2016 annual report mississippi state department of health o ffi c e o f to b ac c o c o n t r o l

table of contents

Introduction...... page 3

Overview...... page 4

Mission + Values...... page 5

Infrastructure, Administration, and Management...... page 6

Economic Impact...... page 12

Tobacco Tax Revenue...... page 16

Adult Tobacco Data...... page 20

Statewide Interventions...... page 24

Cessation Services...... page 27

Community Interventions...... page 29

Youth Tobacco Data...... page 31

Youth Programs...... page 36

Mass Reach Health Communication Interventions...... page 40

Enforcement...... page 42

Protecting the Public...... page 44

Surveillance + Evaluation...... page 51

Appendix I: Tobacco Control Advisory Council...... page 52

Appendix II: Mississippi Tobacco-Free Coalitions...... page 53

Annual Report 2016 | page two introduction

The publication of the Mississippi State Department of Health’s Office of Tobacco Control 2013 Annual Report coincided with the release of two landmark documents essential to any comprehensive, evidence-based tobacco control program: The Health Consequences of Smoking - 50 Years of Progress, A Report from the Surgeon General, and CDC’s Best Practices for Comprehensive Tobacco Control Programs – 2014. Since the publication of the Surgeon General’s first report on smoking and health in 1964, smoking rates have significantly dropped in the United States (43 percent to 18 percent), and the general public has a much greater understanding of the dangers of tobacco use. Smoking is no longer seen as an accepted pastime but a deadly habit. Despite this progress, tobacco use continues to be the single most preventable cause of death, disability, and disease in this country. This year alone, nearly 500,000 adults will die prematurely because of smoking, and 46,000 non-smokers will die from heart attacks due to secondhand smoke exposure. More than 40 million Americans are tobacco dependent. Each day, more than 3,200 youth smoke their first cigarette. The annual economic costs due to tobacco exceed $289 billion.

The CDC’s Best Practices for Comprehensive Tobacco Control Programs – 2014 provides the framework for developing an evidence-based, comprehensive tobacco control program. The war against tobacco is a winnable battle, meaning that when fully funded and implemented, coordinated, sustained efforts can decrease smoking rates and reduce tobacco-related diseases and deaths. This comprehensive approach combines educational, clinical, regulatory, economic, and social strategies to establish smoke-free policies and norms, promote and assist tobacco users to quit, and prevent the initiation of tobacco use. When used together, these efforts produce a synergistic effect, thereby increasing the individual effectiveness of each strategy and the return on investment.

page three | Annual Report 2016 overview

In 2007, the Mississippi State Legislature responded to the growing health and financial crisis associated with tobacco use with definitive action by mandating a comprehensive statewide tobacco education, prevention, and cessation program in §41-113- 1 of the Mississippi Code of 1972. Additionally, the Legislature established a 13-member Tobacco Control Advisory Council. (Appendix I).

The Mississippi Legislature recognizes the devastating impact that tobacco use has on the citizens of our state. Tobacco use is the single most preventable cause of death and disease in this country and this state. Each year, thousands of Mississippians lose their lives to diseases caused by tobacco use, and the cost to the state is hundreds of millions of dollars. Tobacco use is also a large burden on the families and businesses of Mississippi. It is therefore the intent of the Legislature that there be developed, implemented and fully funded a comprehensive and statewide tobacco education, prevention and cessation program that is consistent with the Best Practices for Comprehensive Tobacco Control Programs of the federal Centers for Disease Control and Prevention, as periodically amended. (Mississippi Code of 1972).

Annual Report 2016 | page four mission + values

m i s s i o n The mission of the Office of Tobacco Control (OTC) is to promote and protect the health of all Mississippians by reducing tobacco-related disease and death. The Office of Tobacco Control accomplishes this mission by utilizing a systemic approach to tobacco prevention and control that focuses on evidence-based practices outlined in the Centers for Disease Control and Prevention’s Best Practices for Comprehensive Tobacco Control Programs 2014, (CDC’s Best Practices). Program components include:

Infrastructure, Administration, and Management State and Community Interventions Cessation Interventions Mass-Reach Health Communication Surveillance and Evaluation

v a l u e s Smoke-free air is essential for all Mississippians. We respect the effort it takes to quit smoking and stay quit. We are committed to providing innovative leadership. We cultivate cooperative relationships with traditional and nontraditional partners. We do not accept funding from, or partner with, the tobacco industry.

page five | Annual Report 2016 comprehensive tobacco control programs

infrastructure administration m a n a g e m e n t

The CDC’s Best Practices recognizes that a strong internal capacity within a state health department is essential for program sustainability, efficacy, and efficiency.

The Office of Tobacco Control utilized the funds directly appropriated from the Tobacco Control Program Fund ($9.4 million) in FY 2016 to reduce usage of tobacco products throughout the state. The Office of Tobacco Control’s administration and management activities, in compliance with the CDC’s Best Practices, include the following:

Strategic planning to guide program efforts and resources Developing qualified and diverse technical, program, and administrative staff Awarding and monitoring program contracts and grants, coordinating implementation across program areas, and assessing grantee program performance Maintaining a real-time fiscal management system that tracks allocations and expenditure of funds Increasing capacity at the local level by providing ongoing training and technical assistance to local coalitions and partners Maintaining a comprehensive communication system Educating the public and decision makers on the health effects of tobacco and evidence-based program and policy interventions

Annual Report 2016 | page six prevention

DEATHS IN MISSISSIPPI CAUSED BY SMOKING

Adults who die each year from their own smoking 5,400

Kids now under 18 and alive in Mississippi who will ultimately 68,000 die prematurely from smoking

Source: Campaign for Tobacco-Free Kids, 2016

Since 2007, Mississippi’s Office of Tobacco Control (OTC) has worked to develop and implement evidence- based tobacco education, prevention, and cessation programs. Statewide tobacco control programs that are comprehensive, sustained, and accountable have been shown to reduce smoking rates and tobacco-related deaths and diseases. These initiatives operate with the following objectives:

o b j e c t i v e s

Reduce the number of individuals who start using tobacco. Help current tobacco users quit. Promote a smoke-free environment to reduce adverse health effects of secondhand smoke. Address increasing youth smokeless tobacco prevalence. Identify and eliminate tobacco-related disparities among population groups.

page seven | Annual Report 2016 programs

In fiscal year 2015-2016, OTC oversaw the following programs and activities:

Mississippi Tobacco-Free Coalitions (MTFC’s):

34 coalitions with a presence in each of the state’s 82 counties Charged with providing awareness activities, advocacy and policy work, offering cessation assistance, programmatic activities, and communications for adults and youth in their service areas

Youth Programs:

Administered through a grant provided to the Partnership for a Healthy Mississippi (PHM) Generation FREE activities in grades 7-12 RAT Troupe shows for grades K-6 Development and Implementation of youth conferences (IFLY and LEAD)

State Partners:

Mississippi Academy of Family Physicians Foundation (MAFPF) Mississippi Chapter of the American Academy of Pediatrics (MSAAP) Mississippi Rural Health Association (MRHA) The Institute for Disability Studies (IDS) Mississippi Nurses Foundation (MNF) Mississippi Primary Health Association (MPRHA)

Mississippi Tobacco Quitline:

Provides training and presentations in conjunction with state-wide partners and MTFC’s Professional counselors evaluate and develop treatment plans for callers who phone the Quitline and/or use the web-based services

ACT Center for Tobacco Treatment, Education, and Research (ACT):

Provides treatment including Nicotine Replacement Therapy (NRT) as well as non-nicotine medications. Professional counselors provide face-to-face cessation treatment Provides training and presentations in conjunction with state-wide partners and MTFC’s

Research shows that the more states spend on comprehensive tobacco control programs, the greater the reductions in tobacco use. Additionally, the longer states invest in such programs, the greater and faster the impact.

Annual Report 2016 | page eight appropriations

From the tobacco settlement installment payments that the State of Mississippi receives during each calendar year, the sum of Twenty Million Dollars ($20,000,000.00) shall be expended solely for the purposes specified in Section 2.a-f of 41-113-1 of the Mississippi Code of 1972. None of the funds in the special fund may be transferred to any other fund or appropriated or expended for any other purpose.

FY13 FY14 FY15 FY16 FY17 RECIPIENT

$9,700,000 $9,400,000 $9,400,000 $9,400,000 $9,127,341 MSDH OTC University of MS Medical $5,000,000 $5,000,000 $5,000,000 $5,000,000 $4,918,750 Center Cancer Institute Mary Kirkpatrick Haskell-Mary $3,600,000 $3,600,000 $3,600,000 $3,600,000 $3,541,500 Sprayberry Public School Nurse Program MS Attorney General’s Office $800,000 $800,000 $800,000 $800,000 $787,000 of Alcohol and Drug Enforcement University of MS Medical $700,000 $700,000 $700,000 $700,000 $688,625 Center ACT Center Myocardial Infarction $200,000 $200,000 $200,000 $200,000 $196,750 Program (STEMI) Skool ADS - school poster --- $300,000 $300,000 $300,000 $295,125 program (62 schools)

Source: 41-113-1 of the Mississippi Code of 1972

page nine | Annual Report 2016 In FY 2016, Mississippi ranked 16th among all states in the funding of tobacco prevention programs.

