Tobacco 101Tobacco 101

Barry Sharp, MSHP, CHESBarry Sharp, MSHP, CHES

Texas Department of State Health ServicesTexas Department of State Health Services

Tobacco = ProblemTobacco = Problem

Nationally – One person dies every Nationally – One person dies every 72 seconds from a tobacco related 72 seconds from a tobacco related cause.cause.

Texas – One person dies every 22 Texas – One person dies every 22 minutes from a tobacco related minutes from a tobacco related cause.cause.

1,140 youth take up smoking every 1,140 youth take up smoking every day; one third of them will die from day; one third of them will die from their habit.their habit.

Tobacco = ProblemTobacco = Problem

In Comparison,In Comparison,– Every two and a half days, tobacco’s Every two and a half days, tobacco’s

death toll on Americans equals the death toll on Americans equals the number of deaths from the terrorist number of deaths from the terrorist attacks on September 11, 2001.attacks on September 11, 2001.

– In 2006, alcohol-related car wrecks In 2006, alcohol-related car wrecks claimed the lives of 1,677 Texans. claimed the lives of 1,677 Texans. Tobacco kills more Texans each Tobacco kills more Texans each month.month.

Texas Preventable Texas Preventable Deaths, 2001Deaths, 2001

24,899

2,214

1,607

1,405

1,052

18,649

2,851 3,736

11,132

Suicide

DWI

Tobacco Use

Homicide

AIDS

Overweight/Obesity

Drugs

Auto Accidents

Alcohol

Fire 218

Tobacco use will remain the leading Tobacco use will remain the leading cause of preventable illness and death in cause of preventable illness and death in this Nation and a growing number of this Nation and a growing number of other countries until tobacco prevention other countries until tobacco prevention and control efforts are commensurate and control efforts are commensurate with the harm caused by tobacco use.with the harm caused by tobacco use.

David Satcher, MD, PhDDavid Satcher, MD, PhD

Former U.S. Surgeon GeneralFormer U.S. Surgeon GeneralReducing Tobacco Use, A ReportReducing Tobacco Use, A Report

Of the Surgeon General - 2000Of the Surgeon General - 2000

Tobacco 101Tobacco 101

PrevalencePrevalence Tobacco – Products & ChemistryTobacco – Products & Chemistry The Tobacco IndustryThe Tobacco Industry Health EffectsHealth Effects Tobacco LawsTobacco Laws Pro-Health InitiativesPro-Health Initiatives The Awareness ClassThe Awareness Class Best Practices for SchoolsBest Practices for Schools

Tobacco’s Human Toll Tobacco’s Human Toll

9.5% middle school students smoke.9.5% middle school students smoke. 24.7% of high school students smoke.24.7% of high school students smoke. 18.1% of adults smoke.18.1% of adults smoke. Deaths in Texas from smoking:Deaths in Texas from smoking:

– 24,200 adults each year24,200 adults each year– 503,000 youth alive today will die 503,000 youth alive today will die

prematurely from smokingprematurely from smoking– 2,660 to 4,720 adults, children and babies die 2,660 to 4,720 adults, children and babies die

from diseases caused by secondhand smoke from diseases caused by secondhand smoke and pregnancy smokingand pregnancy smoking

Tobacco’s Economic Tobacco’s Economic TollToll

Texas Economic costs:Texas Economic costs:– $1.6 billion in Medicaid$1.6 billion in Medicaid– $5.83 billion overall health costs$5.83 billion overall health costs– $10.3 million in fire loss$10.3 million in fire loss– $11.7 million in highway trash cleanup$11.7 million in highway trash cleanup– $6.44 billion in lost productivity$6.44 billion in lost productivity

State and federal tax burden from smoking-caused State and federal tax burden from smoking-caused government expenses - $630 per householdgovernment expenses - $630 per household

Each pack of cigarettes sold costs the United States Each pack of cigarettes sold costs the United States $10.28 in health care related costs and lost $10.28 in health care related costs and lost productivity.productivity.

Big Tobacco’s Big Tobacco’s SpendingSpending

$13.36 billion – tobacco industry marketing $13.36 billion – tobacco industry marketing expenditures nationwide in 2005.expenditures nationwide in 2005.

