Tobacco Control Advocacy and Policy Strategies: Identifying the Problem and Implementing Change

1. Advocacy Recap Eyler, Chriqui, Moreland-Russell & Brownson, 2016 https://youtu.be/aTbtKRdYbYo

2. Advocacy Recap Eyler, Chriqui, Moreland-Russell & Brownson, 2016 https://youtu.be/bFlyt8uKy8k

3. Advocacy Recap Eyler, Chriqui, Moreland-Russell & Brownson, 2016 https://youtu.be/Ccr8WLFNkjw

4. Advocacy Policy Eyler, Chriqui, Moreland-Russell & Brownson, 2016 https://youtu.be/atbZYs215Uw

5. Chapter 6 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Public Policy and Tobacco

6. Identifying the Problem:Tobacco Use and Consequences • Cigarette 1900s E-cigarette Now • Utilized production, advertising, design, and social behavior to influence social norms and create a culture around tobacco use • Death and disease patterns have emerged as a result of the cultural influence – Deeply engrained, but this is slowly changing • Public health prevention strategies used by tobacco control advocates have been integral to the changing social norms spurring the decline of tobacco use Eyler, Chriqui, Moreland-Russell & Brownson, 2016

7. Figure 1.1 Adult per capita cigarette consumption and major historical and policy events Eyler, Chriqui, Moreland-Russell & Brownson, 2016

8. Identifying the Problem:Tobacco Use and Consequences • Epidemiology • Tobacco use has long been a leading cause of morbidity and mortality worldwide • Currently accounts for an estimated 9% of deaths across the globe • United States, smoking is the leading preventable cause of premature death and disease. • Linked with several types of cancer, coronary heart disease, chronic obstructive pulmonary disease, diabetes, asthma, and stroke • Nonsmokers who are exposed to secondhand smoke suffer from tobacco-related illnesses as well • Since the United States Surgeon General began reporting on smoking more than 50 years ago, almost 2.5 million nonsmokers have died from smoking- related diseases Eyler, Chriqui, Moreland-Russell & Brownson, 2016

9. Identifying the Problem:Tobacco Use and Consequences • Epidemiology • 1965, 42% of Americans smoked cigarettes • Tobacco prevention and cessation efforts established and various policies implemented and the population better understands risks • 2013 smoking prevalence rates: • 18% of adults • <13% of youth Eyler, Chriqui, Moreland-Russell & Brownson, 2016

10. Identifying the Problem:Tobacco Use and Consequences • Epidemiology • Rate of decline recently slowed recently: above Healthy People 2020 goals • Emerging growth of non-cigarette tobacco product use introduces health risks • More than one in five adults and high school students report using tobacco (non-cigarette tobacco products either alone or in addition to cigarettes) • The most commonly used non-cigarette tobacco products are smokeless products (e.g., snuff), little or regular cigars, pipes, hookah (water pipes), and electronic cigarettes Eyler, Chriqui, Moreland-Russell & Brownson, 2016

11. Identifying the Problem:Tobacco Use and Consequences • Disparities • Differences in tobacco use across: • Gender • Race and ethnicity • Educational status • Poverty status • Sexual orientation • Groups that use tobacco at disproportionately high rates, less likely to quit successfully & experience poorer health outcomes • Military workers (e.g., active service members and civilian employ- ees) • Construction workers • Individuals with a history of mental health problems • Homeless • Incarcerated individuals Eyler, Chriqui, Moreland-Russell & Brownson, 2016

12. Identifying the Problem:Tobacco Use and Consequences • Disparities • Differences across geographic location • United States smoking rates were lower than those in many countries like Norway, Egypt, China, and Chile • Higher rates than Mexico, Australia, Kenya, and India • Within the United States • Fewer than one in ten Utah residents smoke • More than one in four people in Kentucky, Arkansas, and West Virginia smoke • What else do you think contributes to health-related tobacco disparities? Eyler, Chriqui, Moreland-Russell & Brownson, 2016

13. Why continued disparities? • Excessive exposure to tobacco product promotion • Tobacco industry targeting • Lack of comprehensive policies Eyler, Chriqui, Moreland-Russell & Brownson, 2016

14. Public Policy Strategies in Tobacco Control • A variety of tobacco control policies implemented at the international, federal, state, and local levels • Creating Smoke-Free Environments • Smoke-free laws protect employees and the public developing chronic disease due to secondhand smoke (cancer, heart disease, and respiratory diseases) • Encourage people to quit • Prevent smoking initiation • Change social norms around tobacco use and exposure • Smoke-free policies can be designed to impact public areas, private areas, or both. Eyler, Chriqui, Moreland-Russell & Brownson, 2016