In each of the five fiscal years that tobacco control has been charged to the MSDH Office of Tobacco Control, the Mississippi State Legislature has appropriated $20 million from the Tobacco Control Program Fund. Additionally, the state received funding from the Centers for Disease Control and Prevention as follows:

$880,815 CDC Core Grant funding was used to prevent initiation of tobacco use by youth, to promote cessation, to eliminate tobacco- related disparities, and to reduce exposure to secondhand smoke. $195,883 CDC Capacity Grant funding was utilized to increase access to Mississippi Tobacco Quitline services and ensure that every participant received services. The activities included hiring and training qualified Quitline staff to ensure adequate coverage for all participants during peak hours of operation.

$880,815 Total Funds: CDC Grant $ 21,076,698 $195,883 CDC Capacity Grant

$9,400,000 MSDH Office of Tobacco Control Funds $10,600,000 Tobacco Control Program Fund Recipients

Annual Report 2016 | page ten TOBACCO CONTROL FUNDING (IN $ MILLIONS)

Per Capita Health Cessation State & Surveillance Administration Funding Communication Interventions Community & Evaluation & Management

CDC Best Practices, 2016 $1.37 $5.06 $4.19 $1.06 $0.53 Recommendations

MS Tobacco Control Program $0.09 $0.88 $2.81 $0.38 $0.27 fund FY 2016

During FY 2015, total tobacco funding from federal and state sources was $21,076,698 in Mississippi. While $20 million was appropriated for tobacco control, only $10.4 million was available to the MSDH Office of Tobacco Control to implement an evidence-based comprehensive tobacco program. The Centers for Disease Control recommends $36.5 million based on the CDC Best Practices.

page eleven | Annual Report 2016 economic impact

eco n o m i c i m pac ts o f to bacco

{ s p e n d i n g f o r t o b a c c o c o n t r o l t r e n d s }

annual state spending for tobacco prevention for ms | 2000-2015 $31,000,000 $31,000,000 $20,000,000 $20,000,000 $20,000,000 $20,000,000 $20,000,000 $10,900,000 $10,900,000 $10,600,000 $10,300,000 $9,900,000 $9,900,000 $9,700,000 $8,000,000 $0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2 011 2012 2013 2014 2015

percent of cdc minimum recommended funding | 2000-2015 165.0% 165.0% 106.4% 106.4% 106.4% 106.4% 106.4% 42.6% 29.9% 29.9% 27.0% 26.3% 25.3% 25.3% 24.7% 0%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2 011 2012 2013 2014 2015

Source: Campaign for Tobacco-Free Kids p.33 Tobacco Report | MTD 2016

Annual Report 2016 | page twelve economic impact

ANNUAL ECONOMIC BURDEN

Healthcare costs in Mississippi directly caused by smoking $1.23 billion*

Portion covered by the state Medicaid program $319.7 million

Residents’ state & federal tax burden from smoking-caused government expenditures $1,031 per household

Smoking-caused cost to Mississippi businesses: lost productivity $5.28 billion*

Source: Campaign for Tobacco-Free Kids, 2016 *Source: Mississippi State University, Department of Agricultural Economics, 2016

page thirteen | Annual Report 2016 eco n o m i ceconomic i m pac ts o f to bacco impact

MedicaidCosts & SecondhandSmoke

costs attributable attributable to exposure to population risk total costs secondhand smoke population - birth to age 17 low birth weight codes - 18.0% $85,240,444 $15,343,280 icd codes that begin with 765 acute lower respiratory illness (birth to age 5 only) - icd codes 25.0% $28,551,853 $7,137,963 that begin with 480-488, 466 otitis media and middle ear effusion - 14.0% $16,501,901 $2,310,266 icd codes that begin with 382 asthma - icd codes that begin with 493 35.0% $28,344,206 $9,920,472

population - ages 18+ heart attacks and other heart diseases - 6.9% $12,149,244 $838,298 icd codes that begin with 410 lung cancer - icd codes 4.9% $12,204,636 $598,027 that begin with 162 $182,992,284 $36,148,306

specified diagnosis present in either the principle dates of service: 07/01/2012 - 06/30/2013 diagnosis field or other diagnosis codes 1-4 positions

• According to the U.S. Surgeon General, our nation’s leading authority on health, the scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke and eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. • Most Mississippi adults support a statewide law in Mississippi prohibiting smoking in most public places, including workplaces, offices, restaurants, and bars ( 7 7. 3 % ) , while only 14.7% oppose such a law. • Moreover, a recent survey of Mississippi restaurant owners and managers found that 69.9% of { restaurateurs support this law, while less than 20 percent (18.7) oppose.

2 0 mississippi Source: 2014 Medicaid CostsTobacco & Secondhand Smoke Data Factsheet | Mississippi Tobacco Data 1 4

TobaccoAnnual ReportReport | MTD 2016 2017 | page fourteenp.32 economic impact

$ $ LONG TERM DISABILITY How $ 51,647 much $ Mississippians are $ unable to work does due to smoking smoking related illness. COST COSTS TO MISSISSIPPI BUSINESSES missed work due to illness $360 million

lower productivity $1.2 billion $

WHAT CAN EMPLOYERS DO?

- Create a tobacco-free $ workplace. $ - Help employees to stop smoking. $ $

Cost of tobacco cessation benefit $ = 10 to 40¢ per employee $ Savings from cessation programs = up to $6 for each $1 spent $ $ $$ Tobacco cessation = financial returns - Reduced health care costs - Reduced life insurance costs - Reduced absenteeism - Increased productivity

page fifteen | Annual Report 2016 tobacco tax revenue

t a x g e n e r a t e d f r o m t h e s a l e o f t o b a c c o p r o d u c t s

t o t a l r e v e n u e $140,769,176

$7,050,487 $18,876,786 Non-Settling Other Tobacco Manufacturers Fee Products

$114,841,903 Cigarette Stamps

$114,841,903 from cigarette stamps (Cigarette stamps are purchased by wholesalers.) $18,876,786 from other tobacco products (Excluding cigarettes.) $7,050,487 from non-settling manufacturers fee (Fee covers tobacco manufacturers that were not part of the master settlement.)

Annual Report 2016 | page sixteen IT’S TIME TO Clear THE Air of 80%MISSISSIPPIANS FAVOR A Increase in STATEWIDE tobacco tax SMOKE-FREEtobacco tax

Decreases SupportLAW is cigarette use IncreasingBi-Partisan tobacco tax decreases cigarette use and increases tax revenue.

and Increases THE tax revenue MISSISSIPPI TAXEXPERIENCE KEY 273.1 Cigarette Use million 263.1 million Tax Revenue 207.4 million 201.6 198.2 million 190.8 187.3 million million 183.1 million million

Tax Increase May 15, 2009

$141,054,000 $137,064,000 $134,744,000 $129,739,000 $124,474,000 $127,365,000

$67,920,000 $49,153,000

2008 2009 2010 2011 2012 2013 2014 2015

These data from tax records clearly demonstrate that following the 2009 increase in the state cigarette tax, the number of packs of cigarettes sold in Mississippi decreased by more than 30%, while tax revenue from cigarette sales almost tripled.

page seventeen | Annual Report 2016 s tate c i ga r e t te ta x

s tate c i ga r e t te ta x STATE CIGARETTEtobacco EXCISE tax TAX rates & rankings : 2016 STATE CIGARETTE EXCISE TAX rates & rankings : 2016 RANK STATE CIGARETTE TAX 1 NEW YORK $4.35 2 CONNECTICUT $3.90 3 RHODE ISLAND $3.75 RANK 4 STATEMASSACHUSETTS CIGARETTE TAX $3.51 1 NEW YORK $4.35 5 HAWAII $3.20 2 CONNECTICUT $3.90 6 VERMONT $3.08 3 RHODE ISLAND $3.75 4 7 MASSACHUSETTSWASHINGTON $3.51 $3.03 5 8 HAWAIIMINNESOTA $3.20 $3.00 6 VERMONT $3.08 9 WASHINGTON D.C. $2.90 7 WASHINGTON $3.03 10 NEW JERSEY $2.70 8 MINNESOTA $3.00 11 WISCONSIN 9 WASHINGTON D.C. $2.90 $2.52 10 12 NEW JERSEYALASKA $2.70 $2.00 11 WISCONSINARIZONA $2.52 $2.00 12 ALASKA $2.00 MAINE $2.00 ARIZONA $2.00 MARYLAND $2.00 MAINE $2.00 MARYLANDMICHIGAN $2.00 $2.00 17 MICHIGANILLINOIS $2.00 $1.98 17 18 ILLINOIS NEVADA $1.98 $1.80 18 NEVADA $1.80 19 NEW HAMPSHIRE $1.78 19 NEW HAMPSHIRE $1.78 20 MONTANA $1.70 Mississippi ranks 39th, with 37 states and Washington 20 MONTANA $1.70 Mississippi ranks 39th, with 37 states and Washington UTAH $1.70 D.C. placing a higher state tax on cigarettes. Moreover, UTAH $1.70 D.C. placing a higher state tax on cigarettes. Moreover, 22 22 NEW MEXICONEW MEXICO $1.66 $1.66 the 68 centthe 68 tax cent in tax Mississippi in Mississippi is issubstantially substantially 23 23 DELAWAREDELAWARE $1.60 $1.60 lower thanlower the than average the average state state cigarette cigarette tax tax of of $1.61. $1.61. OHIO OHIO $1.60 $1.60 PENNSYLVANIA $1.60 PENNSYLVANIA $1.60 26 SOUTH DAKOTA $1.53 SOUTH DAKOTA 27 26 TEXAS $1.41 $1.53 28 27 IOWA TEXAS $1.36 $1.41 SOURCE 29 28 FLORIDA IOWA $1.34 $1.36 SOURCE 30 OREGON $1.32 State Cigarette Excise Tax Rates and Rankings, 29 FLORIDA $1.34 31 KANSAS $1.29 Campaign for Tobacco-Free Kids, 2016 30 OREGON $1.32 State Cigarette Excise Tax Rates and Rankings, 32 WEST VIRGINIA $1.20 31 KANSAS $1.29 Campaign for Tobacco-Free Kids, 2016 33 ARKANSAS $1.15 34 32 LOUISIANAWEST VIRGINIA $1.08 $1.20