$884.7 million – estimated portion spent in $884.7 million – estimated portion spent in Texas for marketing in 2005.Texas for marketing in 2005.– $37.63 for every Texas resident$37.63 for every Texas resident– $28.05 every second$28.05 every second

$254,500 – political contributions, ‘01-’06$254,500 – political contributions, ‘01-’06– 1 of 2 U.S. Senators from Texas1 of 2 U.S. Senators from Texas– 23 of 32 U.S. Representatives from Texas23 of 32 U.S. Representatives from Texas

Middle School Tobacco Middle School Tobacco UseUse

0

5

10

15

20

25

30

35

1998 1999 2001 2006

Any Tobacco

Cigarettes

Smokeless

Cigars

Pipes

High School Tobacco High School Tobacco UseUse

0

5

10

15

20

25

30

35

40

45

1998 1999 2001 2006

Any Tobacco

Cigarettes

Smokeless

Cigars

Pipes

Boys vs. GirlsBoys vs. Girls

0

10

20

30

40

50

60

MiddleSchoolBoys

MiddleSchoolGirls

HighSchoolBoys

HighSchoolGirls

1998

1999

2001

2006

Tobacco Use by RaceTobacco Use by Race

0

5

10

15

20

25

30

35

40

1998 1999 2001 2006

White MS Black MS Hispanic MS Asian MS

Tobacco Use by RaceTobacco Use by Race

0

10

20

30

40

50

1998 1999 2001 2006

White HS Black HS Hispanic HS Asian HS

Tobacco Use by DSHS Tobacco Use by DSHS RegionRegion

0

5

10

15

20

25

30

35

Reg.1/2

Reg.3

Reg.4/5

Reg.6

Reg.7

Reg.8

Reg.9/10

Reg.11

1998 MS 1999 MS 2001 MS 2006 MS

Tobacco Use by DSHS Tobacco Use by DSHS RegionRegion

0

10

20

30

40

50

Reg.1/2

Reg.3

Reg.4/5

Reg.6

Reg.7

Reg.8

Reg.9/10

Reg.11

1998 HS 1999 HS 2001 HS 2006 HS

Tobacco Use by GradeTobacco Use by Grade

0

10

20

30

40

50

6thGrade

7thGrade

8thGrade

9thGrade

10thGrade

11thGrade

12thGrade

1998 1999 2000 2001 2006

Texas Synar RatesTexas Synar RatesFederal Tobacco Sales Federal Tobacco Sales InspectionInspection

0

10

20

30

40

50

60 199519961997199819992000200120022003200420052006

How Youth Get TobaccoHow Youth Get Tobacco

Methods used by middle school students:Methods used by middle school students:– Gave someone else money to purchaseGave someone else money to purchase– Borrowed from someone willing to shareBorrowed from someone willing to share– Stole (often from parents)Stole (often from parents)– Other (i.e. Internet)Other (i.e. Internet)

Methods used by high school students:Methods used by high school students:– Gave someone else money to purchaseGave someone else money to purchase– BorrowedBorrowed– Bought in store & not asked for IDBought in store & not asked for ID– Other (i.e. Internet)Other (i.e. Internet)

Youth CessationYouth Cessation

More than half of youth smokers:More than half of youth smokers:– Tried to quit in the past 12 monthsTried to quit in the past 12 months– Want to completely stop smokingWant to completely stop smoking– Tried to quit at least twiceTried to quit at least twice

About 8 of 10 current youth smokers:About 8 of 10 current youth smokers:– Think they would be able to quit smoking if they Think they would be able to quit smoking if they

wanted.wanted.

NicotineNicotine

Naturally occurring addictive Naturally occurring addictive substance. Created by nature as an substance. Created by nature as an insecticide. (Commercial use banned insecticide. (Commercial use banned by EPA.)by EPA.)

Enters the blood stream and travels to Enters the blood stream and travels to brain in less than 10 seconds.brain in less than 10 seconds.

Affects brain cells responsible for Affects brain cells responsible for memory and mood control.memory and mood control.

Stays active for 20 - 40 minutes.Stays active for 20 - 40 minutes.

