protecting children and families from tobacco: setting your tobacco agenda tobacco advocacy and...
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Protecting Children and Families from Tobacco:
Setting your Tobacco Agenda Tobacco Advocacy and Policy Issues
Susanne E. Tanski, MD, MPHJulius B. Richmond Center of Excellence
AAP Tobacco Consortium Chair
Adolescent and Adult SmokersAdolescent and Adult Smokers
• Know they are addicted and want to quitKnow they are addicted and want to quit
• Many have tried to quit without success Many have tried to quit without success
• Younger smokers less likely to think there Younger smokers less likely to think there are resources to helpare resources to help
• Many clinicians feel unprepared to helpMany clinicians feel unprepared to help
• With advice, most parents say they would be able to set strict smoking policies
Evidence-based best practices
• Increase price/taxation of tobacco
• Smoking bans and restrictions
• Counseling – reframe expectations of successCounseling – reframe expectations of success– 5A5A’’s - Ask, Advise, Assess, Assist and Arranges - Ask, Advise, Assess, Assist and Arrange– Strict No Smoking Rules - Smoke-free homes and carsStrict No Smoking Rules - Smoke-free homes and cars
• Availability of treatment– Reduced cost for pharmacotherapy treatment – Provider reminder systems– Telephone/web counseling and support
• Mass media counter-marketing campaigns
Community and public health
• Make tobacco control for children and families a priority – Include secondhand smoke – Headstart, schools, housing, etc.
• Age of sale restrictions and enforcement
• Advertising limitations
Community and public health
• Public smoke exposure reduction
• Smoke Free Housing/Smoke Free Public Housing
• Reduce social acceptability of smoking
• Do not allow preemptive efforts by tobacco industry
• Smokefree Movies
.05
.1.1
5.2
.25
.3
Incid
en
ce,
Ever
Tri
ed
Sm
okin
g
0 50 100 150 200 250
Number of Smoking Occurrences Seen (50 movies)
N = 4538
Smoothed Curve of Incident Smoking VS. Exposure to Movie Smoking at BaselineU.S. Sample
Overall Incidence = 0.12
NOTE: Weights are from random effects analysis
.Overall Estimate
Meta-analysis. Smoking in Movies Studies
Combined Estimate, Cross-Sectional Studies6 Country E.U.7
1.84 (1.66, 2.04)
1.53 (0.84, 2.79)
2.50 (1.70, 3.50)
1.70 (1.16, 2.63)
1.19 (1.01, 1.40)
2.00 (1.30, 3.10)
2.23 (1.19, 4.17)
1.74 (1.41, 2.15)
1.39 (0.69, 2.80)
1.00 (0.60, 1.50)
2.60 (1.70, 4.10)
1.91 (1.35, 2.70)
2.70 (1.10, 6.60)
1.97 (1.75, 2.22)
ES (95% CI)
1.70 (1.40, 2.00)
1.66 (1.37, 2.01)
1.98 (1.35, 2.90)
1.40 (0.95, 2.10)1.80 (1.20, 2.70)
2.28 (1.34, 3.87)
2.71 (1.73, 4.25)
2.30 (1.50, 3.60)
1.72 (1.38, 2.16)
2.20 (1.80, 2.80)
1.73 (1.55, 1.93)
2.00 (1.55, 2.47)
2.70 (1.50, 4.70)
100.00
2.32
4.49
3.90
7.75
%
3.63
2.17
23.94
1.82
3.39
3.57
4.68
1.20
41.92
Weight
7.48
7.24
4.22
4.043.94
2.78
3.48
3.59
34.13
6.71
8.63
6.49
2.50
1.84 (1.66, 2.04)
1.53 (0.84, 2.79)
2.50 (1.70, 3.50)
1.70 (1.16, 2.63)
1.19 (1.01, 1.40)
2.00 (1.30, 3.10)
2.23 (1.19, 4.17)
1.74 (1.41, 2.15)
1.39 (0.69, 2.80)
1.00 (0.60, 1.50)
2.60 (1.70, 4.10)
1.91 (1.35, 2.70)
2.70 (1.10, 6.60)
1.97 (1.75, 2.22)
ES (95% CI)
1.70 (1.40, 2.00)
1.66 (1.37, 2.01)
1.98 (1.35, 2.90)
1.40 (0.95, 2.10)1.80 (1.20, 2.70)
2.28 (1.34, 3.87)
2.71 (1.73, 4.25)
2.30 (1.50, 3.60)
1.72 (1.38, 2.16)
2.20 (1.80, 2.80)
1.73 (1.55, 1.93)
2.00 (1.55, 2.47)
2.70 (1.50, 4.70)
100.00
2.32
4.49
3.90
7.75
%
3.63
2.17
23.94
1.82
3.39
3.57
4.68
1.20
41.92
Weight
7.48
7.24
4.22
4.043.94
2.78
3.48
3.59
34.13
6.71
8.63
6.49
2.50
2.01.0
Mexico
U.S., National SampleU.S., Northern New England
India (Bollywood)
Germany
Glasgow, ScotlandBristol, U.K
Cross-sectional Studies, Smoking Onset
.
U.S. National Sample (A, ES, L)
U.S., Texas (Mexican-American)U.S., National Sample
Scotland (YA, CC)
Mexico
Mexico (A, CS, L
U.S. Internet Sample (YA, CS, CC)
Progression of Smoking
U.S., Northern New England (ages 10-14)Longitudinal Studies, Smoking Onset
Germany
Mexico (A, CS, CC)Germany (A, CS, CC)
U.S., North Carolina (Whites only)
U.S., Northern New England (ages 6-8)
U.S. Northern New England (YA, ES, L)
Combined Estimate, Longitudinal Studies
Combined Estimate, Progression
Risk Estimate for High vs. Low Exposure to Movie Smoking*
U.S. Surgeon General 2012 Report:Tobacco Use among Youth and Young Adults
920 page evidence review of tobacco use among US youth
Chapter 5 conclusion:
“The evidence is sufficient to conclude that there is a causal relationship between depictions of smoking in the movies and the initiation of smoking among young people.”
Smoke Free Movies Smoke Free Movies
• Rate new smoking movies "R"
• Certify no pay-offs
• Require strong anti-smoking ads
• Stop identifying tobacco brands