35 33 OKLAHOMAARKANSAS $1.03 $1.15

36 34 INDIANALOUISIANA $1.00 $1.08 37 CALIFORNIA $0.87 35 OKLAHOMA $1.03 38 COLORADO $0.84 INDIANA 39 36 ALABAMA $0.68 $1.00 37 MISSISSIPPICALIFORNIA $0.68 $0.87 41 38 NEBRASKACOLORADO $0.64 $0.84 42 39 TENNESSEEALABAMA $0.62 $0.68 43 KENTUCKY $0.60 MISSISSIPPI $0.68 WYOMING $0.60 41 NEBRASKA $0.64 45 IDAHO $0.57 42 SOUTH CAROLINATENNESSEE $0.57 $0.62 47 43 NORTH CAROLINAKENTUCKY $0.45 $0.60 48 NORTH DAKOTAWYOMING $0.44 $0.60

49 45 GEORGIA IDAHO $0.37 $0.57 50 $0.30 VIRGINIASOUTH CAROLINA $0.57 51 MISSOURI $0.17 47 NORTH CAROLINA $0.45 48 NORTH DAKOTA $0.44

49 GEORGIA $0.37

50 VIRGINIA $0.30 Annual Report 201651 MISSOURI | page$0.17 eighteen

STATE RANKINGS REPORT | JULY 2016 7

Source: Campaign for Tobacco-Free Kids, 2016 State Rankings of Current Cigarette Smoking, July 2016 | Mississippi Tobacco Data

STATE RANKINGS REPORT | JULY 2016 7 p. 43 Source: Campaign for Tobacco-Free TobaccoKids, 2016 Report | MTD 2016 State Rankings of Current Cigarette Smoking, July 2016 | Mississippi Tobacco Data

p. 43 Tobacco Report | MTD 2016 tobacco tax IT’S TIME TO Clear THE Air of 80%MISSISSIPPIANS FAVOR A Increase in STATEWIDE tobacco tax SMOKE-FREE s tateDecreases c i ga r e t te ta x SupportLAW is cigarette use Bi-Partisan

and Increases THE tax revenue MISSISSIPPI TAXEXPERIENCE KEY 273.1 Cigarette Use million 263.1 million Tax Revenue 207.4 support for a ($1) increasemillion 201.6in the state198.2 cigarette tax | 2015 million 190.8 187.3 million million 183.1 million million

Tax Increase overall May 15, 2009 52.2%

$141,054,000 male $137,064,000 $134,744,00047.1% $129,739,000 $124,474,000 $127,365,000 gender | p < .05 female 56.7% $67,920,000 $49,153,000 white 51.7% race | ns black 51.6% 2008 18-242009 2010 2011 44.2%2012 2013 2014 2015 25-44 51.7% age | ns 45-64 53.5% 65 + 54.8% less than HS deg 29.5% HS degree or GED 45.9% education | p < .05 some college 47.3% college degree 59.2% Republican 53.6% affiliation | ns Democrat 55.6%

0.0% 20.0% 40.0% 60.0%

Source: 2015 Mississippi Social Climate Survey of Tobacco Control | Mississippi Tobacco Data page nineteen | Annual Report 2016

p. 45 Tobacco Report | MTD 2016 to bacco & n i coti n e us e toto bacco bacco && nn i i coti coti n n e e usus e e to{ mississippi bacco | a d& u lt n s } i coti n e us e { mississippi | a d u lt s } { mississippi | a d u lt s } tobacco{ mississippi | a d u ltdata s } CURRENT SMOKING(adults) CURRENT SMOKINGcigarette smoking among adults : 2015 CURRENT SMOKINGcigarette smoking among adults : 2015 CURRENT SMOKING2015 cigarette smoking among adults : 2015

