accelerating the national progress to reduce tobacco use

16
Accelerating the National Progress to Reduce Tobacco Use Terry F. Pechacek , Ph.D. Professor of Health Management & Policy Georgia State University School of Public Health Retooling and Recommitting: Policy, Systems, and Environmental Approaches in Tobacco Control August 19 th , 2015 ● Atlanta, Georgia

Upload: georgia-state-school-of-public-health

Post on 15-Apr-2017

193 views

Category:

Health & Medicine


0 download

TRANSCRIPT

Page 1: Accelerating the National Progress to Reduce Tobacco Use

Accelerating the National Progress to Reduce

Tobacco UseTerry F. Pechacek , Ph.D.Professor of Health Management & Policy

Georgia State University School of Public Health

Retooling and Recommitting: Policy, Systems, and Environmental Approaches in Tobacco Control

August 19th, 2015 ● Atlanta, Georgia

Page 2: Accelerating the National Progress to Reduce Tobacco Use

• The current rate of progress in tobacco control is too slow.

• The tobacco industry continues to position itself to sustain its sales by:• recruiting youth and young adults• Maintaining current smokers as consumers of

all their nicotine-containing products including cigarettes

Accelerating the National Progress to Reduce

Tobacco Use

Page 3: Accelerating the National Progress to Reduce Tobacco Use

Tobacco Product Use by Education LevelNSDUH 2013 Adults aged 18 and older

0

5

10

15

20

25

30

35

40

<HS HS Grad Some College College Grad

Percent Using in Past Month

Any Tobacco Cigarettes Cigars

SOURCE: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013

Page 4: Accelerating the National Progress to Reduce Tobacco Use

5.6 Million Projected Deaths

Key Assumptions• Initiation rates of smoking among adolescents and young adults remain high

• Peak birth cohort smoking prevalence in young adulthood remains high

• Adult cessation rates in young adulthood remain low

• Tobacco products most commonly used remain highly lethal

Page 5: Accelerating the National Progress to Reduce Tobacco Use

Past Year Cigarette Initiates among Persons Aged 12 or Older, by Age at First Use: NSDUH 2002-2013

Numbers in Millions Initiated at Age 18 or Older

Initiated Prior to Age 18

SOURCE: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013

Page 6: Accelerating the National Progress to Reduce Tobacco Use

Past Month Cigarette Use among Persons Aged 12 or Older, by Age: NSDUH 2013

Age in Years

Percent Using in Past Month

SOURCE: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013

Page 7: Accelerating the National Progress to Reduce Tobacco Use

Will ENDS be a panacea or peril? From a clinical perspectiveUsing Electronic Nicotine Delivery Systems could help: • Smoking combusted

cigarettes is the single greatest cause of death in the world.

• Current tobacco control methods will not achieve public health objectives.

• Properly regulated, ENDS have the potential of providing nicotine at a much lower level of harm.

From a population perspectiveElectronic Nicotine Delivery Systems could: • Increase youth initiation• Promote dual use• Delay cessation• Entice former smokers back

to nicotine• Re-normalize smoking• Continue addiction• Set back progress from

establishing health promoting social norms

Page 8: Accelerating the National Progress to Reduce Tobacco Use

Potential Health Impacts of ENDS

• Could have negative and positive individual and population health impact

Source: The health consequences of smoking – 50 years of progress: a report of the Surgeon General. – Atlanta, GA. : U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

“The impact of the noncombustible aerosolized forms of nicotine delivery on population health is much more likely to be beneficial in an environment where the appeal, accessibility, promotion, and use of cigarettes and other combusted tobacco products are being rapidly reduced, especially among youth and young adults.” 2014 SGR, Page 859

Scott R. Weaver
This graphic may be hard for audience to see... consider deleting or finding better quality image.
Page 9: Accelerating the National Progress to Reduce Tobacco Use

2014 SGR Recommendations Sustain high-impact media campaigns such as CDC Tips

and FDA youth prevention for 12 months a year for 10+ years

Raise excise taxes – Average Retail Price of at least $10 per pack most effective

Protect 100% of U.S. Population by comprehensive smokefree indoor air policies

Fully fund comprehensive statewide tobacco control programs at CDC-recommended levels

Expand Smoking Cessation for All Smokers Provide access to barrier-free proven tobacco use cessation treatments Promote proven tobacco use cessation treatment as a standard of care in

primary and specialty care settings

Page 10: Accelerating the National Progress to Reduce Tobacco Use

Can novel nicotine products serve as a disruptive technology and advance public health?

Page 11: Accelerating the National Progress to Reduce Tobacco Use

Tobacco Industry in Transition

Industry wants broader nicotine product market

Cigarette Target = slow decline in market Slow down regulations

ENDS Market = Keeping Smokers & Recruiting Youth Cautious adoption of less-profitable ENDS Industry favors tight regulations of innovative “vaping” Seek to reverse non-smoking norms Defending public health benefits of dual-use

Non-combustibles & Heat-not-Burn = Growth Seek FDA MRTP approvals (e.g., SNUS, then H-n-B) Rapidly grow markets (e.g., Marlboro iQOS)

Page 12: Accelerating the National Progress to Reduce Tobacco Use

Tobacco Industry in Transition

Seeking Public Health Endorsement Remember: “When you are dancing with the

BEAR, it is hard to stay in the lead, and when the lights get low, he will eat you alive!”

Companies want to manage transition Cigarettes have very high profit margins (≈ $1 per pack) Disruptive technologies favor innovation NOT established

products Regulations can create barriers for innovation

Financial Analysts Predict Strong Future Tobacco Sales Volumes (US and Globally)

Page 13: Accelerating the National Progress to Reduce Tobacco Use

“A defective and unreasonably dangerous product”1

End Game scenarios for the U.S. include: FDA regulation to:

• Reduce nicotine content to make cigarettes non-addictive

• Make some or all tobacco products less appealing

• Establish standards for toxicant levels in tobacco products

Sales restrictions• including local and state product category

bans 1Proctor RN. Why ban the sale of cigarettes? The case for abolition. Tobacco Control

2013;22:i27-i30

Page 14: Accelerating the National Progress to Reduce Tobacco Use

End Game Strategies at State/Local Level

• Raise the age of sale to 21

• Decrease access to and visibility of tobacco products in the community • decrease density of retail outlets, • proximity of retail outlets to schools, • Sales of tobacco products in pharmacies

• Establish Minimum Prices/Prohibit discounting

• Local and state product category bans

Page 15: Accelerating the National Progress to Reduce Tobacco Use

bit.ly/NoToTobacco

Page 16: Accelerating the National Progress to Reduce Tobacco Use

Thank You! [email protected]

The Georgia State University Tobacco Center Of Regulatory Science