NicotineNicotine

Immediate Immediate Effects:Effects:– Increased heart Increased heart

raterate– Blood vessels Blood vessels

constrictconstrict– Lower skin Lower skin

temperaturetemperature– ““Head rush”Head rush”

Long-term Long-term Effects:Effects:– High blood High blood

pressurepressure– Blockage of blood Blockage of blood

vesselsvessels– Reduced Reduced

effectiveness of effectiveness of immune systemimmune system

– Wrinkling of skinWrinkling of skin

Effects on the BrainEffects on the Brain

Dopamine – pleasure, appetite suppressionDopamine – pleasure, appetite suppression Norepinephrine – arousal, appetite suppressionNorepinephrine – arousal, appetite suppression Acetylcholine – arousal, cognitive Acetylcholine – arousal, cognitive

enhancementenhancement Vasopressin – memory improvementVasopressin – memory improvement Serotonin – mood modulation, appetite Serotonin – mood modulation, appetite

suppressionsuppression Beta-endorphin – reduction of anxiety and Beta-endorphin – reduction of anxiety and

tensiontension

What do tobacco What do tobacco companies think of kids?companies think of kids?

Philip Morris: Philip Morris: “Today’s teenager is “Today’s teenager is tomorrow’s potential regular customer….”tomorrow’s potential regular customer….”

RJ Reynolds: RJ Reynolds: “…the 14-18 year old group “…the 14-18 year old group is an increasing segment of the smoking is an increasing segment of the smoking population. RJR-T must soon establish a population. RJR-T must soon establish a successful new brand in this market .…” successful new brand in this market .…”

Brown & Williamson: Brown & Williamson: “Kool’s stake in the “Kool’s stake in the 16- to 25-year-old population segment is 16- to 25-year-old population segment is such that the value of this audience such that the value of this audience should be accurately weighted and should be accurately weighted and reflected in current media programs . . . reflected in current media programs . . . all magazines will be reviewed to see all magazines will be reviewed to see how efficiently they reach this group.”how efficiently they reach this group.”

Lorillard Tobacco: Lorillard Tobacco: “The base of our “The base of our business is the high school student.”business is the high school student.”

U.S. Tobacco: U.S. Tobacco: “Cherry Skoal is for “Cherry Skoal is for somebody who likes the taste of candy, if somebody who likes the taste of candy, if you know what I’m saying.”you know what I’m saying.”

What do tobacco What do tobacco companies think of kids?companies think of kids?

Tobacco MarketingTobacco Marketing

Tobacco companies spent $13.36 Tobacco companies spent $13.36 billion on U.S. advertising in 2005.billion on U.S. advertising in 2005.– $25,419 per minute$25,419 per minute– $423.64 per second$423.64 per second

DSHS marketing budget for 2006DSHS marketing budget for 2006– $1.5 million for settlement area$1.5 million for settlement area– $730,000 for statewide media$730,000 for statewide media

$4.24 per minute (total for both campaigns)$4.24 per minute (total for both campaigns) 7 cents per second (total for both campaigns)7 cents per second (total for both campaigns)

Tobacco MarketingTobacco Marketing

During the 22-minute interval During the 22-minute interval between the deaths of Texans from between the deaths of Texans from tobacco-related causes, the tobacco tobacco-related causes, the tobacco industry will spend more than industry will spend more than $37,000 in Texas to make their $37,000 in Texas to make their products appealing in order to products appealing in order to replace their dying customers.replace their dying customers.

How’s that as a reward for customer How’s that as a reward for customer loyalty?loyalty?

Tobacco MarketingTobacco Marketing

0

2000000

4000000

6000000

8000000

10000000

12000000

14000000

16000000

Expenditures (Dollars in Thousands)

196319651970197519801985199019951996199719981999200020012002200320042005

U.S. Cigarette ConsumptionU.S. Cigarette Consumption((In billions of individual cigarettes)In billions of individual cigarettes)

0

100

200

300

400

500

600

700

1963-2005

Does Marketing Work?Does Marketing Work?

81.3 percent of youth (12-17) smokers 81.3 percent of youth (12-17) smokers prefer Marlboro, Camel and Newport – prefer Marlboro, Camel and Newport – three heavily advertised brands.three heavily advertised brands.

Marlboro, the most heavily advertised Marlboro, the most heavily advertised brand, constitutes almost 50 percent of brand, constitutes almost 50 percent of the youth market but only about 40 the youth market but only about 40 percent of smokers over age 25.percent of smokers over age 25.