RANK STATE PREVALENCE LOWER CI UPPER CI 1 KENTUCKY 26.0% 24.3% 27.6% RANK STATE PREVALENCE LOWER CI UPPER CI 2 WEST VIRGINIA 25.7% 24.3% 27.1% RANK1 KENTUCKYSTATE PREVALENCE26.0% LOWER24.3% CI UPPER27.6% CI RANK3 ARKANSASSTATE PREVALENCE24.9% LOWER22.6% CI UPPER27.2% CI 12 WESTKENTUCKY VIRGINIA 26.0%25.7% 24.3%24.3% 27.6%27.1% 14 MISSISSIPPIKENTUCKY 26.0%22.6% 24.3%20.9% 24.2%27.6% 23 WESTARKANSAS VIRGINIA 25.7%24.9% 24.3%22.6% 27.1%27.2% 25 WESTMISSOURI VIRGINIA 25.7%22.3% 24.3%20.8% 23.8%27.1% 34 ARKANSASMISSISSIPPI 24.9%22.6% 22.6%20.9% 27.2%24.2% 36 OKLAHOMAARKANSAS 24.9%22.2% 22.6%20.6% 27.2%23.7% 45 MISSISSIPPIMISSOURI 22.6%22.3% 20.9%20.8% 24.2%23.8% 47 MISSISSIPPITENNESSEE 22.6%21.9% 20.9%20.2% 24.2%23.6% 56 MISSOURIOKLAHOMA 22.3%22.2% 20.8%20.6% 23.8%23.7% 5 LOUISIANAMISSOURI 22.3%21.9% 20.8%20.2% 23.8%23.6% 67 OKLAHOMATENNESSEE 22.2%21.9% 20.6%20.2% 23.7%23.6% 96 OKLAHOMAOHIO 22.2%21.6% 20.6%20.2% 23.7%23.0% 7 TENNESSEELOUISIANA 21.9%21.9% 20.2%20.2% 23.6%23.6% 7 10 TENNESSEEALABAMA 21.9%21.4% 20.2%20.0% 22.8%23.6% 9 LOUISIANAOHIO 21.9%21.6% 20.2%20.2% 23.6%23.0% 11 LOUISIANAMICHIGAN 20.7%21.9% 20.2%19.5% 23.6%21.9% 910 ALABAMAOHIO 21.6%21.4% 20.2%20.0% 23.0%22.8% 129 INDIANAOHIO 20.6%21.6% 20.2%18.9% 23.0%22.2% 1011 ALABAMAMICHIGAN 21.4%20.7% 20.0%19.5% 22.8%21.9% 1013 SOUTHALABAMA DAKOTA 21.4%20.1% 20.0%18.3% 22.8%21.9% 1112 MICHIGANINDIANA 20.7%20.6% 19.5%18.9% 21.9%22.2% 1411 SOUTHMICHIGAN CAROLINA 20.7%19.7% 18.5%19.5% 20.8%21.9% 1213 SOUTHINDIANA DAKOTA 20.6%20.1% 18.9%18.3% 22.2%21.9% 1215 INDIANAMAINE 20.6%19.5% 18.9%18.1% 22.2%20.8% 1314 SOUTHSOUTH DAKOTACAROLINA 20.1%19.7% 18.3%18.5% 21.9%20.8% 1316 SOUTHALASKA DAKOTA 20.1%19.1% 18.3%17.0% 21.9%21.2% 1415 SOUTH MAINECAROLINA 19.7%19.5% 18.5%18.1% 20.8%20.8% 14 SOUTHWYOMING CAROLINA 19.7%19.1% 18.5%17.3% 20.8%20.9% 1516 MAINEALASKA 19.5%19.1% 18.1%17.0% 20.8%21.2% MAINE 19.5% 18.1% 20.8% 1815 NORTH CAROLINA 19.0% 17.8% 20.2% 16 WYOMINGALASKA 19.1%19.1% 17.0%17.3% 21.2%20.9% ALASKA 1619 MONTANA 18.9%19.1% 17.0%17.3% 20.5%21.2% 18 NORTHWYOMING CAROLINA 19.1%19.0% 17.3%17.8% 20.9%20.2% 20 NORTHWYOMING DAKOTA 18.7%19.1% 17.3%17.1% 20.9%20.3% 1819 NORTHMONTANA CAROLINA 19.0%18.9% 17.8%17.3% 20.2%20.5% 1821 NORTHIOWA CAROLINA 19.0%18.1% 16.7%17.8% 20.2%19.5% 1920 NORTHMONTANA DAKOTA 18.9%18.7% 17.3%17.1% 20.5%20.3% 19 PENNSYLVANIAMONTANA 18.9%18.1% 16.7%17.3% 20.5%19.5% 2021 NORTHIOWA DAKOTA 18.7%18.1% 17.1%16.7% 20.3%19.5% 2320 NORTHGEORGIA DAKOTA 18.7%17.7% 16.1%17.1% 20.3%19.3% 21 PENNSYLVANIAIOWA 18.1%18.1% 16.7%16.7% 19.5%19.5% 21 KANSASIOWA 18.1%17.7% 16.7%17.1% 18.4%19.5% 23 PENNSYLVANIAGEORGIA 18.1%17.7% 16.7%16.1% 19.5%19.3% 25 PENNSYLVANIANEVADA 18.1%17.6% 16.7%15.2% 19.5%19.9% 23 GEORGIAKANSAS 17.7%17.7% 16.1%17.1% 19.3%18.4% 23 GEORGIA 17.7% 16.1% 19.3% 26 NEW MEXICO 17.5% 16.0% 19.1% 25 KANSASNEVADA 17.7%17.6% 17.1%15.2% 18.4%19.9% 27 DELAWAREKANSAS 17.7%17.4% 15.6%17.1% 18.4%19.1% 2526 NEWNEVADA MEXICO 17.6%17.5% 15.2%16.0% 19.9%19.1% 17.6% 15.2% 19.9% 2528 WISCONSINNEVADA 17.3% 15.9% 18.8% 2627 NEWDELAWARE MEXICO 17.5%17.4% 16.0%15.6% 19.1%19.1% 2629 NEWNEBRASKA MEXICO 17.5%17.1% 16.0%16.2% 18.0%19.1% 2728 DELAWAREWISCONSIN 17.4%17.3% 15.6%15.9% 19.1%18.8% 27 DELAWAREOREGON 17.4%17.1% 15.7%15.6% 18.5%19.1% 2829 WISCONSINNEBRASKA 17.3%17.1% 15.9%16.2% 18.8%18.0% 2831 WISCONSINVIRGINIA 16.5%17.3% 15.9%15.4% 18.8%17.7% 29 NEBRASKAOREGON 17.1%17.1% 16.2%15.7% 18.0%18.5% 2932 MINNESOTANEBRASKA 16.2%17.1% 16.2%15.4% 18.0%17.0% 31 OREGONVIRGINIA 17.1%16.5% 15.7%15.4% 18.5%17.7% 33 VERMONTOREGON 16.0%17.1% 15.7%14.7% 18.5%17.2% 3132 MINNESOTAVIRGINIA 16.5%16.2% 15.4%15.4% 17.7%17.0% 31 WASHINGTONVIRGINIA D.C. 16.5%16.0% 15.4%13.5% 18.4%17.7% 3233 MINNESOTAVERMONT 16.2%16.0% 15.4%14.7% 17.0%17.2% 3235 NEWMINNESOTA HAMPSHIRE 16.2%15.9% 15.4%14.6% 17.0%17.2% 33 WASHINGTONVERMONT D.C. 16.0%16.0% 14.7%13.5% 17.2%18.4% 33 VERMONT 16.0% 14.7% 17.2% 36 FLORIDA 15.8% 14.7% 16.9% 35 WASHINGTONNEW HAMPSHIRE D.C. 16.0%15.9% 13.5%14.6% 18.4%17.2% 16.0% 13.5% 18.4% 37 WASHINGTONCOLORADO D.C. 15.7% 14.6% 16.7% 3536 NEW HAMPSHIREFLORIDA 15.9%15.8% 14.6%14.7% 17.2%16.9% 3835 NEWRHODE HAMPSHIRE ISLAND 15.9%15.5% 14.6%14.0% 17.2%17.0% 3637 COLORADOFLORIDA 15.8%15.7% 14.7%14.6% 16.9%16.7% 3639 NEWFLORIDA YORK 15.8%15.2% 14.7%14.3% 16.9%16.1% 3738 RHODECOLORADO ISLAND 15.7%15.5% 14.6%14.0% 16.7%17.0% 37 COLORADOTEXAS 15.7%15.2% 14.6%14.1% 16.7%16.4% 3839 RHODENEW ISLAND YORK 15.5%15.2% 14.0%14.3% 17.0%16.1% 38 RHODE ISLAND 15.5% 14.0% 17.0% 41 ILLINOIS 15.1% 13.8% 16.5% 39 NEWTEXAS YORK 15.2%15.2% 14.3%14.1% 16.1%16.4% 15.2% 14.3% 16.1% 39 MARYLANDNEW YORK 15.1% 13.7% 16.6% 41 TEXASILLINOIS 15.2%15.1% 14.1%13.8% 16.4%16.5% 43 WASHINGTONTEXAS 15.2%15.0% 14.1% 16.4%15.8% 41 MARYLANDILLINOIS 15.1%15.1% 13.8%13.7% 16.5%16.6% 4441 ILLINOISHAWAII 15.1%14.1% 13.8%12.8% 16.5%15.3% 43 WASHINGTONMARYLAND 15.1%15.0% 13.7%14.1% 16.6%15.8% 45 MARYLANDARIZONA 14.0%15.1% 13.7%12.8% 16.6%15.3% 4344 WASHINGTONHAWAII 15.0%14.1% 14.1%12.8% 15.8%15.3% 43 WASHINGTON 15.0% 14.1% 15.8% 4445 MASSACHUSETTSHAWAIIARIZONA 14.0%14.1%14.0% 13.0%12.8%12.8% 15.0%15.3%15.3% 44 HAWAII 14.1% 12.8% 15.3% 47 IDAHO 13.8% 12.5% 15.2% 45 MASSACHUSETTSARIZONA 14.0%14.0% 12.8%13.0% 15.3%15.0% 45 ARIZONA 14.0% 12.8% 15.3% 48 CONNECTICUT 13.5% 12.5% 14.4% 47 MASSACHUSETTSIDAHO 14.0%13.8% 13.0%12.5% 15.0%15.2% MASSACHUSETTS 14.0% 13.0% 15.0% 13.5% 12.5% 14.6% 4748 NEWCONNECTICUTIDAHO JERSEY 13.8%13.5% 12.5%12.5% 15.2%14.4% 47 IDAHO 13.8% 12.5% 15.2% 4850 CONNECTICUTCALIFORNIA 13.5%11.7%13.5% 10.9%12.5%12.5% 12.4%14.4%14.6% 48 CONNECTICUTNEW JERSEY 13.5% 12.5% 14.4% 5150 NEWUTAH JERSEY 13.5%9.1%11.7% 12.5%8.4%10.9% 14.6%9.8%12.4% NEWCALIFORNIA JERSEY 13.5% 12.5% 14.6% 5051 CALIFORNIAUTAH 11.7%9.1% 10.9%8.4% 12.4%9.8% 50 CALIFORNIA 11.7% 10.9% 12.4% 51 UTAH 9.1% 8.4% 9.8% 51 UTAH 9.1% 8.4% 9.8%

Mississippi ranks 4th among the 50 states and Washington D.C. in the prevalence of current smoking amongMississippi adults. ranks State 4th rankings, among thehowever, 50 states should and Washingtonbe interpreted D.C. with in thecaution. prevalence Rank differencesof current smoking do not Mississippi ranks 4th among the 50 states and Washington D.C. in the prevalence of current smoking Mississippinecessarilyamong adults. reflectranks State 4th meaningful rankings,among the however,differences 50 states should andbetween Washington be interpretedstates. D.C. with in the caution. prevalence Rank of differences current smoking do not amongnecessarily adults. reflect State rankings,meaningful however, differences should between be interpreted states. with caution. Rank differences do not necessarilySOURCE reflect meaningful differences between states. 2015SOURCE Behavior Risk Factor Surveillance System, Centers for Disease Control and Prevention SOURCE 2015 Behavior Risk FactorAnnual Surveillance Report System, 2016 Centers for Disease Control and Prevention | page twenty 2015 Behavior Risk Factor Surveillance System, Centers for Disease Control and Prevention 4 STATE RANKINGS REPORT | FEBRUARY 2017 4 STATE RANKINGS REPORT | FEBRUARY 2017 4 | FEBRUARY 2017 Source:4 Behavioral Risk Factor SurveillanceSTATE RANKINGS System REPORT (BRFSS) | FEBRUARY 2017 Source:State Behavioral Rankings Risk of Factor Current Surveillance Cigarette Smoking,System (BRFSS) February 2017 | Mississippi Tobacco Data Source: Behavioral Risk Factor Surveillance System (BRFSS) Source: BehavioralState Rankings Risk ofFactor Current Surveillance Cigarette System Smoking, (BRFSS) February 2017 | Mississippi Tobacco Data State Rankings of Current Cigarette Smoking, February 2017 | Mississippi Tobacco Data p.3 State Rankings of Current CigaretteTobacco ReportSmoking, | MTD February 2016 2017 | Mississippi Tobacco Data p.3 Tobacco Report | MTD 2016 p..3 Tobacco Report | MTD 2016 ms tobacco data (adults)

