American College of Physicians Oklahoma City, OK October 14, 2011

1. LOW INCOME SMOKERS: UNDERSTANDING THE LONG TERM HEALTH AND FINANCIAL CONSEQUENCES OF SMOKING American College of PhysiciansOklahoma City, OKOctober 14, 2011 Jason Shultz, MD Martina Jelley, MD, MSPH The University of Oklahoma School of Community Medicine

2. Introduction • Smoking is the #1 preventable cause of death in the United States (438,000 deaths annually). • 16 people a day die in Oklahoma from smoking. • 20% of the US population smokes. • 25.4% adults in Oklahoma smoke (692,700 people). • Smoking cigarettes is becoming more prevalent in low socioeconomic classes. • Financial reasons are being more frequently cited as a reason to quit smoking.

3. Introduction • States with the highest cost of cigarettes generally have lower smoking rates. • Oklahoma ranks 3rd in smoking prevalence and 33rd in cost per pack. • Oklahoma received a failing grade from The American Lung Association for tobacco prevention and control spending. • Previous studies suggested that offering financial incentives increases enrollment in smoking cessation programs and short term quit rates.

4. Methods • Low income Internal Medicine clinic and inpatients were surveyed (<$22,350/yr). • Patients smoked at least ½ ppd. • Patients were questioned to assess their understanding of adverse health effects. • Patients were asked about their total monthly income and how much they spend on cigarettes. • Patients were then asked the following question to assess their appreciation for the long term costs of cigarette use. . .

5. Wealth Accumulation • The average cost for a pack of cigarettes in Oklahoma is $4.86. • If a person who smokes a pack per day were to take that money and invest it in the stock market rather than spending it on cigarettes, how much money would this person accumulate from age 18 to 65 (47 years), assuming an 8% average annual rate of return?

6. Results Every smoker was able to state at least two major adverse health risks caused by smoking cigarettes

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11. Discussion • The adverse health risks associated with cigarette smoking are well documented and understood in the general public. • The majority of participants underestimated the long term financial impact of smoking. • Educating patients on both the health AND financial implications of smoking should decrease the overall smoking prevalence in Oklahoma and worldwide.

12. Future Studies • Current research demonstrates single financial incentives for smoking cessation significantly increased the rates of smoking cessation. • However, additional research is needed to examine the impact of long term financial implications on smoking quit rates. • Further studies may also include the impact on smoking prevention.

13. References • 1. Volpp K. et al. A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation. N Engl J Med. 2009;360:699-709. • 2. Fiore M., Baker, T. Treating Smokers in the Health Care Setting. N Engl J Med. 2011;365:1222-31. • 3. Khalil, R., Aoun-Bacha, Z., Richa, S. Financial Motivation of Smokers to Quit Smoking. The American Journal on Addictions. 20: 487, 2011. • 4. McCaul KD, Hockemeyer JR, Johnson RJ, et al. Motivation to Quit Using Cigarettes: A Review. Addict Behav. 2006;31:42-56 • 5. Henrikus DJ, Jeffery RW, Lando HA, et al. The SUCCESS Project: the Effect of Program Format and Incentives on Participation and Cessation in Worksite Smoking Cessation Programs. Am J Public Health. 2002;92:274-279.

14. QUESTIONS?