Youth recall seeing tobacco ads almost Youth recall seeing tobacco ads almost 3:1 over adults.3:1 over adults.

Marlboro Man - AltriaMarlboro Man - Altria

Most successful and longest running Most successful and longest running campaign in tobacco advertising history. campaign in tobacco advertising history. Honored by Honored by AdWeekAdWeek as one of the top as one of the top campaigns of the past century.campaigns of the past century.

Campaign originated in early 1960s.Campaign originated in early 1960s. Images of masculinity and rugged Images of masculinity and rugged

individualism appeal to adolescents individualism appeal to adolescents struggling to define themselves.struggling to define themselves.

Originally marketed as a woman’s Originally marketed as a woman’s cigarette.cigarette.

Joe Camel – R.J. Joe Camel – R.J. ReynoldsReynolds

Introduced in 1988. Voluntarily Introduced in 1988. Voluntarily removed from market in 1997.removed from market in 1997.

During campaign, Camel’s share During campaign, Camel’s share of the children’s cigarette of the children’s cigarette market increased from less than market increased from less than 1% to more than 32% by 1993.1% to more than 32% by 1993.

Joe Camel was as familiar to 6-Joe Camel was as familiar to 6-year-olds as Mickey Mouse.year-olds as Mickey Mouse.

Internet MarketingInternet Marketing

In 2000, there were 40 web sites selling In 2000, there were 40 web sites selling tobacco. By 2002, the number tobacco. By 2002, the number ballooned to 200 U.S. and 200 foreign ballooned to 200 U.S. and 200 foreign web sites.web sites.

Most sellers fail to pay taxes.Most sellers fail to pay taxes. Most do not enforce or ignore age Most do not enforce or ignore age

requirements.requirements. Texas and Maine regulate tobacco sales Texas and Maine regulate tobacco sales

over the Internet; New York and over the Internet; New York and Connecticut ban it completely.Connecticut ban it completely.

Health Effects – Short Health Effects – Short TermTerm

Shortness of breathShortness of breath Smell in hair and clothesSmell in hair and clothes Discolored teeth and skinDiscolored teeth and skin Avoided by non-smokersAvoided by non-smokers Financial costs (Pack/day = Financial costs (Pack/day =

$1,700+)$1,700+)

Health Effects – Long Health Effects – Long TermTerm

Cancers of the lung, larynx, oral Cancers of the lung, larynx, oral cavity, pharynx, esophagus, bladder, cavity, pharynx, esophagus, bladder, pancreas, uterine, cervix and kidneypancreas, uterine, cervix and kidney

Heart DiseaseHeart Disease Cerebrovascular Accidents (stroke)Cerebrovascular Accidents (stroke) Chronic BronchitisChronic Bronchitis EmphysemaEmphysema

CessationCessation

Smoking cessation is more cost Smoking cessation is more cost effective than other commonly effective than other commonly provided clinical preventive provided clinical preventive services, including services, including mammography, colon cancer mammography, colon cancer screening, PAP tests, treatment of screening, PAP tests, treatment of mild to moderate hypertension mild to moderate hypertension and treatment of high cholesterol.and treatment of high cholesterol.

Benefits of QuittingBenefits of Quitting

Begin within 20 minutes of Begin within 20 minutes of quitting.quitting.

Within 1 year, risk of heart disease Within 1 year, risk of heart disease is half that of a smoker.is half that of a smoker.

Within 5 years, risk of cancers of Within 5 years, risk of cancers of lung, mouth and esophagus are lung, mouth and esophagus are half that of a smoker.half that of a smoker.

Within 15 years, risk of heart Within 15 years, risk of heart disease is that of a non-smoker.disease is that of a non-smoker.