Current Cigarette 35 Use by Race + Gender 32.8 30

25

23.2 22.5 20 21.8

15

13.3 10

5

0 Black Male Black Female White Male White Female Overall

Source: 2015 Behavioral Risk Factor Surveillance Survey (BRFSS)

The percentage of Mississippi adults who reported being current smokers was significantly higher among black males (32.8) compared to other gender and race groups, and the percentage among black females (13.3%) was significantly lower compared to their counterparts.

page twenty-one | Annual Report 2016 ms tobacco data (adults)

35

30 31.5 30.4 Current Cigarette 25 Use by Income 23.9

20 21.6

15 Source: 2015 Behavioral Risk Factor 13.3 Surveillance Survey (BRFSS) 10 The percentage of Mississippi adults who reported current cigarette smoking was 5 significantly higher among those with an annual household income of less than $15,000 compared to those with incomes 0 <$15,000 $15-$24,999 $25-$34,999 $35-$49,999 $50,000+ of $35,000 or more.

35 34.1

30 Current Cigarette 25 25.1 Use by Education

20 19.9

15

Source: 2015 Behavioral Risk Factor 10 11.6 Surveillance Survey (BRFSS)

The percentage of Mississippi adults who 5 reported current cigarette smoking was significantly higher among those with 0 less than high school (34.1%) compared to

Annual Report 2016 | page twenty-two to baccoms &tobacco n i coti n e us data e (adults) { mississippi | a d u lt s }

current e-cigarette use

overall 5.1%

male 6.3% gender | p = .05 female 4.1%

black 2.7% race | p < .05 white 6.5%

18-24 5.5%

25-44 7.6% age | p < .05 45-64 4.0%

65 + 2.6%

less than HS deg 7.9%

HS degree or GED 6.4% education | ns some college 6.4%

college degree 3.5%

0.0% 3.0% 6.0% 9.0%

Source: 2015 Mississippi Social Climate Survey of Tobacco Control

page twenty-three | AnnualTobacco Report | MTD 2016 2016 p.10 statewide interventions

The CDC’s Best Practices recommend that state programs provide funding to organizations that can effectively reach, involve, and mobilize identified specific populations. The Office 19,436 people of Tobacco Control provides funding for several health-related organizations to increase the number of Mississippians receiving impacted tobacco control messages and services through their healthcare providers, staff, and related programs.

Tobacco cessation more than doubles when evidence-based intervention programs are utilized. - a a f p

e n g a g i n g mississippi ’ s f a m i l y p h y s i c i a n s Family physicians have real power in the fight Mississippi against tobacco, smoking, and nicotine. Academy At least 70% of people who use tobacco products in the United States see a physician each year. of Family Approximately 42,000 lives could be saved, if physicians Physicians would advise 90% of smokers to quit, and offer them Foundation medication or other assistance. Source: www.aafp.org 66 education, awareness activities, chart reviews, Studies have shown that physicians and their staffs can be trained to successfully deliver office-based smoking cessation interventions and that technical these interventions significantly improve smoking cessation rates. The Office assistance/ of Tobacco Control provides funding to the Mississippi Academy of Family Physicians Foundation (MAFPF) to train physicians on providing tobacco 6,720 people dependency training, effectively distributing educational literature on tobacco reached use and secondhand smoke. The OTC also offers technical support on project objectives. The project has impacted 43 family physician clinics.

Annual Report 2016 | page twenty-four t h e mississippi c h a p t e r o f t h e a m e r i c a n a c a d e m y The Mississippi o f p e d i a t r i c s ( m s a a p ) Chapter of the The Office of Tobacco Control provided funding to the American Academy Mississippi Chapter of the American Academy of Pediatrics of Pediatrics (MSAAP) to administer the Tobacco-Free Mississippi: Engaging Mississippi’s Pediatricians project. The overall goal of this 93 continuing education project was to implement the Public Health Service Guidelines presentations, for Treating Tobacco Use and Dependence recommendations in trainings, community pediatric practice in Mississippi. advocacy/ 6,016

t h e mississippi p r i m a r y h e a l t h c a r e association ( m p h c a ) The Mississippi The Office of Tobacco Control provided funding to the Mississippi Primary Health- Primary Health Care Association (MPHCA) to administer the care Association Tobacco-Free Mississippi: Engaging Federally Qualified Health Centers project. The MPHCA engaged Federally Qualified Health 117 awareness, Center (FQHC) clinicians to conduct clinical tobacco cessation capacity building, programs and activities, as recommended by the CDC’s Best chart reviews, Practices. Because many FQHCs serve low-income populations with limited medical resources, these centers are able to enhance cessation access to cessation services and mitigate barriers for tobacco promotion/ 588 control interventions among disparate populations. Through MPHCA, the Tobacco-Free Mississippi Project has the potential to impact more than 120 primary care sites and over 300,000 Mississippians.

I look at my work as planting seeds. Those seeds are planted in the hearts and minds of our Tobacco Champions and Co-Champions, the front-line responders in the fight to educate, motive and empower tobacco users to quit. If I can keep the work and the challenge before them, then they will keep it before our patients.

w ay n e m i l e y | mississippi p r i m a r y h e a lt h c a r e association page twenty-five | Annual Report 2016 e n g a g i n g mississippi ’ s n u r s e s “If the 3.6 million working nurses in the U.S. each helped one person per year quit smoking, nurses could greatly increase the U.S. quit rate.” The Mississippi – American Nurses Association Nurses Foundation Nurses are uniquely provided with the opportunity to intervene in a patients’ tobacco use, due to the fact that they are on the front 38 awareness and lines working with and interacting with patients daily. The Office programmatic activities of Tobacco Control funded the Mississippi Nurses Foundation and trainings - 3,789 (MNF) to train nursing instructors at colleges and universities throughout Mississippi on tobacco control and tobacco cessation people impacted programs in nursing curriculums and to provide cessation resource information to nurses who use tobacco.

t o b a c c o c o n t r o l s t r a t e g i e s f o r mississippians w i t h disabilities People with serious mental illness treated in the public health The University system die a startling 25 years earlier than those without mental of Southern illness. Tobacco-related illnesses including cancer, heart disease MS Institute and lung disease are among the most common causes of death for Disability in this population. Adults with disabilities are more likely to Studies IDS be cigarette smokers than those without disabilities. In 2015, the prevalence of current cigarette smoking among adults with disabilities was 21.5% compared with 13.8% among adults with 38 monthly no disability. The Office of Tobacco Control funded the Institute education classrooms, for Disability Studies (IDS) at the University of Southern leadership meetings, Mississippi to implement a tobacco control program to reduce the initiation of tobacco use, promote cessation, eliminate exposure community expos/ to secondhand smoke, and lessen tobacco-related disparities 987 Mississippians among Mississippians with disabilities. in attendance

Annual Report 2016 | page twenty-six cessation interventions

mississippi t o b a c c o q u i t l i n e The Mississippi Tobacco Quitline, 1-800-QUITNOW provides free telephone and web-based treatment to adult Mississippi residents. The CDC’s Best Practices recommendations for tobacco cessation interventions clearly outline the importance of quitlines. In FY 2015, the Mississippi Tobacco Quitline received 15,814 calls for treatment (MS Tobacco Quitline, 2015).

The Office of Tobacco Control provides funding for Information and Quality Healthcare (IQH) to provide services for individuals who wish to utilize the Mississippi Tobacco Quitline. Masters- level professional counselors evaluate and develop a treatment plan with callers. Services that callers receive include access to Nicotine Replacement Therapies, routine behavior change therapy with an assigned counselor, referrals to physicians with experience in tobacco cessation counseling, and/or referrals to the nearest ACT Center for Tobacco Treatment, Education and Research.

A Spanish Quitkit was developed and made available for those callers whose first language is Spanish and who wish to receive all information and counseling in Spanish. The MS Quitline collaborated with the MSDH Office of Tobacco Control and Office of Communications to implement media promotions of Quitline services via television, social media, and specialty media.

t h e a c t c e n t e r f o r t o b a c c o t r e a t m e n t , e d u c a t i o n a n d r e s e a r c h A program of the University of Mississippi Medical Center in Jackson, Mississippi, the ACT Center provides intensive treatment including Nicotine Replacement Therapy (NRT) and non-nicotine medications to Mississippi residents interested in quitting tobacco. Through funds provided by the Office of Tobacco Control, the ACT Center subcontracts with hospitals throughout the state for satellite tobacco treatment clinics (Appendix IV). In FY 2015, approximately 1,613 Mississippi residents participated in the intensive tobacco treatment program provided by the ACT Center. Tobacco use is not only a strong behavior, but a very well defined addiction to nicotine. Our program allows those who are ready to quit, have an option of treatment that individualizes the treatment plan, uses qualified counselors and support to help them make a solid attempt at quitting. It is important for callers to know that we are a tobacco cessation treatment program that happens to be telephonic or online - we are not a crisis line or a tip line. It is real treatment.