15. Public Policy Strategies in Tobacco Control • Creating Smoke-Free Environments • Policy has expanded to include: • Public access: Restaurant patios, parks, playgrounds, and beaches • Private settings such as multiunit housing and cars • Smoke-free laws can be adopted voluntarily or via policy • Policy preferred because it mandates rules and closes the gaps in secondhand smoke protection Eyler, Chriqui, Moreland-Russell & Brownson, 2016

16. Public Policy Strategies in Tobacco Control • Raising the Price of Tobacco Products through Tax Increases • Increasing price = less affordable = reducing use = Change social norms • Prevent youth initiation • Decrease tobacco-related healthcare costs • Reduce tobacco related health disparities • Additional benefit = make revenue for governments • Children’s Health Insurance Program in 2009 • Largest increase in federal taxes • Resulted in federal tax of $1.01 per cigarette pack • In 2014, the total per pack tax ranged from $4.35 in New York to only $0.17 in Missouri Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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19. Public Policy Strategies in Tobacco Control Restrictions on Marketing, Packaging, and Youth Access • Tobacco advertising has been banned on television, radio, billboards, and public transportation • Industry focuses on point-of-sale • Exposure at this level = higher odds of initiation and regular daily smoking among youth, unplanned & relapse • Tobacco Control Act gave legal authority to states & communities to pursue intervention at the retail level • Read p.o.s. strategies p. 124 # 1-4 • New York City, New York, Providence, Rhode Island, and Santa Clara County, California • ban on sales of cigars, hookah, cigarillos, pipe and chewing tobacco, and e-cigarettes flavored with tastes that might appeal to youth (e.g., apple, grape, or mint) in establishments where youth could be present Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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22. Tobacco Control Support & Opposition Policy Rationale • Financial burden on government and public • Protection of high-risk populations • Ensure clear and accurate information regarding tobacco products • Consequences of secondhand smoke and other chemicals for nonusers Eyler, Chriqui, Moreland-Russell & Brownson, 2016

23. Testimonies used in new e-cigarette regulations Eyler, Chriqui, Moreland-Russell & Brownson, 2016

24. Tobacco Control Support & Opposition Political Support • Local and state tobacco control programs do not have the flexibility or authority to influence tobacco control policies • Coalitions are most important for comprehensive tobacco control policy • Due to success in organizing and encouraging policy action through legislation and voter initiatives Eyler, Chriqui, Moreland-Russell & Brownson, 2016

25. Tobacco Control Support & Opposition Political Support • National-level voluntary organizations are also integral to advancement of policy • American Heart Association • American Cancer Society • American Lung Association • Advocacy organizations • Americans for Nonsmokers’ Rights • Campaign for Tobacco Free Kids • Counter Tobacco) • Legal partners • Tobacco Control Legal Consortium Eyler, Chriqui, Moreland-Russell & Brownson, 2016

26. Tobacco Control Support & Opposition Political Opposition • Tobacco industry • Utilizes financial resources • Lobbyists • Recruits policymakers via campaign funding in exchange for votes against TCC policies • At the local level • Recruit third parties or front groups • Convenience store associations • hospitality industry groups • groups that oppose government regulation • “astroturf ” groups—grassroots organizations that are funded, organized, and sometimes run by the tobacco industry Eyler, Chriqui, Moreland-Russell & Brownson, 2016

27. CASE STUDY • Pp 131 in your text • First U.S. tobacco-free pharmacy policy • Reduces tobacco-related disparities at the local level • Sets the stage for state and national tobacco-free pharmacy efforts • Break into groups of 5 • Review the case study • Summarize your section on the flip chart (3-4 important take homes) • Come back together as a class to share and discuss Eyler, Chriqui, Moreland-Russell & Brownson, 2016

28. Tobacco-Free Pharmacies Eyler, Chriqui, Moreland-Russell & Brownson, 2016 https://youtu.be/R8-Fso5gieo

29. Health Communications & Tobacco • CDC Smoking and Tobacco Use Video Methods to Spread Awareness Eyler, Chriqui, Moreland-Russell & Brownson, 2016

30. Reference Eyler, A.A., Chriqui, J.F., Moreland-Russell, S.M., & Brownson, R.C. (Eds.). (2016) Prevention, policy, and public health (1st ed.) New York, NY: Oxford University Press. Eyler, Chriqui, Moreland-Russell & Brownson, 2016