Protecting Children and Families from Tobacco:

Leadership Advocacy Training

Jonathan D. Klein, MD, MPHAAP Associate Executive Director and

Director, Julius B. Richmond Center

Sponsoring Partners Sponsoring Partners

• American Academy of PediatricsAmerican Academy of Pediatrics

• American Medical AssociationAmerican Medical Association

• American Academy of Family PhysiciansAmerican Academy of Family Physicians

• American Congress of Obstetrics and American Congress of Obstetrics and Gynecology Gynecology

• American CollegeAmerican College of Physiciansof Physicians

FundersFunders

Grant support to the American Academy of Pediatrics from:

DHHS – National Technical Assistance to the Communities Putting Prevention to Work Program

Flight Attendant Medical Research Institute (FAMRI)

Legacy

Unrestricted donation from:

Pfizer, Inc.

…dedicated to eliminating children’s exposure to secondhand smoke and tobacco.

Global State of Tobacco Control

2011 WHO Report on the Global Tobacco Epidemic:

• Tobacco use continues to be the leading preventable cause of premature death and disease worldwide

• 6 million people die each year due to tobacco related illnesses, most of these in low- and middle-income countries

• This disparity is expected to widen, with deaths expected to increase to > 8 million a year by 2030

• 700 million children – almost half of the world’s children - are exposed to secondhand smoke

US Tobacco Control

• Tobacco is the leading cause of preventable death and disease in the United States, too

• Approximately 443,000 die each year

• 19.3% of adults >18 years smoked in 2010 (45 million)

Secondhand Smoke Exposure

• An estimated 88 million nonsmokers were exposed in the United States in 2007-2008

• Children are at particular risk for exposure

• Only 5.4% of adult nonsmokers live with a smoker

• Among children: – 41.1% exposed to SHS at home– 54.9% exposed to SHS in public places

Global Youth Tobacco Surveillance, 2000—2007 cdc.gov/preview/mmwrhtml/ss5701a1.htm

Secondhand Tobacco Smoke Secondhand Tobacco Smoke • Children exposed to SHTS have greater Children exposed to SHTS have greater

risk/rates of:risk/rates of:• Decreased lung functionDecreased lung function• Asthma Asthma • Sudden Infant Death SyndromeSudden Infant Death Syndrome• Upper and lower respiratory track Upper and lower respiratory track

infections; pneumonia and bronchitisinfections; pneumonia and bronchitis• Ear infectionsEar infections• Neuro-cognitive delay and behavior Neuro-cognitive delay and behavior

problemsproblems

• Increased adult risk of:Increased adult risk of:• LLung cancer and leukemias• HHeart disease, lipid disorders,

and metabolic syndrome• Smoking themselvesSmoking themselves

Screening

Are we asking the right questions?

WHO MPOWER Package

• Monitor tobacco use and prevention policies

• Protect people from tobacco smoke

• Offer help to quit tobacco use

• Warn about the dangers of tobacco

• Enforce bans on tobacco advertising, promotion and sponsorship

• Raise taxes on tobacco.

HHS Strategic Plan Ending the Tobacco Epidemic

• Accelerate progress for four Healthy People 2020 goals:

• Reduce tobacco use by adults and adolescents• Reduce initiation of tobacco use among children,

adolescents, and young adults• Increase successful cessation by smokers• Reduce nonsmokers exposure to secondhand

smoke

• Support FDA regulation of manufacture, marketing, and distribution of tobacco products

Conference Goals

• To improve the spread and effectiveness of clinical services for tobacco cessation

• To engage health care organizations in state, county and local community policy advocacy for better access to tobacco control services.

Tobacco Control “Champions”

• Identify at least two qualities physicians bring to advocacy.

• Describe trends in tobacco use and secondhand smoke prevention.

• Identify risk factors for initiation and barriers to cessation.

• Advocate for coverage of tobacco cessation and pharmacotherapy.

• Educate private and public leaders about tobacco control policiess, cessation and pharmacotherapy.

• Articulate at least two policy changes to improve tobacco control.

• Identify opportunities for tobacco advocacy in states and communities.

• Develop a commitment to change, advocacy goals and strategies.

Social Strategies

ScientificKnowledge

Political Will

Social Strategies

ScientificKnowledge

Political Will

Tobacco Advocacy and Policy Issues

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– 5A’s - Ask, Advise, Assess, Assist and Arrange5A’s - 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 youth a priority – Include secondhand smoke – Headstart, schools, housing, etc.

• Age of sale restrictions and enforcement

• Advertising limitations

• Smokefree Movies

• Public smoke exposure reduction

• Do not allow preemptive efforts by tobacco industry

• Reduce social acceptability of smoking

Exposure to Tobacco Use in Movies and Smoking Among Exposure to Tobacco Use in Movies and Smoking Among 5th-8th grader5th-8th grader

Adapted from Sargent, DiFranza, 2003

8th Grade7th Grade6th Grade5th Grade

Smoke Free Movies Smoke Free Movies

• Rate new smoking movies "R"

• Certify no pay-offs

• Require strong anti-smoking ads

• Stop identifying tobacco brands