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Update on the North Dakota Tobacco Quitline The First Year: 2005

Update on the North Dakota Tobacco Quitline The First Year: 2005. Eric Lind Johnson, M.D. Donna A. Añel, M.D, M.P.H. Department of Family and Community Medicine University of North Dakota School of Medicine and Health Sciences Grand Forks, ND. Objectives.

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Update on the North Dakota Tobacco Quitline The First Year: 2005

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  1. Update on the North Dakota Tobacco QuitlineThe First Year: 2005 Eric Lind Johnson, M.D. Donna A. Añel, M.D, M.P.H. Department of Family and Community Medicine University of North Dakota School of Medicine and Health Sciences Grand Forks, ND

  2. Objectives • Describe the impact of tobacco use in North Dakota 2. Discuss the role of health professionals in helping tobacco users quit 3. Highlight the role of the North Dakota Tobacco Quitline in helping tobacco users quit

  3. Tobacco Use in the US, 1900-2000 Per capita cigarette consumption Male lung cancer death rate Female lung cancer death rate *Age-adjusted to 2000 US standard population. Source: Death rates: US Mortality Public Use Tapes, 1960-2000, US Mortality Volumes, 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002. Cigarette consumption: US Department of Agriculture, 1900-2000.

  4. Trends in Cigarette Smoking Prevalence* (%), by Gender, Adults 18 and Older, US, 1965-2002 Men Women *Redesign of survey in 1997 may affect trends. Source: National Health Interview Survey, 1965-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.

  5. 500 400 300 No.(000s) 200 100 0 Annualsmokingdeaths Environ-mentaltobaccosmokedeaths AllWorldWar II Annualautoaccidents VietnamWar AIDS1983-1990 Annualmurders Annualheroin,morphine& cocainedeaths Tobacco Related Deaths-A Perspective

  6. Tobacco Use in North Dakota • 99,837 ND adults and 8223* HS students smoke cigarettes • 20,454 ND adults and 3,824^ HS students use spit tobacco -HS students: *30% in 2003, 22% in 2005 ^10.3% in 2003, 11.2% in 2005 (BRFSS 2003) (YRBS 2005)

  7. Tobacco Use in North DakotaBehavioral Risk Factor Surveillance System (BFRSS) -Between 2001 and 2004, Adult smoking rates in North Dakota dropped from 23.2% to 19.9%, similar to national trends -Healthy People 2010: 12% or less -In 2003, 52% of adult smokers reported tobacco cessation attempts -Smokeless Tobacco rates are above the National median at 23.6%

  8. Tobacco Use in North Dakota • Native American population: 46% adults use tobacco (highest smoking rate of any ethnic group in U.S.) • Smoking in pregnancy higher in North Dakota than national average: 17% vs. 12% • WIC Clinic population survey: 45% smoked prior to pregnancy vs. 16% non-WIC

  9. Tobacco Use in North Dakota In 1999, tobacco use cost the State: • $193 million in Direct Medical Expenditures • $153 million in Productivity Costs (lost wages, etc) • $37 million (11%) of Medicaid expenditures • These figures exclude costs associated with teen smoking, spit tobacco use, and care for premature and LBW babies of smoking mothers

  10. North Dakota Costs Each year 860 North Dakotans die prematurely due to smoking.

  11. Tobacco Use in North Dakota • Heart Disease and Cancer are the leading causes of death in North Dakota • Tobacco use is the leading preventable cause of death

  12. Smoking Prevalence by AgeNorth Dakota 2003 BRFSS

  13. 13.2-14.5 years of life lost due to smoking 440,000 people die annually in the U.S. due to smoking related illnesses Cancer 36% ~90% of lung cancers Are smoking attributed 42% 22% Cardio-vascular Respiratory MMWR 51:300, 2002 CP1120369-13

  14. Cancer Death Rates*, for Women, US,1930-2001 Rate Per 100,000 Lung & bronchus Uterus Breast Colon & rectum Stomach Ovary Pancreas *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes 1960-2001, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.