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Annual Report 2016 | page twenty-eight community interventions

mississippi t o b a c c o - During the period from July 1, 2015 to fJune r e30, e 2016 c, osix a MTFC l i t project i o n directors s were hired. The largest turnover occurred in Region OneThe where Office four of new Tobacco hires wereControl made. (OTC) Anjanette and its partners Ratliff, workdirector with for Alcorn and Tippah counties was hiredthe June Mississippi 1, 2016, Tobacco-Free Pearl Watts (Tallahatchie Coalitions (MTFCs) and Quitman) to educate on March 3, 2016, Shatara Agnew (Chickasawcitizens and - Lee) both on young July and1, 2016, old - and on theJasmine dangers Pittman of tobacco (Coahoma use. and Tunica) on September 6, 2016. All Thedirectors OTC in provides Region fundingTwo remained to 34 MTFCsthe same that during work the in fiscalall 82 year. In Region Three, Tabitha WilsonMississippi (Pike, Amite, counties and Wilkinson) to implement was tobacco hired in control July 2015 programs and at Meisha Smith (Copiah and Lincoln) in February 2016. As of this writing, the Rankin, Scott, and the grassroots level (Appendix III). Simpson County MTFC director position is vacant. In Region Four, Rachel Ward was hired in October as the project director for Harrison County and resigned in June 2016 when Kim Hart took over her duties. Shakeizia Jones assumed the position of project director for Hancock and Pearl River Counties in September 2016. Because of the turnover in Harrison County (Hart), Tallahatchie and eQuitman a c h (Watts)m t f, and c : Copiah and Lincoln (Smith) evaluations are not comprehensive for some areas Conductedof the scope tobacco of work. control programmatic and awareness activities throughout the year that Scope of work requirements included: general reporting, coalition membership, awareness activities, contain messages for youth and adults advocacy/policy, communications, cessation and programmatic activities. As a whole, the coalition Workeddirectors to increasesuccessfully tobacco-free met the objectivespolicies in set for them in their contractual obligations. In fact, 87% municipalitiesmet or exceeded statewide all of the Scope of Work requirements for the fiscal year. For a snapshot of all Promotedactivities, the see use Appendix of tobacco A, prevention and for a more individualized look at each of the coalitions, see Appendix curriculaB. in schools throughout the state

Mississippi Tobacco Free Coalitions (MTFC’s)

703,188 people impacted

• 34 MTFC’s with a presence in each of the 82 counties • 3,171 General Awareness Presentations with 441,851 people in attendance

• 1,759 Advocacy & Policy Activities with 92,039 people impacted

• 1,058 Cessation Activities with 62,781 people impacted • 28 Ordinances passed (19 Comprehensive smoke-free & 9 e-cig amendments) with 106,517 residents impacted

Collectively, the MTFC’s directly impacted 527,192 Mississippians through their work with

youth teams (85,341) and awareness activity presentations/activities (441,851) alone. Some of the activities include but are not limited to: Collectively,Awareness the Presentations MTFC’s directly 1,286 impacted events with 527,192 178,809 Mississippians people in attendance; through their Health work Fairs; with Fieldyouth teamsDays; (85,341) School/teacher and awareness orientations; activity RATpresentations jeopardy/activities with youth; (441,851 Sawmill) alone. Festival; Some Watermelonof the activities includeFestival; but are Open not House; limited Tobacco to: information disseminated; Second hand smoke presentations; AwareneChurchss events,Presentations etc. (Not High Level): 1,286 events with 178,809 people in attendance including set up for: Health Fairs; Field Days; School/teacher orientations; RAT jeopardy with youth; Sawmill Festival; Watermelon Festival; Open House; Tobacco information disseminated; Second Hand Smoke Source:presentations; 2016 Annual church State events Tobacco etc. Prevention and Control Evaluation Report | Mississippi Tobacco Data page twenty-nine | Annual Report 2016

Annual State Tobacco Prevention and Control Evaluation Report | September 2016 20 Mississippi Tobacco-Free Coalitions

DeSoto Benton Alcorn County DIRECTORS OFFICERS 1d Marshall Itawamba & Monroe 1a Helen Boerner 1g Tippah Tishomingo Chickasaw & Lee 1b Shatara Agnew A Tate 1h Prentiss C l Tunica Boliv ar & Sunflower 1c Bev erly Johnson h b 1e Alcorn & Tippah 1d Anjanette Ratliff Union e r 1f Prentiss & Tishomingo 1e Melissa Nash r i 2g Lafayette Coahoma & Tunica 1f Jasmine Pittman e t Panola Itawamba Lee Desoto & Tate 1g Marcus Ross e t CoahomaQuitman Pontotoc Union, Benton & Marshall 1h Linda Turner o n 1b Tallahatchie & Quitman 1i Pearl Watts 1a 1i Yalobusha Issaquena, Sharkey & Washington 2a Tasha Bailey M Tallahatchie W Calhoun Chickasaw Noxubee, Kemper & Neshoba 2b Bev erly Knox i 2d Monroe e Attala, Leake & Winston 2c Leigh Lamkin c b Bolivar1c Grenada, Yalobusha & Calhoun 2d Sue Mashburne h Grenada s e Montgomery, Webster & Choctaw 2e Keetha Mosely t Clay l Sunflower Webster Leflore, Humphreys & Carroll 2f Desiree Norwood e l Leflore Panola, Lafayette & Pontotoc 2g Justin Pope r 2f Montgomery e 2e 2h Oktibbeha, Clay & Lowndes 2h Yolanda Pruitt Carroll Oktibbeha Lowndes Warren & Claiborne 3a Vickie Bailey Washington Choctaw S Hinds 3b Jacqueline Carter B a Copiah & Lincoln 3c Meishia Smith o Humphreys b Holmes Madison, Yazoo & Holmes 3d Rochelle Culp l Winston Noxubee r Attala d 2a Adams, Jefferson & Franklin 3e Paige Dickey i e Rankin, Scott & Simpson 3f Jon Weeks n n Sharkey 3d 2c Lauderdale & Newton 3g Sabrina Wilson a 2b Pike, Amite & Wilkinson 3h Tabitha Wilson Yazoo Issaquena Leake Neshoba Kemper Lamar & Marion 4a Cassie Clinton Hancock & Pearl Riv er 4b Shakeizia Jones Madison S B Cov ington & Smith 4c Rhonda Hayes a r Jackson 4d Kellie Lamb n a Warren Scott Newton Forrest, Jones & Perry 4e Wendy Magee f 3b Lauderdale n o Harrison 4f Kim Hart d 3g r Hinds Rankin Greene, George & Stone 4g Stephanie Mayfield i d 3a Clarke, Jasper & Wayne 4h Pamela Lang-Prestage 3f Jeff Dav is, Lawrence & Walthall 4i Casey Ward Clarke Claiborne Smith Jasper Simpson Copiah 4c 4h Jefferson 3c 3e Lawrence Covington Jones Wayne Lincoln Jefferson Adams Franklin 4i Davis 4a Forrest4e Marion Lamar Greene Wilkinson 3h Amite Pike Perry Walthall 4g

Stone George 2016/17 Fiscal Year Pearl River 4b Jackson Harrison 4d Hancock 4f

19 Annual State Tobacco Prevention and Control Evaluation Report | September 2016

Source: 2016 Annual State Tobacco Prevention and Control Evaluation Report | Mississippi Tobacco Data

Annual Report 2016 | page thirty current cigarette smoking m s p u b l i c h i g h s c h o o l s

+

32.5% 30.3% 29.2% 23.5%

23.1% 23.4% 22.1% 20.2% 19.7% 18.8% 19.0% 18.7% 18.1%

13.3% 12.2% 9.9%

- 1998 1999 2000 2002 2003 2004 2006 2008 2009 2010 2011 2012 2013 2014 2015

In 2015, 13,508 Mississippi public high school students were current smokers. The prevalence of current smoking has decreased by 67% since 1998, leading to 27,834 fewer young smokers. { In the past year, the prevalence of current smoking has not changed significantly. page 7 The Mississippi Youth Tobacco Survey 1998 -2015 : cigare t te smoking Source: 2016 Youth Tobacco Survey Data Book | Mississippi Tobacco Data

page thirty-one | Annual Report 2016 current cigarette smoking m s p u b l i c m i d d l e s c h o o l s

+

23.0% 20.6%

18.1%

11.9% 12.0% 11.0% 8.9% 8.4% 7.2% 5.7% 5.8% 5.8% 4.1% 4.7% - 3.0% 1998 1999 2000 2002 2003 2004 2006 2008 2009 2010 2011 2012 2013 2014 2015

In 2015, 3,362 Mississippi public middle school students were current smokers. The prevalence of current smoking has decreased by 85% since 1998, leading to 19,724 fewer young smokers. { In the past year, the prevalence of current smoking has not changed significantly.