Withdrawal SymptomsWithdrawal Symptoms

Withdrawal Symptoms can Withdrawal Symptoms can include:include:– NervousnessNervousness– Irritability, anger and frustrationIrritability, anger and frustration– Lack of concentrationLack of concentration– DepressionDepression– Increased appetite and weight gainIncreased appetite and weight gain– Insomnia, restlessnessInsomnia, restlessness

The Texas Tobacco The Texas Tobacco PlayersPlayers

Texas Department of State Health Texas Department of State Health ServicesServices– Mental Health & Substance Abuse ServicesMental Health & Substance Abuse Services

Tobacco settlement initiativeTobacco settlement initiative Statewide programs for prevention & controlStatewide programs for prevention & control Synar inspectionsSynar inspections Alcohol, tobacco and other drugs prevention & Alcohol, tobacco and other drugs prevention &

treatment treatment

Comptroller of Public AccountsComptroller of Public Accounts– Cigarette & tobacco retailer permits/taxesCigarette & tobacco retailer permits/taxes– Enforcement & criminal investigationEnforcement & criminal investigation– Grants to law enforcement agenciesGrants to law enforcement agencies

Texas Department of State Texas Department of State Health Services Tobacco Health Services Tobacco StaffStaff Region 1 – PanhandleRegion 1 – Panhandle

– Sherri Scott, CanyonSherri Scott, Canyon Region 2/3 – North TexasRegion 2/3 – North Texas

– Betty Boenisch, Betty Boenisch, ArlingtonArlington

Region 4/5 – East TexasRegion 4/5 – East Texas– Lana Herriman & Dreka Lana Herriman & Dreka

Strickland, TylerStrickland, Tyler Region 6/5 – Southeast Region 6/5 – Southeast

TexasTexas– Debbie Melecio, Debbie Melecio,

HoustonHouston

Region 7 – Central TexasRegion 7 – Central Texas– Sylvia Barron & Lance Sylvia Barron & Lance

Starzyck, TempleStarzyck, Temple Region 8 – South TexasRegion 8 – South Texas

– Rick Meza, San AntonioRick Meza, San Antonio Region 9/10 – West Region 9/10 – West

TexasTexas– Becky Zima & Sandra Becky Zima & Sandra

Herrera, El PasoHerrera, El Paso Region 11 – Rio Grande Region 11 – Rio Grande

ValleyValley– Martha Gonzalez, Martha Gonzalez,

HarlingenHarlingen

Legislative Legislative InterventionsInterventions

While prevention is always the best While prevention is always the best method, and is a key focus of the Texas method, and is a key focus of the Texas Department of State Health Services Department of State Health Services and other anti-tobacco advocates, kids and other anti-tobacco advocates, kids are still using tobacco products.are still using tobacco products.

The Texas Legislature in the 1990s passed The Texas Legislature in the 1990s passed two major bills aimed at curbing tobacco two major bills aimed at curbing tobacco abuse by minors.abuse by minors.

Tobacco at SchoolsTobacco at SchoolsEducation Code, Section 38.006 (passed 1995)Education Code, Section 38.006 (passed 1995)

The board of trustees of a school district The board of trustees of a school district shall:shall:

1)1) Prohibit smoking or using tobacco products Prohibit smoking or using tobacco products at a school-related or school-sanctioned at a school-related or school-sanctioned activity on or off school property;activity on or off school property;

2)2) Prohibit students from possession of tobacco Prohibit students from possession of tobacco products at a school-related or school-products at a school-related or school-sanctioned activity on or off school property.sanctioned activity on or off school property.

3)3) Ensure that school personnel enforce the Ensure that school personnel enforce the policies on school property.policies on school property.

Selling TobaccoSelling TobaccoHealth & Safety Code, Section 161.081-161.087Health & Safety Code, Section 161.081-161.087Tax Code, Sections 154.111, 154.121, 154.1142-Tax Code, Sections 154.111, 154.121, 154.1142-154.1143, 154.504, 155.0592 – 155.0593 ( Passed 154.1143, 154.504, 155.0592 – 155.0593 ( Passed 1899, Modified 1989, 1997)1899, Modified 1989, 1997)

Maintains existing penalty for store Maintains existing penalty for store clerks who sell tobacco to a minor.clerks who sell tobacco to a minor.

Photo identification to verify anyone Photo identification to verify anyone under the age of 27.under the age of 27.

Specified signage to include language Specified signage to include language that it is both illegal to sell to a minor that it is both illegal to sell to a minor and for minors to purchase tobacco.and for minors to purchase tobacco.

Restricts vending machines and self service Restricts vending machines and self service sales to places not open to those under the sales to places not open to those under the age of 18.age of 18.

Prohibits the giveaway of free samples and Prohibits the giveaway of free samples and coupons to anyone under 18.coupons to anyone under 18.

