Primary Prevention of Cancer Primary Prevention of Cancer Tobacco Use Prevention & Cessation Tobacco Use Prevention & Cessation 1
Overview Overview POLICY OVERVIEW – Joan Stine � POLICY OVERVIEW – Joan Stine � � Introduction � Introduction � Goals and strategies � Goals and strategies � Public policy � Public policy PROGRESS REPORT – Bob Fiedler � PROGRESS REPORT – Bob Fiedler � � Objectives � Objectives � Progress Report - Data � Progress Report - Data STATEWIDE INITIATIVES – Dawn Berkowitz � STATEWIDE INITIATIVES – Dawn Berkowitz � � Quitline (1-800-QUIT-NOW) � Quitline (1-800-QUIT-NOW) � Youth Initiatives � Youth Initiatives � Counter-marketing and media � Counter-marketing and media COUNTY-LEVEL INITIATIVES – Lawrence Carter � COUNTY-LEVEL INITIATIVES – Lawrence Carter � � Local Public Health Component initiatives � Local Public Health Component initiatives 2
POLICY OVERVIEW POLICY OVERVIEW 3
Goals Goals � Substantially reduce tobacco use by � Substantially reduce tobacco use by Maryland adults and youth. Maryland adults and youth. � Substantially reduce Maryland youth and � Substantially reduce Maryland youth and adult exposure to secondhand smoke. adult exposure to secondhand smoke. 4
Strategies Strategies Establish a public policy framework that: � Establish a public policy framework that: � Consistently seeks to discourage the initiation of Consistently seeks to discourage the initiation of 1. 1. tobacco use; tobacco use; Encourages those who use tobacco to quit; and Encourages those who use tobacco to quit; and 2. 2. Complements and supports programmatic efforts to Complements and supports programmatic efforts to 3. 3. reduce the use of tobacco products. reduce the use of tobacco products. Implement and sustain a comprehensive � Implement and sustain a comprehensive � programmatic framework that discourages the programmatic framework that discourages the initiation of tobacco use and encourages cessation. initiation of tobacco use and encourages cessation. 5
Maryland Policy Environment Maryland Policy Environment Creating/ Sustaining Programmatic Framework Creating/ Sustaining Programmatic Framework � General Fund support for initial tobacco use prevention � General Fund support for initial tobacco use prevention and cessation program (1993) and cessation program (1993) � ‘Cigarette Restitution Fund’ as recipient of all tobacco- � ‘Cigarette Restitution Fund’ as recipient of all tobacco- related litigation proceeds related litigation proceeds � ‘Minimum’ program funding for Governor’s annual budget � ‘Minimum’ program funding for Governor’s annual budget of $21 million (subject to ‘holdbacks’ and budget cuts) of $21 million (subject to ‘holdbacks’ and budget cuts) � Statutory CDC ‘ Best Practices’ Program Structure � Statutory CDC ‘ Best Practices’ Program Structure Statewide Public Health Component Surveillance & Evaluation Component Statewide Public Health Component Surveillance & Evaluation Component Counter-marketing/Media Component Administrative Component Counter-marketing/Media Component Administrative Component Local Public Health Component Local Public Health Component 6
Maryland Policy Environment Maryland Policy Environment Policy Framework Achievements - Cigarettes Maryland, Pre-Settlement: Maryland, Post-Settlement: Maryland, Pre-Settlement: Maryland, Post-Settlement: Retailers must be licensed Cigarettes must be ‘fire-safe’ � � Retailers must be licensed Cigarettes must be ‘fire-safe’ � � Sale of clove cigarettes banned Ban on the sale of single cigarettes � � Sale of clove cigarettes banned Ban on the sale of single cigarettes � � Minimum age to purchase/possess Minimum package size, 20 cigarettes � � Minimum age to purchase/possess Minimum package size, 20 cigarettes � � tobacco products – 18 years old tobacco products – 18 years old Ban on Internet/Telephone sales of � Ban on Internet/Telephone sales of � cigarettes cigarettes � Ban on vending machine sales except � Ban on vending machine sales except at adult locations at adult locations � Maryland ban on ‘candy-like’ products � Maryland ban on ‘candy-like’ products Federal, Post-FDA Legislation: Federal, Post-FDA Legislation: containing tobacco containing tobacco � FDA ban on fruit, candy, or clove � FDA ban on fruit, candy, or clove Three (3) increases in excise tax since � Three (3) increases in excise tax since � flavored cigarettes flavored cigarettes settlement, now $2 per pack settlement, now $2 per pack 7