Source: 2016The Youth Mississippi Tobacco Youth Tobacco Survey Survey Data1998 Book -2015 :|cigare Mississippi t te smoking Tobacco Data page 8

Annual Report 2016 | page thirty-two current smokeless tobacco use mississippi p u b l i c s c h o o l s

+

13.8% In 2015, 10,506 Mississippi public high 11.8% school students were current SLT users. 10.4% 9.7% 9.8% 9.9% 9.4% 9.6% 9.6% 9.6% 9.6% 9.1% Since 1998, the prevalence of current

8.0% 8.0% SLT use has not changed significantly.

s c h o o l s 7.7%

In the past year, the prevalence of current SLT use has not changed significantly. h i g h

- 1998 1999 2000 2002 2003 2004 2006 2008 2009 2010 2011 2012 2013 2014 2015

+

In 2015, 4,035 Mississippi public middle school students were current SLT users.

9.6% 9.1% The prevalence of current SLT use has 8.7% s c h o o l s 8.2% decreased by 63% since 1998, leading 7.7% 7.5% 7.2% to 6,724 fewer young SLT users. 6.4% 6.4%

5.3% 5.5% 4.8% In the past year, the prevalence of current 4.4% 4.5% 3.6% SLT use has not changed significantly. m i d d l e

- 1998 1999 2000 2002 2003 2004 2006 2008 2009 2010 2011 2012 2013 2014 2015

The Mississippi Youth Tobacco Survey 1998 -2015 : smokeless tobacco use page 1 4 Source: 2016 Youth Tobacco Survey Data Book | Mississippi Tobacco Data

page thirty-three | Annual Report 2016 electronic cigarette use m s p u b l i c h i g h s c h o o l s

c u r r e n t u s e {2010-2015} +

12.0%

10.1% Changes between 2013 and 2014 in the wording and placement of questions about the use of e-cigarettes might have had an impact on reported use of these products.

2.9% 2.7% 2.3% - 1.2% 2010 2011 2012 2013 2014 2015

Source: 2016 Youth Tobacco Survey Data Book | Mississippi Tobacco Data

page 2 3 The Mississippi Youth Tobacco Survey 1998 -2015 : elec tronic cigare t te use

Annual Report 2016 | page thirty-four electronic cigarette use m s p u b l i c m i d d l e s c h o o l s

c u r r e n t u s e {2010-2015} +

Changes between 2013 and 2014 in the wording and placement of questions about the use of e-cigarettes 6.7% might have had an impact on reported use of these products. 4.6%

- 0.6% 1.0% 1.1% 1.5% 2010 2011 2012 2013 2014 2015

Source: 2016 Youth Tobacco Survey Data Book | Mississippi Tobacco Data

The Mississippi Youth Tobacco Survey 1998 -2015 : elec tronic cigare t te use page 2 4

page thirty-five | Annual Report 2016 y youth programs The Partnership for a Healthy Mississippi (PHM) partnersyouth with the Office of Tobaccoprograms Control to educate Mississippi’s youth about the dangers of tobacco use. This is accomplished in two primary ways: the development of RAT (Rejecty All Tobacco) activities and programs designed for children in grades K-6 and Generation FREE activities andThe conferences Partnership, designed for for a youth Healthy in grades Mississippi 7-12. (PHM) partners with the Office Curriculum is developed and distributed to MTFC’sof Tobacco so that youth Control teams can to be educate established. Mississippi’s youth about the dangers of Additionally, PHM is responsible for RAT Troupetobacco shows use.for children This enrolledis accomplished in public and private in two primary ways: the development elementary schools (K-6) across the state. In FY 2015-2015, 72 RAT Troupe shows were conducted reaching approximately 25,057 children all aroundof RAT the state (Reject (see map All 7). Tobacco) Of the 72 performances, activities onandly programs designed for children three werein conducted grades in K-6 private and schools. Generation Five dancing FREE RAT Troupes activities performed and (Oxfordconferences, High School, designed for youth in grades 7-12. Simmons CurriculumHigh School (Hollandale), is developed Ocean and Springs distributed High School, to two MTFC’s Jackson so teams that made youth up of teams high can be established. Additionally, schools in the Jackson area). In May, funding became available to add an additional troupe from StarkvillePHM High School is responsible which will be readyfor RATfor performances Troupe inshows the 2016/17 for FY.children Five teachers enrolled were in public and private elementary selected fromschools each performance (K-6) across to fill outthe a questionnairestate. In FY which 2015-2015, were mainly open72 -RATended questions.Troupe shows were conducted reaching Of the 52 approximatelyrespondents, there was 25,057 overwhelmingly children positive all around feedback. the When state asked (see what map they 7). liked Five best teachers were selected from each about the performanceperformance, teacher to responsesfill out included: a questionnaire. When asked what they liked best about the performance, • Theteacher student responsesinvolvement included: • Interaction with students and student knowledge of information • Live performers, conveying an important message to the students • The• facts The and student explanations involvement • I think• Interaction Terrance the Rat with should students be out during and studentthe whole knowledgeperformance of information • I think• Live the best performers, part of the performance conveying were an the important students dancing message and also to getting the studentsstudents out of the audience to dance along with them • The energy of the performers. The video was very good. Six LEAD Conferences were held in November 2015. Locations were Six LEAD Conferences were held in November 2015. Locations were Southaven, Pearl, Hattiesburg, Oxford, Starkville,Southaven, and Greenwood. Pearl, Hattiesburg, A total of 1,649 Oxford, students in Starkville, 9th through 12 andth gra Greenwood.des were in attendance.In In the the spring, spring, six six iFLY iFLY events events were held were in Southaven, held in Southaven,Hattiesburg, Jackson, Hattiesburg, Oxford, Starkville,Jackson, and Greenwood. Oxford, 1,294 Starkville,students in 7th -8andth grades Greenwood. attended. Year round, 130 FREEStyle events took place around the state impacting about 12,775 students in grades 7-12. Just over Withforty-five over thousand 85,000 (45,496) students youth wereparticipating impacted by inthe MTFCRAT Troupe youth performances, teams in LEAD and iFLY conferences, Free Style events, and YAB trainings for the fiscal year. With over 85,000 studentsschool participating and community in MTFC youth settings, teams inthe school reach and ofcommunity the Partnership settings, the extendsreach of the Partnershipbeyond extends the beyondnumbers the numbers reflected reflected here. here.

The Partnership for a Healthy Mississippi Youth Activities 45,496 youth impacted

• 72 RAT Troupe Performances for 25,057 K-6th graders

• 6 LEAD conferences with 1,649 9th -12th students attending • 6 iFLY conferences with 1,294 7th & 8th grade students attending • 130 FreeStyle Events reaching 12,775 in 7th- 12th grade • 37 activities & A3 training sessions for 4,411 YAB students • Facebook & Twitter users (310)

33 Annual State Tobacco Prevention and Control Evaluation Report | September 2016 Source: 2016 Annual State Tobacco Prevention and Control Evaluation Report | Mississippi Tobacco Data Annual Report 2016 | page thirty-six Map 7 depicts the performance locations around the state.

2015-2016 RAT Troupe Performances (72)

Olive Branch

Holly Springs Ripley Tunica Hickory Flat BoonevilleTishomingo Sarah

SardisSardis Blue Springs

Dorsey Clarksdale Watervalley Nettleton Sumner Rosedale Drew Grenada CedarbluffWest Point

Winona Greenville

Belzoni Durant

Goodman Noxapater Rolling Fork Philadelphia Scooba Canton Walnut Grove Madison Forest Bolton Brandon Jackson Meridian Newton Vicksburg Jackson Richland NewtonEnterprise Florence

Hazlehurst Pinola Heidelberg

Fayette Collins Prentiss Brookhaven Natchez Monticello

Summit FoxworthColumbia Magee Woodville Leakesville Liberty McLain

Lucedale

Location within Zip Code Perkinston

RAT Performance Gulfport Gautier Long Beach

Source: 2016 Annual State Tobacco Prevention and Control Evaluation Report | Mississippi Tobacco Data page thirty-seven | Annual Report 2016 Annual State Tobacco Prevention and Control Evaluation Report | September 2016 34 The Office of Tobacco Control (OTC) collaborates with the Mississippi High School Activities Association (MHSAA) to provide coaches, athletes and spectators with tobacco education in order to help reduce tobacco initiation/prevalence rates with citizens from across Mississippi.

The partnership with OTC and MHSAA focuses on reducing smokeless tobacco rates with MHSAA coaches and athletes. Coaches are very influential in the lives of their athletes and their health choices. MHSAA serves over 600 middle and high schools, approximately 55,000 athletes and over 4,000 coaches. OTC attended conferences and championship games hosted by MHSAA to reach targeted audiences across Mississippi.