Prohibits the sales of cigarettes of less than Prohibits the sales of cigarettes of less than 20 per package.20 per package.

Requires a fee for a retail permit to sell Requires a fee for a retail permit to sell tobacco. Penalty for violations is $500 to tobacco. Penalty for violations is $500 to $1,000, suspension or revocation of permit.$1,000, suspension or revocation of permit.

Requires employers to train employees on Requires employers to train employees on tobacco laws.tobacco laws.

Selling Tobacco (cont’d.)Selling Tobacco (cont’d.)

Advertising TobaccoAdvertising TobaccoHealth & Safety Code, Section 161.122 (Passed Health & Safety Code, Section 161.122 (Passed 1997)1997)

Outdoor advertising is prohibited within Outdoor advertising is prohibited within 1,000 feet of a church or school. 1,000 feet of a church or school. (Measured along roadways/property lines (Measured along roadways/property lines from sign.)from sign.)

Cigarette advertising is in limbo due to Cigarette advertising is in limbo due to Supreme Court ruling in Supreme Court ruling in Lorrilard Lorrilard Tobacco Co. et al v. Reilly, Attorney Tobacco Co. et al v. Reilly, Attorney General of Massachusetts, et al.General of Massachusetts, et al.

Texas Tobacco Settlement prohibits Texas Tobacco Settlement prohibits tobacco billboards since June 24, 1998.tobacco billboards since June 24, 1998.

Minor PossessionMinor PossessionHealth & Safety Code, Section 161-252-161.254 Health & Safety Code, Section 161-252-161.254 (Passed 1997)(Passed 1997)

Possession and consumption of Possession and consumption of tobacco products is Class C tobacco products is Class C misdemeanor.misdemeanor.

Consequences:Consequences:– Fine of up to $250;Fine of up to $250;– 8-hour tobacco awareness class;8-hour tobacco awareness class;– 8-12 hours of community service;8-12 hours of community service;– 6 month loss or delay of driver’s license.6 month loss or delay of driver’s license.

Additional EffortsAdditional Efforts

Texas Tobacco Settlement InitiativeTexas Tobacco Settlement Initiative– Comprehensive tobacco prevention and Comprehensive tobacco prevention and

control effort in Southeast Texascontrol effort in Southeast Texas Community coalition building and Community coalition building and

technical assistancetechnical assistance– TDH regional staff throughout the stateTDH regional staff throughout the state

State level partnerships with other State level partnerships with other stakeholders agencies seeking stakeholders agencies seeking synergistic outcomes through synergistic outcomes through collaborative effortscollaborative efforts

Recent DevelopmentsRecent Developments

Increase in the state cigarette tax to Increase in the state cigarette tax to $1.41 per pack$1.41 per pack

Increased compliance with youth tobacco Increased compliance with youth tobacco laws (7.2% Synar buy rate for 2006)laws (7.2% Synar buy rate for 2006)

Increased number of local secondhand Increased number of local secondhand smoke ordinances across statesmoke ordinances across state

Statewide smoking ban proposed (but not Statewide smoking ban proposed (but not passed)passed)

2006 U.S. Surgeon General’s report on 2006 U.S. Surgeon General’s report on involuntary exposure to secondhand involuntary exposure to secondhand smokesmoke

New Direction New Direction From the 80From the 80thth LegislatureLegislature

Create competitive statewide grant program Create competitive statewide grant program allowing health departments and school allowing health departments and school districts in communities statewide to apply for districts in communities statewide to apply for funds.funds.

Dedicate $3 million in tobacco settlement funds Dedicate $3 million in tobacco settlement funds to the Texas Education Agency for tobacco to the Texas Education Agency for tobacco education in schools statewide.education in schools statewide.

Dedicate $1 million for smokeless tobacco Dedicate $1 million for smokeless tobacco prevention in rural communities.prevention in rural communities.

Produce resource list identifying best practice Produce resource list identifying best practice and evidence-based interventions for use by and evidence-based interventions for use by organizations receiving state appropriated organizations receiving state appropriated funds.funds.

New DirectionNew Direction

DSHS and grantees must use only best DSHS and grantees must use only best practice or evidence-based tobacco practice or evidence-based tobacco prevention, cessation, and enforcement prevention, cessation, and enforcement interventions.interventions.

