products
• Maintaining a healthy body weight
• Getting plenty of physical activity
• Eating healthy food
• Avoiding the midday sun and protecting skin with
  a hat, shirt, and sunscreen
• (American Cancer Society 2005)

45
Conclusions

1. Tobacco control is the work of Public Health.
2. New Institute of Medicines Model includes
   everyone as members of the Public Health System .
3. Our cultural values are a barrier to a healthier
   population.
4. Broader understanding of successful child
   development equals public health.
5. Opportunities for improving population health are
   everywhere!

46
Contact me at

• dkretz_at_pressenter.com
• Phone [phone]
• Michael Kretz, MD
• 256 Troon Court
• Hudson, WI 54016