Maria AzzarelliMaria AzzarelliOffice of Chronic DiseaseOffice of Chronic Disease

Prevention and Health PromotionPrevention and Health PromotionSouthern Nevada Health DistrictSouthern Nevada Health District

Tobacco Control ProgramTobacco Control Program

Southern Nevada Health District Southern Nevada Health District Tobacco Control ProgramTobacco Control Program

THEN: 1999

• Highest adult smoking rates in the nation (30%)

• Youth smoking rates were among the highest in the nation as well (33%)

• Public was largely unaware of the dangers of secondhand smoke

• No culturally or linguistically tailored tobacco prevention programs

• No comprehensive law in place to protect the public from secondhand smoke exposure

Comprehensive Tobacco Program

Population-Based Approach, CDC’s Best Practices and Program Goals

Goal 1: Prevent youth initiation of tobacco products

Goal 2: Promote quitting among youth and adults

Goal 3: Reduce exposure to secondhand smoke

Goal 4: Reduce tobacco related health disparities

in diverse communities

VirtualStrategie

s

Community Partnerships

Social Branding,

XPOZ, Urban Fuel, and

Crush

Media (TV, Radio, Magazine,

Newspaper, Billboards)

CoalitionBuilding

Social Marketing

Event Sponsorship

s

DiverseCommunityPrograms

OutreachProgram

s

Brief Intervention –

Healthcare Providers

Policy and Advocacy

Tobacco Control Program

Surveillance and

Evaluation

The Toll of Tobacco

• Smoking is the leading cause of preventable death and kills more people each year in the U.S. than alcohol, AIDS, motor vehicle crashes, illegal drugs, murders, and suicides combined.*

• Tobacco use kills 1200 people every day in the U.S.**

• Secondhand smoke is the third leading cause of preventable death in the U.S., killing an estimated 53,000 nonsmokers each year.**

*Campaign for Tobacco-free Kids**U.S. Centers for Disease Control and Prevention

The Toll of Tobacco• The tobacco industry

spends over $116 million each year to market their products in Nevada.*

• In Nevada, $565 million is spent in annual health care costs directly caused by smoking.*

*Campaign for Tobacco Free Kids

A Global Problem

• Tobacco kills one person every six seconds.

• 5.4 million deaths a year - and rising worldwide.

Photo taken in Liberia, Africa

Health Impacts of Secondhand Smoke Exposure

For adults who are exposed: • Increased risk of lung cancer and many other cancers;

heart disease

For pregnant women who are exposed:• Increased risk of having low birth weight babies and other

dangerous conditions

For children who are exposed:• Especially dangerous because children’s lungs are still

developing

• Increased risk of Sudden Infant Death Syndrome (SIDS), asthma, bronchitis, pneumonia, ear infections

What is a Brief Intervention?:Using the 3A Approach

The Agency for Healthcare Research and Quality (AHRQ) recommends brief interventions, which includes the following steps:

1. Ask (about tobacco use)

2. Advise (client to quit)

3. Assist (in quit attempt by educating client on dangers of tobacco use and referring client to NTUH for further assistance)

Brief Intervention Project Background

2-year collaboration project between SNHD and Nevada Tobacco Users’ Helpline (NTUH).

Phase 1: (Jul06- Jun07) Pilot project at SNHD; trained SNHD health care providers to deliver brief tobacco use interventions to clients on a regular basis (Results: 200+ total providers trained, calls to NTUH quadrupled).

Phase 2: (Jul07- current) Used pilot project as model for community health providers outside of the district; developed online educational module and order form; used mailings to contact health care providers.

Goal is never to stigmatize or be critical of smokers but to provide resources to those who want to quit.

Why use brief interventions?

• 70% of all smokers report wanting to quit smoking.

• Professional assistance or community health provider advice increases quit rates by 30%.

• For many clients, you may be the only link they have to health information like this.

