The State of Tobacco Control in North Dakota: 2019 – 2021

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The State of Tobacco Control in North Dakota: 2019 – 2021 The State of Tobacco Control in North Dakota: 2019 – 2021 Innovation. Community focus. Fiscal responsibility. Successes, challenges, and opportunities of the North Dakota comprehensive Tobacco Prevention and Control Program during the 2019 – 2021 biennium. Professional Data Analysts | www.pdastats.com | Prepared December 2020 | Page 1 Tobacco annually costs each North Dakota household $724 in taxes due to smoking- related expenses.1 Tobacco use is the single most preventable cause of death and disease in North Dakota and the United States, causing more deaths annually than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides, combined.1 The North Dakota Tobacco Prevention and Control Program serves the health and economic interests of North Dakotans. North Dakota youth displaying a poster Brody Maack, PharmD, CTTS, presenting a gift to tribal promoting #ENDit, a call to be the first tobacco- speakers before a presentation on sacred tobacco use at the free generation. Nicotine Dependence Conference in Fargo, February 2020. Nakisha, holding Kenzie, was able to quit Audience at the 2020 Nicotine Dependence Conference in Grand Forks, a smoking with help from North Dakota’s BABY & collaboration of four health systems: Altru Health, Family Healthcare, ME – Tobacco Free Program. North Dakota State University, and Spectra Health. Tobacco is still a problem. What is North Dakota doing to address it? Tobacco is still a problem Tobacco Control Programs The financial and human toll from tobacco and Grantees use – either directly or from exposure to Funding for North Dakota’s Tobacco secondhand smoke – continues to be the Program supports a small staff of 6.35 most costly, preventable cause of death in fulltime employees at the Department of the state. With the increase in availability Health, who manage several programs and of Electronic Nicotine Delivery Systems grantees. (ENDS), vaping of nicotine and other substances has only escalated NDQuits. North Dakota’s quitline is related health concerns. available to all North Dakotans, year- round. Telephone counseling and/or web counseling is available, as is Nicotine Here is how North Dakota Replacement Therapy. is addressing it BABY & ME – Tobacco Free Program™ North Dakota’s Tobacco Prevention and (BMTFP). North Dakota funds 15 grantees Control Partnership (TPCP) has to provide cessation support to pregnant mothers, starting by 32 weeks prenatal and implemented innovative and evidence- continuing for up to 12 months postpartum. based strategies to engage North Dakota communities in developing local NDQuits Cessation (NDQC) Grant solutions. These efforts work in tandem Program. North Dakota funds 17 grantees toward ensuring the program is fiscally to provide brief cessation interventions and education to patients and the community. responsible and working to prioritize the health and economic interests of the Local Public Health Units (LPHU). All 28 state. LPHUs are funded to provide prevention, cessation, and policy work in their communities. "It is important to keep in mind that many little steps will lead to big things in the future and sometimes it is hard to stay positive in the world of tobacco.“ -Local Public Health Tobacco Coordinator Professional Data Analysts | www.pdastats.com | Prepared December 2020 | Page 5 Who benefits from Tobacco Prevention and Control? All who use nicotine, a Here is who is most at risk highly addictive drug In public health, equity is the just and fair Nicotine, which can be found in a variety of inclusion into a society in which all can participate, tobacco and vaping products, is a powerful prosper, and reach their full potential. The Centers drug. Nicotine, a drug that reaches the brain for Disease Control and Prevention’s (CDC) Best within seconds, increases dopamine, a Practices in Tobacco Control defines tobacco- reward center of the brain. However, the related disparities as: “Differences that exist effects are temporary, meaning a user of among population groups with regard to key nicotine needs to reach for another tobacco-related indicators, including patterns, cigarette, dip, or vape sooner as they crave prevention, and treatment of tobacco use; the more, and they will use any kind of nicotine risk, incidence, morbidity, mortality, and burden of to satisfy the addiction.1 Nicotine is one of tobacco-related illness; capacity, infrastructure, thousands of ingredients in cigarettes, chew and access to resources; and secondhand smoke tobacco, other combustible tobacco exposure.”2 In North Dakota, these groups are: products (cigars), and a major ingredient of Rural: Adults in rural areas are more likely to smoke, nearly all ENDS products used to vape. more likely to be