Post on 28-Mar-2015
Tobacco In North Dakota
Eric L. Johnson, M.D.
Assistant Professor
Department of Family and Community Medicine
University of North Dakota
School of Medicine and Health Sciences
Physician Consultant North Dakota Tobacco Quitline/Quitnet
Assistant Medical Director
Altru Diabetes Center
Objectives
• Review Tobacco Related Disease in the U.S. and in North Dakota
• Understand Negative Health Effects of Second Hand (Passive) Smoke
• Review Negative Economic Impact of Tobacco
• Review High Quality Tobacco Cessation Resources in North Dakota
Tobacco Use in North Dakota
• ~20% of U.S. Adults smoke (41% in 1965)
• ~18% of ND adults smoke (~21% when Quitline launched 2004)
• 41% of ND Native Americans smoke
• 18% of Pregnant women in ND smoke vs. 12% in the U.S.
CDCND Dept of Health
Tobacco Use in North Dakota
• ~116,000 ND adults and ~8,000* HS students smoke cigarettes
• ~20,000 ND adults and ~3,800^ HS students use spit tobacco
(BRFSS 2008)(BRFSS 2008)
(YRBS 2005,2007)(YRBS 2005,2007)
North Dakota Department of HealthDivision of Tobacco Prevention and Control
North Dakota Department of HealthDivision of Tobacco Prevention and Control
Tobacco Use in North Dakota
• Native American population: 49.3% adults use tobacco (highest smoking rate of any ethnic group in U.S.)
• Smoking in pregnancy higher in North Dakota than national average: 18% vs. 12%
• WIC Clinic population survey: 45% smoked prior to pregnancy vs. 16% non-WIC
Tobacco’s Health Cost inNorth Dakota
• Smoking-attributable direct medical expenditures:
$250,000,000• Smoking-attributable productivity costs:
$192,000,000• Medicaid expenditures for smoking-related illnesses and
diseases:
$47,000,000
Annual Costs! CDC. Smoking-Attributable Mortality, Morbidity and Economic Costs (SAMMEC) report, 2008. CDC Data Highlights, 2006.
North Dakota spends $691 per capita on direct
medical expenditures and
lost productivity due to smoking
Tobacco Use in North Dakota
• Heart Disease and Cancer are the leading causes of death in North Dakota
• Tobacco use is the leading preventable cause of death
Smoking Causes Death
Smoking causes approximately• 90% of all lung cancer deaths in men• 80% of all lung cancer deaths in women• 90% of deaths from chronic obstructive lung
disease (COPD)
CDC
Smoking Causes DeathCompared with nonsmokers smoking increases
risk of—• Coronary heart disease by 2 to 4 times• Stroke by 2 to 4 times• Men developing lung cancer by 23 times• Women developing lung cancer by 13 times• Dying from chronic obstructive lung diseases (COPD) by
12 to 13 times• Also associated with risk of type 2 diabetes
CDC
Secondhand Smoke(Passive Smoking)
• Negative effects of smoke on people who aren’t doing the smoking
• No longer speculation that this is dangerous for those exposed to secondhand smoke
Secondhand Smoke DeathsUnited States• Lung cancer – 3,000 deaths annually • Heart Disease – 35,000 deaths annually
North Dakota• 80-140 deaths annually
CDCAmerican Cancer Society
Second Hand Smoke and Cardiovascular Risk (Heart Attack)• Cardiovascular Risk (Heart Attack) is
~80-90% of primary smoking
• Secondhand smoke increases risk of heart attack by 30%
• Well understood phenomenon- no longer speculative concerning harmful effects
Barnoya A, Glantz S Circulation May 24 2005The Health Consequences of Involuntary Exposure to Tobacco Smoke: Report of the Surgeon General 2006
“Smoking Ban”
• “Smoking Ban” is not an appropriate description
More descriptive….
