MDQuit 13th Annual Best Practices Conference Statewide Tobacco Control Updates

Dawn Berkowitz, MPH, CHES

Director, Center for Tobacco Prevention and Control

Prevention and Health Promotion Administration

January 31, 2019

MISSION AND VISION

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Prevention and Health Promotion Administration

MISSION

The mission of the Prevention and Health Promotion Administration is to protect, promote and improve

the health and well-being of all Marylanders and their families through provision of public health

leadership and through community-based public health efforts in partnership with local health

departments, providers, community based organizations, and public and private sector agencies, giving

special attention to at-risk and vulnerable populations.

VISION

The Prevention and Health Promotion Administration envisions a future in which all Marylanders and

their families enjoy optimal health and well-being.

National Updates

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American Lung Association Report

4Source: https://www.lung.org/our-initiatives/tobacco/reports-resources/sotc/state-grades/?setstate=MD

Access to Cessation

Services Grade improved from a “C” to a “B” in

2019

All medications are covered for Medicaid and State employees without any co-pays.

20th anniversary of the landmark 1998 Master Settlement Agreement (MSA)

The MSA requires major tobacco companies to compensate the states for tobacco-related health care costs, restricted some forms of tobacco marketing and

provided funding for a national public education campaign to prevent youth tobacco use

5Source: https://www.tobaccofreekids.org/assets/content/what_we_do/state_local_issues/settlement/FY2019/2018_State_Report_Summary.pdf;

https://truthinitiative.org/master-settlement-agreement

1994 Congressional Hearings

The MSA created new restrictions:

Limits for the advertising, marketing and promotion of cigarettes

Tobacco advertising that targets people younger than 18 was prohibited

Cartoons in cigarette advertising were eliminated

Outdoor, billboard and public transit advertising of cigarettes was eliminated

Cigarette brand names can no longer be used on merchandise

Many millions of tobacco company internal documents were made available to the public

Overall Impact

Cigarette Price Increases

Tobacco Marketing Restrictions

National Public Education Campaign Funding

State Tobacco Prevention and Cessation Programs

“Broken Promises to Our Children: A State-by-State Look at the 1998 State Tobacco Settlement 20 Years Later” Report by The Campaign for Tobacco Free Kids

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Source: https://www.tobaccofreekids.org/what-we-do/us/statereport/maryland

“Broken Promises to Our Children: A State-by-State Look at the 1998 State Tobacco Settlement 20 Years Later” Report by The Campaign for Tobacco Free Kids

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National Updates

Source: https://www.tobaccofreekids.org/what-we-do/us/statereport/maryland

Death Caused By Smoking Each Year

7,500 people

Annual Healthcare Costs

Directly Associated with

Smoking

$2.71 Billion

Proportion of Cancer Deaths Attributable to

Smoking

27.3 percent

Estimated Annual Tobacco

Industry Marketing

$131.1 million

Ratio of Industry Marketing to MD Tobacco Prevention Spending

12.5 to 1

2019 Year of Cessation

8Source: CDC OSH: Strategic Planning and Reimagining Cessation, Jan 10, 2019 OSH NTCP Webinar

Maryland Statewide Updates and Accomplishments

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Monitoring Changing Tobacco Use Behaviors – 2016 Summary Report

10https://phpa.health.maryland.gov/ohpetup/

10th Anniversary Smoke-free Bars and Restaurants!

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• MDH Press Releases on February 1st and August 30th, 2018

• Maryland State Fair Outreach/Celebration

• Press Conference held at a local restaurant

• Outreach table with resources and materials

• Distributed Clean Indoor Air Anniversary Kits to 76 Maryland Restaurants

• Kits contained posters, flyers, window clings, coasters, pens, and table tents

MDH Press Conference, 8.30.18

Maryland State Fair 2018

Quitline Updates

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MARYLAND TOBACCO QUITLINEUPDATES• Free service available 24/7 to all

Maryland residents over the age of 13

• FY18 – nearly 8,000 enrollees

• Quitline volume nearly doubled between December 2018 and January 2019

• The Quitline provides:

• Trained Quit Coaches

• A free supply of NRT, while supplies last

• Specialized programs for youth and pregnant women

• Phone, web-based, and text support services

• Information for non-smokers seeking to help friends, families, patients, and clients

• Referrals to local resources, including Local Health Departments

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27.27

70.91

1.82

0

10

20

30

40

50

60

70

80

No Yes Don't know

%

People use e-cigarette/e-vaping

products for a variety of reasons.