heavier smokers, and kids in rural areas are more likely to start smoking at an earlier Residents with an interest age.3 in the economic well-being American Indians: The commercial tobacco use rate in of the state North Dakota’s American Indian populations is double that of the general population.4 Tobacco costs the state of North Dakota much more than is brought in from the Pregnant women: Just over 10% of women reported smoking in their first trimester, which has implications current tobacco tax. These tobacco taxes for the development of the fetus and the mom. bring in $19.7 million annually but tobacco costs the state $326 million annually. All Behavioral health: An estimated 35% of cigarette smokers have a behavioral health disorder.5 Tobacco North Dakotans who care about the users with a behavioral health disorder use tobacco economic status of the state have an two times more often than the general population. interest in the costs of tobacco to all Youth and young adults: Over half (52.8%) of North citizens. Dakota high schoolers reporting trying an e-cigarette Intersectionality is a “prism for understanding” and over one-third (34.5%) have tried a cigarette 4 problems, a legal term that coined in 1989 by before the age of 13. Both rates have increased. Kimberlé Crenshaw. In tobacco control, this means taking a lens that a North Dakotan is Medicaid: Nearly 40% of North Dakotans who use Medicaid also use tobacco, double the rate of the impacted by tobacco control through multiple 4 factors, living in a rural area, Medicaid eligible, general population. and having a behavioral health disorder. Professional Data Analysts | www.pdastats.com | Prepared December 2020 | Page 6 What is the purpose of this report? The purpose of this report is to Professional Data Analysts synthesize evaluation and (PDA) is a B-corporation that surveillance activities during the is contracted to conduct an 2019 – 2021 biennium. The external evaluation of the North Dakota Department of North Dakota TPCP activities. Health (NDDoH) facilitates the PDA has been evaluating state’s TPCP. This partnership tobacco control efforts for includes over 50 organizations, over 20 years across the mostly from North Dakota, with United States. This some support from national experience informs this partners. comprehensive evaluation of the TPCP during the 2019 – The TPCP work is driven by the 2021 biennium. Interested in more North Dakota Tobacco details? Prevention and Control State Transparency and data + North Dakota Plan, which is a strategic plan excitement are core values Comprehensive Tobacco coordinated by multiple of PDA. While this report is Prevention and Control agencies within the state. intended to be visually State Plan appealing and easy to read The of the TPCP is to mission for a broad audience, readers + Tobacco Prevention improve and protect the health interested in the details can and Control Evaluation of North Dakotans by reducing find our methods in Plan the negative health and Appendix B. A dashboard economic consequences of the visualizing progress on the + CHI St. Alexius Case state's number-one cause of State Plan can be found in Study preventable disease and death - Appendix D. Please contact tobacco use. Melissa Chapman Haynes, + NDQuits FY2019 PhD, with questions about Annual Report The objectives and targets of this report. Questions about this plan are externally the TPCP should be directed + North Dakota Tobacco evaluated and reported to Neil Charvat, Director, Surveillance Data biennially to the North Dakota TPCP. Legislature, the NDDoH and all of the TPCP partners and + 2017 – 2019 Synthesis stakeholders. Report Professional Data Analysts | www.pdastats.com | Prepared December 2020 | Page 7 7 key takeaways This report is organized around three themes: innovation in addressing tobacco control and prevention, community focus in policy and overall engagement with North Dakotans, and fiscal responsibility to reduce tobacco prevalence and support North Dakota’s economic interests. Communication of Vaping is at epidemic tobacco control levels. North Dakota has messages has been done had an innovative in an innovative and response, but more effective manner, though policies and regulation the messages would are needed to fully reach more North address this epidemic. Dakotans with increased funding. Partnerships and The collaboration persistence moved Partnership with throughout North local tobacco policies American Indians in Dakota is helping forward. There are now tobacco control tobacco users quit, but over 900 policies, advanced this biennium, there is still more work including raising the laying the groundwork to do. Additional age to purchase for future impact. The resources would expand nicotine products and number of smoke-free evidence-based, restricting flavored
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