• “Comprehensive Smoke Free” legislation
• “Smoke Free” Policy
Smoke Free Legislation• Typically, legislation that eliminates smoking in public
places• The smoker is NOT the medical focus of this type of
legislation
(not protecting the smoker from themselves)• Focus in on reducing injury inflicted on others• Business impact (negative) is little or none (recent
Fargo area survey, others)
Smoke Free Legislation and Heart Attack
Location PopulationChange in Heart Attack
Hospital Admissions
Helena 68,140 −40%
Pueblo 698,229 (2counties) −41%
New York 18,976,457 −8%
Indiana 239,332 −50%
Ohio 29,636 −20%
Saskatoon 202,340 −13%
Communities Similar to Grand Forks
• Pueblo, CO
• Population 103,648
• College Town
• Decrease in Heart Attacks following “smoking ban” 27%
Communities Similar to Grand Forks
• Bowling Green, OH
• Population 29,636
• College Town
• Reduction in Heart Attacks following “smoking ban” 19%
Communities Similar to Grand Forks
• Helena, MT• Population 47,154 • College Town• Reduction in Heart Attack with “smoking
free” legislation 40%• Increase in Heart Attacks following smoke
free legislation repeal 40%
“Smoke Free Legislation” and Heart Attack
• 11 legitimate studies
• Europe, U.S., Canada
• Approx 17% reduction in Heart Attack across all studies
• Approx 195,000 Heart Attacks would be avoided in U.S. annually
• In an age of health care cost containment, can’t disregard
Long Term Tobacco Control
• California has longest running law in U.S.
• Reduction in adult smoking 40% 1998-2006
• Reduction in lung cancer 4 times faster than rest of U.S.
• Maine, New York, Washington 45-60% reduction in youth smoking
CDC MMWR 9-10-10
Tobacco Cessation
Nicotine is addictive…and this is precisely why it is there
• The cigarette is a highly engineered nicotine delivery device
• Chemicals like ammonia are added to release more nicotine
• Nicotine is there on purpose, for a purpose
• Nicotine is not a carcinogen (patients may not know this)
Pharmacotherapy(Medications)
For Tobacco Cessation
Pharmacotherapy(Medications)
• Nicotine replacement therapy (NRT)– Gum– Patch– Spray– Inhaler– Lozenge
• Bupropion (Zyban, Wellbutrin) • Varenicline (Chantix)• All are considered 1st line treatment
Medications typically will give better results when combined with
counseling
USPHS Guidelines 2008
Effective, High Quality Counseling Exists to
Assist in Quitting Tobacco in North
Dakota-NO cost to user to
access
Tobacco Quitlines
Web Based Cessation• Both are individualized, population-based, clinically
effective• Quitlines are specifically endorsed by U.S. Public Health
Service for Tobacco Cessation
• Free to all North Dakota residents• Up to 5 telephone counseling sessions• Counselors are in North Dakota at UND• FREE Nicotine replacement therapy (gum, patches) for
qualifying
• 7-month quit rate 34%*
• 13-month quit rate 33%*
• 3-5% quit rate with no support
*June 2010
nd.quitnet.com
Free to all North Dakota Residents
North Dakota Tobacco Quitline
• Launched Sept. 2004
• Large roll-out to ND providers- ~1800 providers received face to face or teleconference CME information from UND (Dr. Johnson and Dr. Anel)
• Continues to have excellent acceptance by North Dakota Providers
Client Satisfaction
North Dakota Tobacco Cessation• North Dakota Has High Quality, well respected
Options• Quitline: Thousands of Clients since 2004• Quitnet: Good roll-out since Feb. 2010 ~ 670
registered users through 9/5/10• These 2 services are integrated- ease of use• These programs have high acceptance by North
Dakota Providers and clients
Other Tobacco Control Incentives
• Several studies in the U.S. and Europe have shown that increasing tobacco taxes tend to drive down smoking rates
• California has shown that every $1 spent on tobacco control has saved $50 in their health care system-net savings is $80-$100 billion over 20 years
Tob Control - 01-APR-2010; 19 Suppl 1: i68-76Health Policy. 2007 Jul;82(2):142-52PLoS Med - 26-AUG-2008; 5(8): e178
Summary• Tobacco Related diseases have significant
impact on overall morbidity and mortality in North Dakota and the U.S.
• Tobacco Cessation has a positive impact on many disease states and is cost effective
• Tobacco Use is a Habit and an Addiction• Effective telephone based counseling and/or
web-based counseling is an effective tool in Tobacco Cessation
Acknowledgements• North Dakota State Department of Health,
Division of Tobacco Prevention and Control• University of North Dakota School of Medicine
and Health Sciences Department of Family and Community Medicine
• Mayo Clinic Tobacco Quitline• Dr. Donna A. Anel• Healthways Inc.