Are you currently using e-cigarette/e-

vaping products to quit smoking?

MARYLAND TOBACCO QUITLINEE-cigarette Use Data

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88.83

10.62

Have you used an e-cigarette or

other electronic vaping product in

the past 30 days?

No Yes

10.91%

81.82%

7.27%

Do you intend to completely quit

using e-cigarettes/e-vaping products

within the next 30 days?

No Yes Don't know

Source: Optum Maryland Tobacco Quitline Report, 12/1/18-12/31/18

Health Systems Updates

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Health Systems Initiatives

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Public Health Service Guideline Strategies:

Implementation of tobacco user screening systems integrated into EMRs

System level training, cessation

resources/materials, and feedback to providers

Having a dedicated tobacco dependence treatment

coordinator on site

Promote hospital polices that support/provide inpatient

tobacco dependence services

To provide effective cessation interventions, relationships with healthcare systems/key stakeholders must be built and maintained

Institute health systems change in health care systems that serve residents with low income, low educational attainment and those with behavioral health issues

Targeted systems include (but not limited to): Hospitals, FQHCs and mental health/behavioral health service organizations

Health Systems Initiatives

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Awardees

➢ Johns Hopkins Health System

• Provided approximately 1,700 electronic referrals to the Quitline (FY18) since implementation. Of those referrals, approximately 400 residents have accepted Quitline services to begin their quit attempts.

➢ University of Maryland Baltimore School of Medicine (University of Maryland Medical System)

• Provided approximately 311 electronic referrals to the Quitline since implementation in December 2018. Of those referrals, approximately 58 residents have accepted Quitline services to begin their quit attempts.

➢ Cecil County Health Department

• Partner with two local urgent care centers to implement systems changes that will address tobacco dependence and link patients to available tobacco cessation resources.

Health Systems Initiatives

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Awardees

➢ Sheppard Pratt

• Provide systematic screening, clinician education, clinician training, and tobacco dependence treatment services to patients. Referred 290 patients to the Quitline through updated EMR.

➢ Mosaic Community Services

• Provide systematic screening, clinician education, clinician training, and tobacco dependence treatment services to patients. Provide tobacco cessation services to approximately 140 residents per month.

➢ National Alliance on Mental Health (NAMI)

• Provide workshops based on the national NAMI program “NAMI Maryland Hearts and Minds Initiative” with tobacco cessation emphasis.

Local Tobacco Control Updates

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Accomplishments

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Local Health Departments

A Few Highlights

• Funded 17 schools with grants to incorporate ESD prevention education, reaching a total of 7,788 youth

Baltimore County

• Conducted an anti-ESD PSA targeting youth on 17 youth-friendly cable channels

Cecil County

• Collaborated with Veterans Helping Veterans, a group of older veterans helping younger veterans, to provide education and access resources on ESD use, cessation services, and secondhand smoke in homes

Dorchester County

• Partnered with the Kent County’s Office of Emergency Services to incorporate tobacco and ESD awareness information into the new substance use addiction video and educated 235 parents on dangers of tobacco products

Kent County

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Local Health Departments

Program Evaluation Update

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Evaluation – Recommendations and Enhancements

Statewide Enhancements

• Increased Communication

• Host in-person meetings bi-annually and online meetings quarterly.

• MDQuit meetings, webinars, and Best Practices Conference

• Legal Resource Center meetings, webinars, and Statewide Tobacco Control Conference

• LHD Coordinator Listserv

• Sharing/transparency of evaluation results and strategic planning process

• Streamlined Grant Applications

• Released earlier in the year

• Condensed PCAs from five to two

• Reduced burden of data analysis by providing local data sheets

• Provided a menu/recommended activities

• Additional enforcement funds have led to increased retailer compliance

• Option to consolidate coalitions23

County Profiles and Additional Enhancements

Coming Soon

Youth Access and Enforcement

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Statewide Responsible Tobacco Retailer Efforts

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Mailings

• Packets (2019 retailer calendar, updated quick reference guide,

letter from MDH, and a window cling) were sent to licensed

tobacco retailers and vape shops in December.

Printing

• Window clings, posters, quick reference guides,

stickers/magnets, pledges, and checklists are available for

order/download on the website.

• Retailer guides and law charts are available for download.

Advertisements

• Responsible Retailer ads will run April - June 2019 on various

mediums, including: Transit, Gas Station TV, and Digital

platforms.