  15. Cancer Death Rates*, for Men, US,1930-2001 Rate Per 100,000 Lung & bronchus Stomach Prostate Colon & rectum Pancreas Leukemia Liver *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes 1960-2001, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.

  16. Lung Cancer • Leading cause of cancer death in men and women • Smoking causes 87% of lung cancers in the USA • Smoking increases risks of all four major types of lung cancer • Cigar and pipe smoking associated with increased risk • 5-year survival for lung cancer 15% • Reduced risk with smoking cessation • Average 2 year cost per patient - $48,000 MMWR, ACS

  17. Lung Cancer Mortality (CPD) 1-19 >20 CPS I(men) 6.5 13.7 CPS II(men) 18.8 26.9 CPS II(women) 7.3 16.3 Rate Ratio vs never smoked CPS=Cancer Prevention Study-American Cancer Society

  18. Tobacco Use and Oral Cancers • Major inducer of SCC….. Tobacco exposure • Effects of tobacco use, heavy alcohol use, and diet explain 90% of all cases of head & Neck cancer Epstein JB, Spec Care Dent 1997 • SCC incidence 4-7times that in nonsmokers Piyathilake CJ, Canc Epi Biomarker 1995 Ko YC, J Oral Path Med 1995 • Higher cigarette smoke-related risk for oral cancer manifest by reduction in mean age of development of disease by 15 years vs nonsmokers Bross IDJ, Oncol 1976

  19. Tobacco Use and Oral Cancers • ACS - 28,900 cases & 7,400 deaths annually • 90% are Squamous Cell Carcinoma (SCC) • Worldwide - 300,000 cases annually • Ranks 6th among all cancers • 3rd most common site in males in developing countries Vokes EE, NEJM 1993 • Tobacco causes of >85% oral cancer deaths in males Johnson N, J Dent Educ 2001 • High rate of morbidity & mortality • 5-yr average survival < 50%

  20. Tobacco Use and Oral Cancers • Cigars/Pipes • Cigar smoking demonstrated to increase risk of death due to cancer of the oral cavity & pharynx [rate ratio, 4.0, 95% CI 1.5-10.3] Shapiro JA, J Nat’l Can Inst 2000 • Pipe smoking among men associated with increased mortality rate ratios for cancer of the oral cavity [rate ratio, 2.0 to 3.5] Nelson DE, Prev Med 1996

  21. COPD and Smoking • 4th leading cause of death • Accounts for > 100,000 deaths/yr • Symptomatic improvement and lung function preservation with tobacco cessation Report of the U.S. Surgeon General 2004 American Lung Association

  22. Coronary Heart Disease Smoking Attributed CHD Deaths ~30% • Smoking Cessation: Decreased Mortality post-MI • Meta Analysis: Wilson, et al Archives of Internal Medicine, 2000 • Former Smokers OR .54 compared to Continuing smokers

  23. Second Hand Smoke • The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General June 27, 2006 • Landmark Report

  24. Conclusions of the 2006 Surgeon General’s Report • 1) Many millions of Americans, both children and adults, are still exposed to secondhand smoke • 2) Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke. • 3) Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma

  25. Conclusions of the 2006 Surgeon General’s Report • 4) Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer • 5) The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke • 6) Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposures of nonsmokers to secondhand smoke

  26. United States Lung cancer – 3,000 deaths annually Ischemic heart disease – 35,000 deaths annually North Dakota 80-140 deaths annually Secondhand Smoke Deaths

  27. Secondhand Smoke • Cardiovascular Risk is approximately equal to 80% of smoking Circulation, May 2005 • Possible Reduction in MI admits in a Community with Indoor Smoking Ban BMJ April, 2004

  28. Objectives • Describe the impact of tobacco use in North Dakota • Discuss the role of health professionals in helping tobacco users quit 3. Highlight the role of the North Dakota Tobacco Quitline in helping tobacco users quit

  29. The Five “A”s • ASK about tobacco use • ADVISE to quit • ASSESS willingness to make a quit attempt • ASSIST • Provide counseling • Prescribe NRT/WB unless contraindicated • ARRANGE for follow-up

  30. Personalizing Advice • ‘Teachable moments’ within the clinical setting • Current illness • Family history • Medications • Pre-op • Other links to tobacco use • Social and economic costs • Impact on family and friends “I think your sinus infection keeps coming back because of your smoking. Now is a really good time to quit.”