DSHS or its contractor must notify DSHS or its contractor must notify Comptroller’s tobacco law enforcement Comptroller’s tobacco law enforcement grantees and local sheriff’s departments grantees and local sheriff’s departments in writing when Synar violations occur in writing when Synar violations occur during the annual survey.during the annual survey.

DSHS must prepare a report on the DSHS must prepare a report on the progress of the program to the progress of the program to the legislature.legislature.

Texas Youth Tobacco Texas Youth Tobacco Awareness ProgramAwareness Program

Goal is behavior modification, not Goal is behavior modification, not punishmentpunishment

Intended for 14-17 year oldsIntended for 14-17 year olds Program delivered in 8 hours in four Program delivered in 8 hours in four

two-hour sessions over two weekstwo-hour sessions over two weeks Small Class size, 20 participants Small Class size, 20 participants

maximum (10-12 ideal)maximum (10-12 ideal) Sessions are activity orientedSessions are activity oriented

Risk ReductionRisk Reduction

Secondary preventionSecondary prevention– Gain knowledge and skill with each Gain knowledge and skill with each

sessionsession Awareness and behavioral disruptionAwareness and behavioral disruption

– Challenges participants to make Challenges participants to make changes in tobacco use behaviorschanges in tobacco use behaviors

– Meets mandate of Senate Bill 55Meets mandate of Senate Bill 55 Focus is on long-term cessationFocus is on long-term cessation

TYTAP StudentsTYTAP Students

About 20% of the youth say their About 20% of the youth say their primary supplier of tobacco is their primary supplier of tobacco is their parents. They also state that parents parents. They also state that parents can be a big help in quitting.can be a big help in quitting.

Social support is essential for youth Social support is essential for youth desiring to quit. They need desiring to quit. They need encouragement and understanding encouragement and understanding from a variety of social sources.from a variety of social sources.

TYTAP StudentsTYTAP Students

Many youth are engaging in a Many youth are engaging in a variety of risky behaviors, not just variety of risky behaviors, not just tobacco use. Drawings and tobacco use. Drawings and writings in the workbooks indicate writings in the workbooks indicate a substantial number are involved a substantial number are involved in poly-drug use, including alcohol in poly-drug use, including alcohol & illegal drugs.& illegal drugs.

Some have indicated suicide Some have indicated suicide fantasies and evidence of fantasies and evidence of depression.depression.

How does enforcement How does enforcement affect your affect your community?community?

A study of tobacco enforcement in A study of tobacco enforcement in Illinois showed:Illinois showed:– Enforcing tobacco laws led to a Enforcing tobacco laws led to a

decrease in youth tobacco abuse and decrease in youth tobacco abuse and retail sales.retail sales.

– Enforcing tobacco laws led to a Enforcing tobacco laws led to a decrease in other drug offenses.decrease in other drug offenses.

– Enforcing tobacco laws led to a Enforcing tobacco laws led to a decrease in overall juvenile crime.decrease in overall juvenile crime.

Guidelines for School Guidelines for School Health ProgramsHealth Programs CDC’s CDC’s Guidelines for School Health Guidelines for School Health

Programs to Prevent Tobacco Use and Programs to Prevent Tobacco Use and Addiction.Addiction.– Prohibit tobacco use at all school facilities Prohibit tobacco use at all school facilities

and events.and events.– Encourage and help students and staff to Encourage and help students and staff to

quit using tobacco.quit using tobacco.– Provide developmentally appropriate Provide developmentally appropriate

instruction in grade K-12 that address instruction in grade K-12 that address social and psychological causes of tobacco social and psychological causes of tobacco use.use.

Guidelines for School Guidelines for School Health ProgramsHealth Programs CDC’s CDC’s Guidelines Guidelines continued:continued:

– Provide developmentally appropriate Provide developmentally appropriate instruction in grade K-12 that instruction in grade K-12 that address social and psychological address social and psychological causes of tobacco use.causes of tobacco use.

– Part of a coordinated school health Part of a coordinated school health program.program.

– Reinforced by community efforts.Reinforced by community efforts.