Materials Available at

NoTobaccoSalestoMinors.com

Local Level Impact

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Responsible Retailer – Local Health Departments

•Completed 101 store-to-store tobacco sales education visits and hosted three community meetings.

Asian American Center of Frederick County

•Collaborated with High School students to sponsor a “No Smoking Skating Party” to raise awareness among youth and adults about tobacco prevention, compliance with youth access laws, and to promote an atmosphere of prevention.

Black Mental Health Alliance of Baltimore City

•Conducted two community meetings with police, sheriff, minster, and other community members to garner support for youth prevention and store-level compliance.

Brothers United Who Dare to Care, Inc. of Washington County

•Met with the local Chamber of Commerce to discuss reducing the sale of tobacco to minors, placing newsletter ads and distributing window clings to 560 businesses.

Allegany County

•Collaborated with local agencies (Health Department, Social Services, School System, Public Library, and local churches) at a parent and teen summit to discuss illegal sales of tobacco to minors with 82 attendees.

Charles County

•Conducted monthly “Alcohol Law Education Regulatory Trainings (ALERT)” through the county’s Department of Liquor Control to 470 participants.

Montgomery County

Community partners conducted 2,656 store-to-store education visits and facilitated 15

community meetings on reducing youth

access to tobacco products.

SYNAR Compliance Rates

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Youth Access and Enforcement

24.1

31.4

13.8

10.8

13.9

8.5

0

5

10

15

20

25

30

35

2013 2014 2015 2016 2017 2018 2019 2020

SYNAR COMPLIANCE RATES2014 – 2019

• More than 70 percent (73%) decrease in

the SYNAR Retailer Violation Rate from

FFY2015 to FFY2019

• Over half (56%) of the jurisdictions had

no violations during FFY2019

• 71 percent of jurisdictions have RVRs at

or below 5 percent (17 out of 24)

• First Year since FFY2015 that no

jurisdiction surpassed SYNAR Retailer

Violation Rate of 20 percent

• Merging of MDH tobacco control

initiatives

Youth Vape Use Prevention

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May 1, 2018

Progress (?) on Preventing Youth Use of Electronic Smoking Devices

FDA Commissioner Scott Gottlieb’s proposed new steps to protect youth by preventing access to flavored tobacco products and banning menthol in cigarettes

2018 National Youth Tobacco Survey:

Dramatic Increase in Youth E-cigarette Use

FDA “The Real Cost” Youth E-Cigarette

Prevention Campaign

CDC Information for Parents, Educators, and Health Care Providers

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• CTPC ran digital advertising in September and October 2018

• Currently under development for additional creative components and expansion of the vape experiment creative universe

• Planning to run additional media in winter/spring 2019

The Vape ExperimentMedia Overview

The Vape ExperimentVape 2.0 – Under development

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Key Takeaway Points…

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Today’s youth are embracing these

new products as their own,

developing a new habit that fits the

image of this generation … and

addicting themselves to nicotine at

potentially higher levels than has

been seen in decades.

Illegal Retail Sales of Tobacco Products (Including ENDS) Hotline: 1-866-703-3266

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COMING SOON: Behavioral Health Campaign

• MDH is developing a new Behavioral Health Campaign for 2019

• In 2018, MDH completed online and in-person qualitative information gathering with patients and health providers to assess receptiveness to this type of campaign

• Based on this research, MDH will be reaching out to health providers who work with behavioral health and substance use communities in order to educate providers on the Quitline, and the evidence-based benefits patients can receive from quitting tobacco.

Approximately 25% of adults in the U.S. have some form of mental

illness or substance use disorder, and these

adults consume almost 40% of all cigarettes

smoked by adults

Tobacco smoke can interact with and inhibit

the effectiveness of certain medications

taken by mental health and substance abuse

patients

COMING SOON:

• Holding 2-hr. information-gathering meetings with stakeholders at MDH 2/12 and 2/13.

• Contact Dawn.Berkowitz@Maryland.gov if interested and available!

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New MDH “Tobacco Free Living”

Branding!

https://phpa.health.maryland.gov

Maryland Department of Health

Prevention and Health Promotion Administration

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dawn.berkowitz@maryland.gov

CONGRATULATIONS TO LINDA PEGRAM ON HER

RETIREMENT

THANK YOU FOR 12 YEARS IN HARFORD COUNTY AND

IMMEASURABLE CONTRIBUTIONS TO TOBACCO CONTROL IN MARYLAND