  31. Objectives • Describe the impact of tobacco use in North Dakota • Discuss the role of health professionals in helping tobacco users quit • Highlight the role of the North Dakota Tobacco Quitline in helping tobacco users quit

  32. Tobacco Quitlines • Individualized yet population-based, clinical yet public health-focused too

  33. Quitlines: Great for Rural Settings

  34. Streamlining the 5 A’s—A Role for the Quitline • Ask • Assess • Advise – refer to Quitline • Assist – refer to Quitline • Arrange Follow-up – refer to Quitline (Schroeder, 2003)

  35. North Dakota Tobacco Quitline

  36. Quitlines: Best Practices • Efficacy • Accessibility • Convenience • Quasi-anonymity • No face-to-face encounter – less “demand response”, social desirability bias • Used more by populations under-utilizing traditional cessation services - minorities • Centralized – data collection, staffing, promotion efforts • Have I mentioned FREE? (to users)

  37. North Dakota Tobacco Quitline • Free to all North Dakota residents • Up to 5 telephone counseling sessions • Nicotine replacement therapy (gum, patches) for those meeting income qualification • 6-month quit rate ~36% • 12-month quit rate ~33%

  38. Who answers the phone? • Professional counselors from the Mayo Clinic Tobacco Quitline and the UND Department of Community Medicine • All hold professional degrees • All trained at the Mayo Clinic Nicotine Dependence Center

  39. What happens on the quitline? • Individualized treatment plan • Up to 5 live counseling sessions • Quit Kit sent directly to home • Screen/offer advice for pharmacotherapy • Free NRT mailed to low-income callers

  40. ND Quitline: how are we doing? In the first 12 months, • Served 2,868 calls • 810 callers enrolled for counseling • 372 received free NRT for four weeks

  41. Medications • Nicotine Replacement Therapy (NRT)- Patches, Gum, Lozenges, Inhaler • Varenicline (Chantix) • Buproprion (Wellbutrin)

  42. Impact of Free NRT From Sep 2004 to May 2005: - Monthly call volume: 246 - Monthly counseling enrollees: 34 From June 2005 to August 2005: - Monthly call volume: 809 - Monthly counseling enrollees: 144

  43. Impact of Free NRT: free is good

  44. Quit happens. • 25.6% of North Dakotans are ex-smokers

  45. In summary, today… • We discussed the impact of tobacco use in ND • We discussed the need for effective population-based tobacco cessation programs in ND • We highlighted the role of the North Dakota Tobacco Quitline in helping tobacco users quit

  46. In summary… • The North Dakota Tobacco Quitline helps TOBACCO USERS—it offers gold-standard, highly effective treatment • The North Dakota Tobacco Quitline helps YOU—saves your time, allows you to provide better quality care

  47. Contact us danel@altru.org ejohnson@altru.org • To schedule a lecture/conference or to request materials, please contact: Melissa Gardner Phone: 701-777-3191 Email: ostlund@medicine.nodak.edu

  48. Web Resources • http://www.cdc.gov/tobacco/ • http://www.ahrq.gov/ • http://www.surgeongeneral.gov/tobacco/ (also includes Spanish language handouts-can download and print USPHS guidelines) • http://www.mayoclinic.org/ndc-rst/ (Nicotine Dependence Center-includes links to publications by Mayo staff) • http://www.health.state.nd.us/ (ND Dept. of Health) • http://www.ndtobaccoprevention.net/Facts/ TobaccoAnnualReport.pdf (2004 ND Tobacco) *soon to be updated

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