Impact of Chronic Diseases Maine

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Impact of Chronic Diseases - Maine

• Dora Anne Mills, MD, MPH

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Maine
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Maine

• Population 1.3 million
• 96 White
• 4 Native American, African American, Hispanic
• Rural
• Poor

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Impact of Chronic Diseasein Maine
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What Are Chronic Diseases?

• Cardiovascular Disease(heart disease and
  stroke)
• Cancer
• Chronic Lung Disease(emphysema and asthma)
• Diabetes

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Other Chronic Diseases?

• Dental Disease
• Depression

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Chronic Diseases

• Leading causes of death and disability
• 75 of Mainers will die from 1 of 4 diseases
  CVD, Cancer, Diabetes, Chronic Lung Disease
• Mostly preventable Tobacco and Obesity
• Direct health care costs 40 of Maines Health
  Care Budget

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Cardiovascular Disease

• 1 cause of death and disability
• 40 of all deaths
• 25 of all hospital costs

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Cancer

• 2 cause of death
• 65 due to Tobacco or Obesity
• Most are curable if screened, detected, and
  treated early

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Diabetes

• 8 of adult Mainers now have diabetes

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Lung Disease

• Asthma
• Emphysema, Chronic Obstructive Pulmonary Disease

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Dental Disease

• 1 in 3 Mainers over age 65 have lost all their
  teeth
• 40 of Maine 3rd graders have tooth decay
• Highly associated with other chronic diseases

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Depression
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Mainers suffering from frequentmental distress
are twice as likely to

• Have Diabetes
• Be Tobacco Addicted
• Have Asthma

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Effective Strategies
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Primary Prevention Strategies

• Tobacco
• Physical Inactivity
• Poor Nutrition

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Primary Prevention Strategies

• State and Community Interventions
• Health Communication
• Treatment
• Surveillance and Evaluation

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1. State and Community Interventions
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Statewide Interventions
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Tobacco Tax

• 1991 0.37
• 1997 0.74
• 2001 1.00
• 2004 2.00

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1997 Some Tobacco Tax Revenues (3 per capita)
put aside for first state funds for tobacco
prevention
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1999 18 million (17 per capita) from Tobacco
Settlement Funds set aside for state funds for
Tobacco and Obesity prevention
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Laws Banning Smoking

• 1981 Public meetings
• 1983 Court houses
• 1985 Stores
• 1986 Most workplaces
• 1989 Hospitals, except psychiatric patients
  and hospitals
• 1999 Restaurants
• 2003 Bars
• 2005 All loopholes closed

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2005 All Indoor Public Places inMaine are
Smokefree
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2007 Outdoor School Groundsare Smokefree
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Community Interventions
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2000 Healthy Maine Partnerships
Maines Community Network forChronic Disease
Prevention
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Healthy Maine Partnerships

• 28 Comprehensive Community Health Coalitions
• Cover all of Maine
• Funded with Tobacco Settlement and Federal Funds
• Tobacco, Obesity, Substance Abuse community
  interventions

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Obesity Interventions
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City/Town ordinances forwalkable communities
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Food policies for organizations
X
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Bans on schoolvending machines
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2. Health Communication
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Goals

• Change culture
• Secondhand smoke
• Children watching TV
• Walking
• Portion Sizes
• Support community and statewide interventions
• Promote quitting Tobacco

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3. Treatment Interventions
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Effective Treatments

• Behavioral Counseling
• Medications
• Brief Messages by Health Professionals
• Intensive Interventions by Professionals
• Insurance Benefit Coverage

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PTM Treatment Components

• Maine Tobacco HelpLine
• Medication Voucher Program
• Tobacco Treatment Training
• Chronic Disease Initiative

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Social Support
Counseling
Medications
Telephone Counseling / NRT
Health Professionals and Community
Tobacco Specialists
HelpLine
Medication Vouchers
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Motivate Tobacco Usersto Quit
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Assist Tobacco Users to Quit
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HelpLine Services

• For any Maine resident
• Ready to Quit 30 days Specialist
• 4 counseling sessions total
• Not Ready to Quit now materials
• 7 days a week 8am 8pm

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Percent of Adult Smokers in Maine Callingthe
Tobacco HelpLine each year, 20012006
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Six-month Quit Rates by HelpLine Services
Delivered
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www.tobaccofreemaine.org
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Improved Treatmentof Chronic Diseases
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Care Model

• Decision Support
• Information Systems
• Self-Management Support

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Diabetes
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Decision Support Information Systems

• Diabetes Registries
• Learning Collaboratives

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Self-Management Support

• Diabetes Educators
• Diabetes Support Groups

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4. Surveillance Evaluation
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Tobacco and Obesity

• Comprehensive Adult Tobacco Survey(phone every
  3 years)
• Behavioral Risk Factor Surveillance Survey(phone
  every year)
• Comprehensive Youth Tobacco Survey(in schools
  every 3 years)
• Simplified Youth Risk Behavior Survey(in schools
  every 2 years)

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Disease Surveillance

• Cancer Registry and Vital Records
• Cardiovascular Disease Hospitalizationsand
  Vital Records
• Diabetes Behavioral Risk Factor Surveillance
  System Survey and Vital Records
• Asthma Behavioral Risk Factor Surveillance
  System Survey and Hospitalizations

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Evidence of Impact
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Tobacco Successes
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Obesity
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Cardiovascular Disease
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Cancer
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Diabetes
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Respiratory Disease
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www.mainepublichealth.gov
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Questions Answers