Transcript Making Tobacco Control Personal

Making Progress in Tobacco
Control: The Good, Bad, and Ugly
Michael Kretz, M.D.
7/22/05
President
Pierce-St. Croix Tobacco Free Coalition
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)
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)
Annual Smoking Deaths
Average Annual
Number of U.S.
Deaths Attributable to
Cigarette Smoking,
1995-99 (Total
average number,
442,532)
(CDC)
Morbidity and Mortality 2005
Doubly Ugly
Wisconsin spends about
2.4% of the $423.6 million
in tobacco-generated
revenues on tobacco
prevention (Rank 24th).
(www.tobaccofreekids.org)
1. 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
State Snapshot 2004 from the National Healthcare Quality Report
2003: St. Croix County
Community Health Needs Assessment
3 Focus Groups
Health Survey (683)
1. Lack of access to
care (affordable
health insurance)
2. Poor diet/exercise
3. Tobacco, alcohol,
drugs
1. Health insurance
cost
2. Cost of prescriptions
5. Health care cost
Smoking-caused lung diseases
(Department of Health and Family services, 2002)
Lung cancer
COPD (emphysema)
1. Cost:
$23,247
2. Number:
2,325
3. Smoking %
88
1. Cost:
2. Number :
3. Smoking %:
4. Total hospital cost due
to smoking:
4. Total hospital cost due
to smoking:
$47.5 million
$11,116
7,277
83
$67.4 million
Heads-Up on Health Costs
Average 65-year-old couple
(first 15 to 20 years of retirement)
1. Medicare Premiums
2. Prescription Drugs
3. Other health-care needs
(Study by Fidelity Investments)
$58,900
$62,700
$68,400
$190,000
National Report Card
State of Tobacco Control 2004
Grades:
1. Cessation
2. Framework Convention
on Tobacco Control
3. FDA Tobacco Regulation
4. Cigarette tax
(www.lungusa.org)
F
D
F
F
Wisconsin Report Card
State of Tobacco Control 2004
Grades:
1. Smokefree Air
2. Youth Access
3. Tobacco Prevention and
Control Spending
4. Cigarette Tax
(www.lungusa.org)
F
D
F
D
Building Infrastructure—the
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 (>10,000)
FACT (6,000)
Tobacco Free Coalitions (7744)
Wisconsin Wins (33.78.3%)
First Breath Sites (111)
Information distribution (www.tobwis.org)
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
6:1 return on investment
Key Cultural Values
Western Cultures
1) Independence (go it
alone)
2) Individualism (be
unique)
3) Competition (go for
the gold)
4) Involvement (them
and us thinking)
(Hantiuk and Gebretensae 2005)
Eastern Cultures
1) Interdependence (all
together)
2) Collectivism (blend
in)
3) Collaboration (team
first)
4) Partnership (we and
ours thinking)
Gallup Survey (1993)
1. 94% feel responsibility to speak up to a
friend or loved one about an unhealthy
behavior
2. Only 38% felt comfortable or confident
Reluctance is cultural!
• “If you can’t say something nice, don’t 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 someone’s
personal business.”
• “If you live in a glass house…”
More than Quitting…Processes 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. 1994—Stages of
Change/Transtheoretical Model)
Pieces of Child Development
1. Physical
2. Emotional
3. Social
4. Language
5. Cognitive
(not either/or—school
is part of child
development)
Overarching Goals
1. Improve the health of the public
2. Reduce disparities
3. Transform the Public Health System
Keys to Successful Change
• Empathy, communication, participation
• Communication means more than “telling.”
It means “creating understanding.”
(Managing Change Effectively: Kirkpatrick, 2001)
THE PUBLIC HEALTH SYSTEM
Community
Governmental
Public Health
Infrastructure
Health Care
Delivery
System
Assuring the
Conditions for
Population
Health
Academia
Employers
And Business
The Media
Inter-sectoral engagement in partnership with government. (Institute of Medicine-2003; The Future of the Public’s Health
in the 21st Century)
Model = Capacity
• Holistic (everyone has a role)
• Ecological (all interrelated and interdependent—
no 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
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
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)
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.
My Perspective/Relationships
Getting 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 Director—Wisconsin Child Care
Improvement Project
• University Committee on Health and Wellness
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, 1993—Vol. 270, No. 4, pp. 490-493
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)
(Wisconsin Tobacco Facts 2004)
Support for new smoking bans
• 74% favored smoking bans
• 80% “go out” as often—or 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)
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)
Conclusions
1. Tobacco control is the work of Public Health.
2. New Institute of Medicine’s 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!
Contact me at …
[email protected]
Phone (715) 377-0101
Michael Kretz, MD
256 Troon Court
Hudson, WI 54016