blue.ppt

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Tobacco Control Yesterday, Today and Tomorrow
Christopher Squier Commission on Tobacco Use
Prevention and Control American Cancer Society
(ACS) Clean Air for Everyone (CAFÉ)
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In the Beginning Iowa Cigarette Control
Law1897
In 1897 Iowa banned the manufacture, sale,
exchange, and disposition of cigarettes and
cigarette paper. The ban was repealed after the
1st World War but in 1921 Iowa became the first
state to impose a cigarette tax!
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In the Beginning Strange Bedfellows Henry
Ford and Adolf Hitler
In 1941, Hitler introduced a comprehensive public
health program to restrict smoking and limit
advertising
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1930s and 1940s -the Age of Innocence? Physicia
ns selling cigarettes!
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Physicians and cigarettes

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The 1950s - the Health Context-cruel realities
tobacco can kill you
1964 - the 1st Surgeon Generals Report linked
smoking and lung cancer
But in 1961 Philip Morris had already identified
42 carcinogens in tobacco smoke!
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The Health Context -cruel realities tobacco can
kill you
1966 Health warnings begin on cigarette packs
Caution--cigarette smoking may be hazardous to
your health
1971 Cigarette advertisements are taken off TV
and radio
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The Response of Big Tobacco lies and
prevarication
The filtered fifties and the low tar sixties
cruel hoaxes

• April 14, 1994 the chief executive officers of
  the 7 major tobacco companies testified before
  Congress that they did not believe nicotine was
  addictive.

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Tobacco Control ?

• Education and just say no
• An adult habit

Website funded by R J Reynolds to promote adult
choice
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The Litigous Nineties and the 1998 Master
Settlement Agreement
Q Could you please explain the recent historic
tobacco settlement? A Sure. Basically, the
tobacco industry has admitted that it is killing
people by the millions, and has agreed that
from now on it will do this under the strict
supervision of the federal government. Dave
Barry
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The Attorneys General Master Settlement Agreement

• In 1998 the tobacco industry agreed to pay 46
  states 206b over 25 years
• the agreement included provisions to
• refrain from targeting youth
• to limit brand name sponsorship
• reduce outside advertising (billboards and
  transit)
• refrain from opposing state or local laws
  intended to protect youth
• cease to sell merchandise with tobacco brand
  names

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2000 - a new era for tobacco control
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Comprehensive Tobacco Control Programs Work

• CDC showed
• Dose response relationship between levels of
  spending and program effect
• Increase in spending per capita associated with
  larger tobacco control program effect
• Increased efficiency from lessons learned

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Tobacco Control in Iowa

• 2001 - Iowa Code Annotated
• Chapter 142A. Tobacco Use Prevention and Control
• Establishment of a Division of Tobacco Use
  Prevention and Control with a full time Director
• Establishment of a Commission to develop policy
  and provide direction
• Establish youth programs that are directed by
  youth participants for youth.
• Establish community partnerships

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What Happened in Iowa? - an unprecedented
decrease in smoking prevalence!
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What happened in Iowa? A relationship between
tobacco control spending and outcomes
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What happened in Iowa?A successful youth program
(JEL) and a reduction in youth smoking
A greater reduction in youth smoking in Iowa than
nationally
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What happened in Iowa?A decrease in hospital
admissions for diseases related to secondhand
smoke exposure
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Tobacco Control - what is happening now in
Iowa?Snatching Disaster from the Jaws of Success

• Since 2009 we have seen continual cuts in the
  budget of the Division of Tobacco Control

• This culminated in a halving of the current years
  budget!

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Tobacco Control - what is happening in
Iowa?Snatching Disaster from the Jaws of Success

• Devastating budget cuts are having predictable
  effects
• Iowa smoking rates have gone up to 16 in 2010
  (Iowa Adult Tobacco Survey)

O
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Tobacco Control - what is happening in
Iowa?Snatching Disaster from the Jaws of Success

• But there is no shortage of funding!

• Tobacco settlement and tax income is almost one
  hundred times greater than the appropriations to
  tobacco control

Meanwhile, the tobacco industry spends 102M a
year promoting its products in Iowa!
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Tobacco Control - what is happening in Iowa?

• We have a Governor who claims that Iowa will be
  the healthiest state in the nation
• But actions speak louder than words!
• Tobacco funding has been halved
• The Director was dismissed and the Division of
  Tobacco Control is threatened with elimination!

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Is there a tomorrow? An end game for tobacco? A
global view
As smoking rates decrease, how do we finally
eliminate a lethal but addictive product?
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Framework convention on tobacco control
2005The treaty sets an international floor for
tobacco control with provisions on advertising
and sponsorship, tax and price increases,
labeling, illicit trade and secondhand smoke.
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How effective are these strategies?
The USA has not ratified the Convention!
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Tobacco Free New Zealand 2020 Tupeka Kore
Aotearoa 2020

• Vision
• Future generations of New Zealand children will
  be free from exposure to tobacco and will enjoy
  smokefree lives
• Strategies
• Tobacco retail displays will be banned
• Plain packaging and graphic warnings will replace
  brand imagery
• Tobacco retail prices will increase
  systematically and significantly (20 per year)
• The supply and sale of tobacco products will be
  controlled retailers licensed and number of
  licenses decreased annually

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Singapore has proposed the end of tobacco
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Australia is currently enacting legislation that
will only permit plain packaging with warning
labels
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In the US, the tobacco industry takes the FDA to
court over warning labels but they even have them
in Russia!
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Tobacco Control Tomorrow Whither Iowa?
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Tobacco Control - what is to be done in Iowa?

• 30 of all cancers are related to tobacco use
• 80 of lung and oral cancers are related to
  tobacco use
• 4,400 Iowa adults die each year from tobacco
  use
• But there is an industry that lobbies against the
  actions that are necessary to prevent or reduce
  tobacco related diseases!

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Tobacco Control - what is to be done in Iowa?
There are new challenges smokeless tobacco
products -dissolvables

• There are a variety of flavored, soluble
  tobacco products being promoted in the US, some
  with a great similarity to candy!
• Attempts to regulate these have been resisted!

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Tobacco Control - what is to be done in Iowa?
New challenges snuff, snus and cross-branding

• Snus is a form of smokeless tobacco manufactured
  in Sweden that has much lower levels of
  carcinogens (nitrosamines) than are found in US
  snuff.
• Snus has recently been marketed in the US but
  there is no information on the level of
  carcinogens or its health effects. Some is sold
  under cigarette brand names, suggesting it is
  intended to supplement smoking, not replace it!

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Tobacco Control - what is to be done in Iowa?

• Education we have an administration and
  legislature that needs a lot of help
• We must advocate and where necessary apply
  political pressure follow the money!
• Grassroot and grasstop support is essential
  that means you!

4,400 Iowa adults die each year from tobacco
use