addressing disparities in tobacco use & cessation ... · pharmaceutical nicotine replacement...
TRANSCRIPT
Addressing Disparities in Tobacco Use & Cessation:
Challenges and Opportunities
Jacqui Drope Managing Director
Global Cancer Prevention
November 2016
The ACS Center for Tobacco Control: Fighting Disparities
• The Center’s overarching priority is to combat tobacco-related disparities in communities suffering from disproportionately higher tobacco use rates and disproportionate incidence of tobacco-caused morbidity and mortality, such as:
• Low socioeconomic status (SES) • Behavioral and substance abuse disorders • Lesbian, gay, bisexual, and transgender (LGBT) • Racial/ethnic minorities • Homeless
Benefits of Cessation
10 years of life gained back
6 years of life gained back
4 years of life gained back
QUIT BY AGE
50
QUIT BY AGE
60
QUIT BY AGE
40
Smokers Want to Quit
• 70% of smokers want to quit
• Fewer than 5% of those who try to quit smoking succeed
Smoking Among Vulnerable Groups
• High prevalence of combustible tobacco use among vulnerable populations
• Low quit rates
• Need to consider less harmful options and new products to enhance long-term cessation success
Three Populations Smoke at Highest Rates in U.S.
• The poor (>8 million smokers below poverty level)
• The least educated (>22 million smokers with a high school education, or less)
• Those with co-morbid mental health or addictive disorders smoke 40% of all cigarettes
Pharmaceutical Nicotine Replacement Therapies: Benefits
• Safe to use
• Use of NRT approximately doubles the likelihood of quitting
• Use of a combination of NRT products has been shown to increase cessation rates compared to use of a single product
NRT: Disadvantages
• Slow nicotine delivery
• Cost considerations • Misconceptions about health risks
• Developed to be cessation aids rather
than long-term alternatives to smoking
• Strict product regulation
• Lack of wide availability
• Questions about long-term effectiveness
Smokeless Tobacco
• Used around the world in a wide variety of forms
• Carcinogenic and chemical compounds vary considerably depending on the type of product and manufacturing process
• Low nitrosamine smokeless tobacco products less harmful compared to conventional cigarettes
Smokeless Tobacco: Swedish Style Snus
• Sweden is the world leader in
reducing smoking prevalence and smoking-related mortality and morbidity
• Research does not support the belief that widespread use of snus or smokeless tobacco is a gateway to smoking among youth
Electronic Nicotine Delivery Systems (ENDS)
• Devices that do not burn or use tobacco leaves
• Some contain nicotine; some do not
• The main constituents of the solution, in addition to nicotine when nicotine is present, are propylene glycol and flavouring agents
• ENDS solutions and emissions contain other chemicals, some of them considered to be toxicants
ENDS Efficacy for Cessation?
Continuum of Risk
Source: Nutt, DJ et al (2014). Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res, 20, 218-225
Synthesis
• NRTs are safe alternatives to smoking but have led to limited
long-term success in cessation
• Evidence supports that ENDS are less harmful than combustible tobacco
• Smoking marginalized to vulnerable populations who have a
difficult time quitting or are unwilling to quit
• Majority of smokers will likely continue combustibles without acceptable less harmful alternatives
• Continuum of risk associated with nicotine-containing products
• We need to figure out how best to start communicating this
continuum better so that smokers make informed decisions
Contact Us
ACS Center for Tobacco Control [email protected]
Cliff Douglas, J.D. Vice President, Tobacco Control Director, Center for Tobacco Control American Cancer Society [email protected]
Jacqui Drope Managing Director, Global Cancer Prevention and Early Detection American Cancer Society [email protected]