Tobacco Progress Review May 14, 2003

1. Tobacco Progress Review May 14, 2003

2. 28% of High School Students 11% of Middle School Students 54% of Nonsmokers Exposed 22% of Adults (46 million adults) Annual Impact ~440,000 Premature Deaths Lung / Other Cancers Chronic Respiratory Disease Cardiovascular Disease 14% of Medicaid Expenditures Direct and Indirect Costs: $157 Billion Tobacco Impact and Public Health Challenges Public Health Challenges Environmental Tobacco Smoke Current Smokers

3. Annual Impact ~440,000 Premature Deaths Lung / Other Cancers Chronic Respiratory Disease Cardiovascular Disease 14% of Medicaid Expenditures Direct and Indirect Costs: $157 Billion Tobacco Impact and Public Health Challenges Public Health Challenges Future Smokers Current Smokers Environmental Tobacco Smoke

4. Smoking-Attributable Mortality, 1995-1999 Number of average annual deaths All Deaths Smoking-attributable (19%) Other Respiratory disease Burn deaths Cardiovascular diseases Perinatal conditions Total Total Neoplasms Lung cancer Ischemic heart disease Environmental Tobacco Smoke Sources: CDC. Annual Smoking –Attributable Mortality, Years of Potential Life Lost, and Economic Costs—United States, 1995-1999. MMWR 2002 51;300-3. Burn deaths from: Hall JR. The U.S. smoking-material fire problem. Quincy, Massachusetts: National Fire Protection Association, Fire Analysis and Research Division, 2001. Environmental tobacco smoke deaths from: National Cancer Institute. Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protection Agency. Smoking and tobacco control monograph 10. Bethesda, Maryland: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 1999. Total does not equal sum due to rounding.

5. 3-2. Lung Cancer Death Rates Age-adjusted death rate per 100,000 standard population Black male Total male White male Total population 2010 Target White female Total female Black female Notes: Data are age adjusted to the 2000 standard population. Source: National Vital Statistics System-Mortality (NVSS-M), NCHS, CDC.

6. 27-1a. Current Cigarette Smoking: Adults 18 Years and Older Age-adjusted percent Black male White male White female Black female 2010 Target 1975 1965 1975 1985 1995 2001 Notes: Data are age adjusted to the 2000 standard population. Survey redesigned in 1997 and data for 1998 and subsequent years may not be directly comparable to earlier years. Source: National Health Interview Survey (NHIS), NCHS, CDC.

7. 3.2 Lung Cancer Death Rates 27-1a. Current Cigarette Smoking: Adults 18 Years and Older Age-adjusted death rate per 100,000 standard population Age-adjusted percent Black male 60 Black male White male Total male 40 White male Black female Total population White female White female 20 Total female Black female 0 1970 1980 1990 2000 1965 1975 1985 1995 2001 1950 1960 Sources/Notes: Same as previous slides for objectives 3-2 and 27-1a.

8. Annual Adult Per Capita Cigarette Consumption Broadcast Ad Ban 1st World Conference on Smoking and Health 1st Great American Smokeout 1st Surgeon General’s Report Nicotine Medications Available Over the Counter End of WW II Master Settlement Agreement Fairness Doctrine Messages on TV and Radio 1st Smoking- Cancer Concern Surgeon General’s Report on Environmental Tobacco Smoke Nonsmokers’ Rights Movement Begins Federal Cigarette Tax Doubles Great Depression Sources: Centers for Disease Control and Prevention and the United States Department of Agriculture.

9. 1998 Baseline Current Level 2010 Target 27-1a. Current Cigarette Smoking for Adults Age-adjusted percent American Indian/ Alaska Native only 16 years or more Total* White only, not Hispanic* Males* Females* 9-11 years Asian only High school graduate 13-15 years Black only, not Hispanic* Hispanic* Education level *Preliminary data: January-September 2002, current data year for other groups is 2001. Notes: Current smokers report smoking everyday/some days and have smoked at least 100 cigarettes. Data are age adjusted to the 2000 standard population. American Indians/Alaska Natives or Asians/Pacific Islanders may be of Hispanic origin. Hispanics may be of any race. For 1998 and 2002, persons reported only one race or reported more than one race and identified one race as best representing their race. Adults: 18 years and older. Source: National Health Interview Survey (NHIS), NCHS, CDC.