Maryland Policy Environment Maryland Policy Environment Policy Framework Achievements – Cigars & Other Products Maryland, Pre-Settlement: Maryland, Post-Settlement: Maryland, Pre-Settlement: Maryland, Post-Settlement: � Minimum age to purchase or possess � One (1) increase in excise tax, now � Minimum age to purchase or possess � One (1) increase in excise tax, now tobacco products – 18 years old 15% of wholesale price (equivalent to tobacco products – 18 years old 15% of wholesale price (equivalent to $0.33 per pack of cigarettes) $0.33 per pack of cigarettes) ¢ 8
Maryland Policy Environment Maryland Policy Environment Policy Framework Achievements – Secondhand Smoke Maryland, Pre-Settlement: Maryland, Post-Settlement: Maryland, Pre-Settlement: Maryland, Post-Settlement: � Regulatory ban on smoking inside 85% � Statutory ban on smoking at all indoor � Regulatory ban on smoking inside 85% � Statutory ban on smoking at all indoor of worksites worksites of worksites worksites � Regulatory ban on smoking inside � Statutory ban on smoking inside all � Regulatory ban on smoking inside � Statutory ban on smoking inside all restaurants not possessing liquor restaurants restaurants not possessing liquor restaurants ¢ license, designated smoking areas in � Statutory ban on smoking inside all license, designated smoking areas in � Statutory ban on smoking inside all remainder remainder bars bars � Provision for “waivers” expires 2011 � Provision for “waivers” expires 2011 9
Cancer Plan Policy Goals Cancer Plan Policy Goals Fund Program at least at � � Enhanced access to Fund Program at least at � Enhanced access to � minimum CDC minimum CDC cessation Services cessation Services recommended levels recommended levels � Comprehensive Clean � Comprehensive Clean Enhance program � Enhance program � Indoor Air Legislation Indoor Air Legislation activities activities Continuous Evaluation of � Continuous Evaluation of � Increase excise tax on � � Increase excise tax on State and local program State and local program cigarettes to $1.50 cigarettes to $1.50 Civil youth access � Civil youth access � enforcement legislation enforcement legislation 10
Program I mpact and Program I mpact and Sustainability Sustainability $16 Selected Costs and Expenditures Calculated Per Pack of Cigarettes Sold in Maryland (FY 2009) $13.79 $14 $12 $10 $8 $6 $4 $2.00 $2 $0.89 $0.49 $0.31 $0.23 $0.10 $0.02 $0 Medical Costs MD Excise Tax Settlement Revenue CDC Minimum CDC Recommended CDC Upper MD Statutory Minimum Maryland's FY2009 Investment in Tobacco Control Per Pack of Cigarettes Sold in FY 2009 11
STATUS REPORT: STATUS REPORT: TOBACCO USE I N MARYLAND TOBACCO USE I N MARYLAND Bob Fiedler Bob Fiedler 12
Behavior Target: Behavior Target: Reduce Cigarette Smoking Reduce Cigarette Smoking 2008 Objectives for Relative Relative 2008 Objectives for 2008 Actual Change Cigarette Smoking 2008 Actual Change Cigarette Smoking Reduce Middle School � Reduce Middle School � - 52.1% smoking to less than 6.2% 3.5% - 52.1% smoking to less than 6.2% 3.5% 2000 MYTS Baseline – 7.3% 2000 MYTS Baseline – 7.3% Reduce High School smoking � Reduce High School smoking � - 35.4% 15.3% - 35.4% 15.3% to less than 20.3% to less than 20.3% 2000 MYTS Baseline – 23.7% 2000 MYTS Baseline – 23.7% Reduce Adult smoking to � Reduce Adult smoking to � 14.9% - 27.3% - 27.3% less than 15.0% 14.9% less than 15.0% 2000 MATS Baseline – 16.9%, 2008 12.4%, - 26.6% 2000 MATS Baseline – 16.9%, 2008 12.4%, - 26.6% 2000 BRFSS Baseline – 20.5% 2000 BRFSS Baseline – 20.5% 13 Sources: Maryland Youth and Adult Tobacco Surveys, 2000 and 2008. Behavioral Risk Factor Surveillance System (BRFSS) 2000, 2008.
Adult Use of Tobacco Products Adult Use of Tobacco Products 35% 35% 2000 2002 2004 2006 2008 2000 2002 2004 2006 2008 30% 30% 25% 25% 21.9% 21.9% 20.5% 20.5% 19.5% 19.5% 20% 20% 17.7% 17.7% 14.9% 14.9% 15% 15% 10% 10% 5.9% 5.9% 5.9% 5.9% 5.1% 5.1% 4.0% 5% 4.0% 5% 1.3% 1.1% 1.1% 1.3% 1.1% 1.0% 1.1% 1.0% 0% 0% Cigarette Cigar Smokeless Cigarette Cigar Smokeless 14 Sources: Behavioral Risk Factor Surveillance System (BRFSS) 2000-2008, Maryland Adult Tobacco Survey (MATS) 2000-2008.
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