Guidelines for School Guidelines for School Health ProgramsHealth Programs Policy:Policy: Develop and enforce Develop and enforce

school policy developed in school policy developed in collaboration with all stakeholders.collaboration with all stakeholders.– Prohibit tobacco useProhibit tobacco use– Prohibit tobacco advertisingProhibit tobacco advertising– Students receive instructionStudents receive instruction– Access to cessation programsAccess to cessation programs– Help violators quit rather than Help violators quit rather than

punishpunish

Guidelines for School Guidelines for School Health ProgramsHealth Programs Instruction:Instruction: Short & long term Short & long term

negative physiologic and social negative physiologic and social consequences, social influences, consequences, social influences, peer norms and refusal skills.peer norms and refusal skills.– Decrease social acceptabilityDecrease social acceptability– Understand why people start and Understand why people start and

identify more positive activitiesidentify more positive activities– Developed skills in assertiveness, Developed skills in assertiveness,

goal setting, problem solving and goal setting, problem solving and resisting pressure from media and resisting pressure from media and peers.peers.

Guidelines for School Guidelines for School Health ProgramsHealth Programs Curriculum:Curriculum: Provide prevention Provide prevention

education in grade K-12education in grade K-12– Instruction should begin in Instruction should begin in

elementary and intensify in elementary and intensify in middle/junior high when middle/junior high when exposure to older students exposure to older students increases initiation rates.increases initiation rates.

– Reinforce throughout high Reinforce throughout high school years.school years.

Guidelines for School Guidelines for School Health ProgramsHealth Programs Training:Training: Provide program-specific Provide program-specific

training on tobacco use prevention training on tobacco use prevention for teachers. The training should for teachers. The training should include reviewing curriculum, include reviewing curriculum, modeling instructional activities, modeling instructional activities, and providing opportunities to and providing opportunities to practice implementing lessons. Well practice implementing lessons. Well trained peer leaders can be an trained peer leaders can be an important adjunct to teacher-led important adjunct to teacher-led instruction.instruction.

Guidelines for School Guidelines for School Health ProgramsHealth Programs Family Involvement:Family Involvement: Involve Involve

parents or families in supporting parents or families in supporting school-based programs to prevent school-based programs to prevent tobacco use.tobacco use.– Promote discussions at home about Promote discussions at home about

tobacco use by assigning homework tobacco use by assigning homework and projects that involve families.and projects that involve families.

– Encourage parents to participate in Encourage parents to participate in community efforts to prevent community efforts to prevent tobacco use and addiction.tobacco use and addiction.

Guidelines for School Guidelines for School Health ProgramsHealth Programs Tobacco-Use Cessation Efforts:Tobacco-Use Cessation Efforts:

Support cessation efforts among Support cessation efforts among students and school staff who use students and school staff who use tobacco. Schools should provide tobacco. Schools should provide access to cessation programs that access to cessation programs that help students and staff stop using help students and staff stop using tobacco rather than punishing them tobacco rather than punishing them for violating tobacco use policies.for violating tobacco use policies.

Guidelines for School Guidelines for School Health ProgramsHealth Programs Evaluation:Evaluation: Assess the tobacco use Assess the tobacco use

prevention program at regular prevention program at regular intervals. Schools can use CDC’s intervals. Schools can use CDC’s Guidelines for School Health Guidelines for School Health Programs to Prevent Tobacco Use Programs to Prevent Tobacco Use and Addictionand Addiction to assess whether they to assess whether they are providing effective policies, are providing effective policies, curricula, training, family curricula, training, family involvement and cessation.involvement and cessation.

SummarySummary

Tobacco by itself is a dangerous, addictive Tobacco by itself is a dangerous, addictive and deadly substance.and deadly substance.

Youth tobacco use is tied to a number of Youth tobacco use is tied to a number of major short and long term health hazards, major short and long term health hazards, including substance abuse.including substance abuse.

Enforcement can lead to getting youth help Enforcement can lead to getting youth help with tobacco abuse and other health with tobacco abuse and other health threats.threats.

Solutions involve all community partners Solutions involve all community partners and institutions coming together in a and institutions coming together in a collaborative and comprehensive approach.collaborative and comprehensive approach.

Questions?Questions?Discussion?Discussion?

All Tobacco Deaths Are Preventable

Barry Sharp, MSHP, CHES

www.dshs.state.tx.us/tobacco