10. 27-5. Current Adult Smokers Who Attempted and Failed to Quit in the Past Year, 2001 2010 Target Age-adjusted percent American Indian/ Alaska Native only Asian only Total Hispanic Black only, not Hispanic White only, not Hispanic I 95% confidence interval *Current smokers (everyday/some days and have smoked at least 100 cigarettes) who have quit smoking one day or longer in the year prior to interview. Notes: American Indians/Alaska Natives or Asians may be of Hispanic origin. Hispanics may be of any race. Data are age adjusted to the 2000 standard population. Adults:18 years and older. Source: National Health Interview Survey (NHIS), NCHS, CDC.

11. 27-1a, 27-2b. Current Cigarette Smoking Percent Students (grades 9-12) Adults (18 and older) 2002* 2010 Target: Students 2010 Target: Adults 1965 1970 1975 1980 1985 1990 1995 2000 *Preliminary data, January-September 2002. Notes: Adults, age adjusted to the 2000 standard population. Current Smoking: Adults-every/some days (and have smoked at least 100 cigarettes), Students-1+ day/past month. Sources: Adults, National Health Interview Survey (NHIS), NCHS, CDC. Students, Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

12. Healthy People 2010 Objectives Past Month* Tobacco Users: Students (Grades 9-12), 2001 *Tobacco use on one or more days in the 30 days preceding the survey. Note: Tobacco users may have used more than one tobacco product. Source: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

13. 1999 Baseline 2001 2010 Target 27-2b. Cigarette Use in Past Month*:Students (grades 9-12) Percent In 2000, 11% of students in grades 6-8 smoked** Total Black, not Hispanic White, not Hispanic Females Males Hispanic I 95% confidence interval *Smoked cigarette(s) on one or more days of the 30 days preceding the survey. Note: Data for American Indians/ Alaska Natives, and Asians/Pacific Islanders are unreliable. Sources: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC and **National Youth Tobacco Survey, OSH, CDC and The American Legacy Foundation.

14. Current Cigarette Smoking, Price and Tax: Students (12th Grade) Dollars Percent Current smoking Current smoking Real price per pack Mean excise tax on a pack of cigarettes *Current cigarette smoking: Have smoked at least once in the past 30 days. ** Real price is Consumer Price Index-adjusted national average retail price. Real price and mean excise tax per pack of cigarettes adjusted for inflation. Sources: Original analysis/slide prepared by the ImpacTeen Project. Estimated prices for the period covered by the survey data are based on the 11/01 price for each year reported by Orzechowski and Walker, adjusted for changes in state and federal cigarette taxes and trends in the non-tax component of price. Price data from: Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation 2001. Arlington, Virginia: Orzechowski and Walker, 2002. Smoking prevalence data from: Monitoring the Future Study, NIH, NIDA. Tax data from: The Tax Burden on Tobacco, The Tobacco Institute.

15. Serum Cotinine Levels for Persons Aged 4 Years and Older, 1988-1991 5 ETS exposure among non-smokers Smokers 4 3 Percentage of the population 2 1 0 0.1 1.0 10 100 1000 0.05* Serum cotinine (ng/mL) *Lowest level of detection Source: Pirkle et al. Exposure of the US population to Environmental Tobacco Smoke. The Third National Health and Nutrition Examination Survey, 1988 to 1991. JAMA, April 24, 1996-Vol 275, No. 16 pp.1233-1240.

16. 1988-94 Baseline 1999-2000 27-10. Exposure to Environmental Tobacco Smoke: Nonsmokers* with Detectable Cotinine Levels**, Ages 4 and Older Age-adjusted percent with detectable serum cotinine 2010 Target Total Mexican American Black, not Hispanic White, not Hispanic I 95% confidence interval * Nonsmokers defined by serum cotinine levels < 11 ng/mL. **Detectable serum cotinine levels: > .05 ng/mL and < 10 ng/mL. Notes: Age adjusted to the 2000 standard population. Data for other Hispanics, American Indians,/Alaska Natives, Asians/Pacific Islanders are unreliable. Source: National Health and Nutrition Examination Survey (NHANES), NCHS, CDC.

17. 2010 Target 2002 1998 Baseline 27-13. Smoke-Free Indoor Air Laws* Total number of States with laws (including D.C.) 2010 Target 24 25 18 22 17 16 13 6 5 3 1 4 3 Transportation Workplace *Indoor air laws: smoking bans or limited to separately ventilated areas. Source: State Tobacco Activities Tracking and Evaluation System (STATE System), OSH, NCCDPHP, CDC .

18. 27-8b. Number of States With Medicaid Coverage for Treatment of Nicotine Dependency 2010 Target: 51 (50 States and D.C.) Source: Health Policy Tracking Service, National Conference of State Legislators.

19. Progress review data and slides can be found on the web at: http://www.cdc.gov/nchs/hphome.htm