Smoking and Diabetes• People who have diabetes and smoke are at an increased

risk of diabetes-related complications, including:• Damaging blood vessels throughout the body • Increasing the risk of nerve damage • Tripling the risk of kidney disease• Increasing the risk of blindness• Increasing the chance of tooth loss

• Smoking increases insulin resistance.• Smoking just one cigarette can reduce the body’s ability to use

insulin by 15%

• Of people with diabetes who need amputations, 95% are smokers.

• Currently there are studies suggesting tobacco use is an independent risk factor for type 2 diabetes.

(California Smokers’ Helpline, 2002)

Smoking and Diabetes PSA

Step 1: ASK (1 minute)

• Ask every client about their tobacco use at every visit.

• Determine if the client currently uses tobacco, formerly used tobacco, or has never used tobacco.

• Determine what form of tobacco is used (ex: cigarettes, smokeless tobacco, etc.).

• Determine how often tobacco is used.

• Document tobacco use status in the medical record or chart, if applicable.

Step 2: ADVISE (1 minute) • In a clear, strong, and personalized manner,

urge every tobacco user to quit using a non- judgmental approach.

• Tobacco users who have failed in previous quit attempts should be told that most people make repeated quit attempts before they are successful.

• Employ the teachable moment: link diabetes

health issues with advice.

Step 3: ASSIST (1 minute) • Determine if the client is interested in quitting. • Provide educational materials on quitting.

• For those clients interested in quitting, provide information on the Helpline or other cessation programs.

• Provide a referral to NTUH using quit cards.

• Document this interaction with client on medical record or chart, if applicable.

The Role of Health Professionals in Tobacco Control

• Utilize the Brief Intervention method when dealing with

patients: • Ask each patient about their tobacco use at each visit • Advise them to quit • Assist them in quitting by providing resources

• Participate in policy initiatives that result in limiting exposure to secondhand smoke (i.e., offer to speak to the media regarding the dangers of secondhand smoke, participate in a tobacco prevention coalition or advocacy group in your area).

• Advocate for and support the development of smoke free medical facility policies (outdoor/doorway).

Threats to Tobacco Prevention and Control in Nevada

• The SNHD is funded by two primary sources (Centers for Disease Control and Tobacco Master Settlement dollars)

• Funding allocated for tobacco prevention and controlling programming in Nevada has been declining.

• Tobacco programs face further funding reductions in the future legislative session.

What will happen if funding is further reduced or eliminated?

• Once tobacco prevention funding is eliminated or reduced significantly, smoking rates begin to increase quickly, resulting in a dramatic reversal of positive tobacco trends.

• Other states that have reduced or eliminated tobacco prevention funding such as Florida, Massachusetts, and California saw:– increase in youth and adult smoking rates – alarming increase in illegal sales of tobacco

products to minors

Local Lead Agency Model

• SB340 (2009) restructured tobacco control spending so that funds are now allocated based on a recommended model.

• This improves funding efficiency, allows for local control, assures statewide services are available (including rural), and allows for “best practice” programming.

S.B. 340 - TOBACCO PREVENTION AND CONTROL FUNDING STRUCTURE

MASTER SETTLEMENT AGREEMENT DOLLARS FROM

DHHS - Director’s Office

NEVADA STATE

HEALTH DIVISION

LOCAL LEAD AGENCIES

Southern Nevada Health District

Washoe County Health District

RURAL SERVICES

Carson City Health and Human Services

Nevada Statewide Coalition Partnership

STATEWIDE SERVICES

Nevada Tobacco Users’ Helpline

NOW: 2010

• Adult smoking prevalence in Clark County has decreased to 22%.

• Some diverse community smoking rates have declined.

• Youth smoking prevalence has declined from 33% to 14%, the 3rd lowest youth smoking rate in the nation.

• 90% of Clark County adults (2008) surveyed believe people should be protected from secondhand smoke.

• Comprehensive law was passed to protect the public from exposure to secondhand smoke (Nevada Clean Indoor Air Act – NCIAA).

Questions

For more information on SNHD’s Tobacco Control Program visit www.gethealthyclarkcounty.org or call (702) 759-1270.