The following list contains the various tobacco education delivery methods that were used during MHSAA events: On site information table/booth at the Mississippi Association of Athletic Administrators Conference for distribution of information on youth tobacco-prevention programs On site information table/booth and Full page ad in Soccer and Basketball Championship game programs Tobacco-Free announcements prior to and during each Baseball Championship game at Trustmark Park Generation Free 30-second commercial focusing on tobacco usage reduction aired on outfield video board at least twice per game during Football Championship games RAT coloring sheet focusing on smokeless tobacco usage reduction included in soccer and baseball game program On site information table/booth for Mississippi Tobacco Quitline for distribution of information/incentives to game attendees Terrance the RAT mascot on site to interact with youth Access to all State Basketball championship games for OTC FREEstyle interactive activities at games Access to Trustmark Park for OTC FREEstyle interactive activities at baseball games

Annual Report 2016 | page thirty-eight Care for Their Air Program is a program for Mississippi child care centers and Head Start centers to educate parents and caregivers about the health risks to children from secondhand smoke exposure. It is also designed to encourage them to commit to providing a smoke-free environment in their homes and cars. An estimated 11 percent of U.S. children ages six years and younger are regularly exposed to secondhand smoke in homes and cars. Exposure to secondhand smoke can cause asthma, increases the risk for Sudden Infant Death Syndrome (SIDS), and leads to increased risk of respiratory infections and middle ear infections.

page thirty-nine | Annual Report 2016 mass-reach health communication interventions

The Mississippi State Department of Health, Office of Tobacco Control implemented a statewide media campaign to prevent the initiation of tobacco use among youth and to promote tobacco cessation services among Mississippians.

The CDC’s Best Practices recommends that an effective state health communication intervention should deliver strategic, culturally appropriate, high-impact messages in sustained and adequately funded campaigns integrated into the overall state tobacco control program. The Office of Tobacco Control (OTC) works with the MSDH Office of Communications to provide a statewide media campaign that builds on existing prevention programs.

r e j e c t a l l t o b a c c o ( r a t )

RAT TV commercials, website activities, and school manuals Generation FREE social media (Facebook, Twitter, Instagram), monthly manuals Parents and Kids monthly magazine article, RAT puzzle page, and “Find Terrance” contest National CDC Tips From Former Smokers Campaign: TV, newspaper, radio, online, and theatres

Annual Report 2016 | page forty r e s c u e s o c i a l c h a n g e a g e n c y ( r e s c u e ) In FY16 the Office of Tobacco Control (OTC) continued its partnership with Rescue. Down and Dirty (D&D), the youth tobacco prevention program, continues with its aims of changing what it means to be a Country teen and shifting social norms by breaking the association between tobacco use and the Country culture. D&D specifically targets this peer crowd because prior research indicated Mississippi Country teens are at significantly higher risk of using chewing tobacco and cigarette smoking than their peers. This targeting is completed through social media and event attendance.

Through the use of social media, highly targeted paid digital advertising, and experiential “event” marketing, D&D targets the high-risk Country teen peer crowd with anti-tobacco messages that align with the audience’s values, interests, attitudes and beliefs. The goal in 2016 was to continue to build the brand’s credibility and social authority among high-risk Country teens while delivering tobacco-free messages through stronger and better-integrated social marketing activities both online and off.

d & d e v e n t a c t i v i t i e s a n d m e t r i c s D&D has participated in events across the state, including a Mud Bog and a Demolition Derby near Kiln, two fishing tournaments on the Mississippi coast, rodeos in Pontotoc and Southaven, and a professional bull riding tour that made stops in multiple cities across the state. In February, D&D attended the annual Dixie National Rodeo in Jackson. The events are staffed by brand ambassadors: young people who embody the Country peer crowd image and live a tobacco-free lifestyle. During the events, these ambassadors interact with local youth to build relationships through the delivery of a tobacco-free lifestyle message.

Event Metric Total Total Estimated Event Attendance 37,000 Total Contact Cards Collected 875 Total Brand Ambassadors Trained 37 Total Mailing Addresses Collected 823 Total Email Addresses Collected 780

page forty-one | Annual Report 2016 youth prevention t h e s y n a r a m e n d m e n t Federal lawmakers passed Section 1926 of Title XIX of the Federal Public Health Service Act, commonly called the Synar Amendment, in 1992. The Synar Amendment requires states to pass and enforce laws that prohibit the sale of tobacco to individuals less than 18 years of age.

The Mississippi Department of Mental Health, Division of Alcohol and Drug Abuse, is the agency responsible for compliance with the Synar Amendment. The Annual Synar Report was submitted to the Substance Abuse and Mental Health Administration Center for Substance Abuse Prevention.

Mississippi is required to provide detailed information on progress made in enforcing youth tobacco access laws and future plans to ensure compliance with the Synar requirements to reduce youth tobacco access rates.

t h e s y n a r r e g u l a t i o n r e q u i r e s s t a t e s t o : Enforce such laws in a manner that can reasonably be expected to reduce the extent to which tobacco products are available to individuals under the age of 18. Have in effect a law prohibiting any manufacturer, retailer, or distributor of tobacco products from selling or distributing such products to any individual under the age of 18. Conduct annual random, unannounced inspections to ensure compliance with the law. These inspections are to be conducted in such a way as to provide a valid sample of outlets accessible to youth. Develop a strategy and time frame for achieving an inspection failure rate of less than 20 percent of outlets accessible to youth. Submit an annual report detailing the state’s activities to enforce their laws; the state’s overall success during the previous fiscal year in reducing tobacco availability to youth; the state’s method of conducting inspections and identifying outlets to inspect; and the state’s plans for enforcing the law in the coming fiscal year.

For a full copy of the Mississippi Synar Report go to www.dmh.state.ms.us.

Annual Report 2016 | page forty-two s t a t e l a w s In an effort to prohibit the sale of tobacco to minors, The Mississippi Juvenile Tobacco Access and Prevention Act of 1997 was passed and became effective February 1, 1998. Major provisions included in this legislation were:

Tobacco retailers must obtain permits to sell tobacco. Tobacco retailers must notify their employees of the state tobacco laws. Possession of tobacco by minors is illegal. Stiff penalties exist for noncompliance by retailers or youth. Tobacco vending machines are only permitted in places inaccessible to minors. Warning signs are required at each point of sale of tobacco.

Since January 1998, Mississippi state law has authorized the Office of the Attorney General to conduct random, unannounced inspections to ensure compliance with the state statute prohibiting the sale of tobacco to minors. It is the lead enforcement agency involved in enforcing youth alcohol and tobacco laws.

page forty-three | Annual Report 2016 protecting the public

s e c o n d h a n d s m o k e Secondhand smoke is a serious health hazard. Of the more than 7,000 chemicals it contains, at least 70 are known to cause cancer. Secondhand smoke is classified by the Environmental Protection Agency as a known carcinogen. Exposure to secondhand smoke can lead to heart disease, stroke, decreased immune function, impaired lung function, asthma, ear infections, lower respiratory illness, low birth weight, and sudden infant death syndrome (SIDS). Inhaling secondhand smoke causes approximately 3,000 lung cancer deaths and 46,000 heart disease deaths each year among adult nonsmokers. Secondhand smoke may increase the risk of breast cancer, nasal sinus cavity cancer, and nasopharyngeal cancer in adults and increase the risk of leukemia, lymphoma, and brain tumors in children. The Surgeon General has stated that there is no safe level of exposure to secondhand smoke (Surgeon General Report, 2014). http://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html

d e v e l o p i n g m u n i c i p a l comprehensive s m o k e - f r e e o r d i n a n c e s i n mississippi The Office of Tobacco Control, in collaboration with the Mississippi Municipal League, engaged municipalities within Mississippi to increase the number of individuals in the state protected by comprehensive smoke-free air ordinances.

Through Developing Municipal Comprehensive Smoke-free Ordinances in Mississippi, municipalities worked with tobacco control partners to educate citizens and elected officials about the dangers of secondhand smoke (Appendix II).

The CDC’s Best Practices recognizes the importance of community support and involvement at the grassroots level in implementing highly effective policy interventions, such as creating smoke-free environments. In 2015, Mississippi received national recognition from Americans for Nonsmokers’ Rights for passing the most smoke-free ordinances of any state.

Annual Report 2016 | page forty-four Southaven walnut Corinthfarmington h e r n a n d oholly springs coldwater Iuka 100% Smoke-free Senatobia booneville communities friar s new albany baldw yn poin t sledge Oxford Saltillomantachie CoahomaBatesville jonestown courtland Tupelo in Mississippi Lyon Ecru plantersville clarksdale marks Pontotoc verona Nettleton u pdat e d | j u n e 2016 AlligatorTutwilerCharlestonbruce okolona d u n c a n sumner pittsboro Amory Drew c a l h o u n c i t yAberdeen Beulah Grenada duck hill Mathiston shaw greenwood Itta Bena s t a r k v i l l e i n d i a n o l amoorhead Sidon Artesia cruger Weir Crawford i s o l a louisville brooksville Metcalfe Macon a r c o l a Belzoni EthelNoxapater Hollandale lexingtonDurantkosciusko anguilla Louiseeden mayersville pickens s h u q u a l a k r o l l i n g f o r k There Cary are Flora Canton Walnut Grove 123 Smoke-Free Madison communities ridgeland f l o w o o dMorton i n mississippi Clinton Meridian Jackson Brandon Pearl forest *77 of which have ordinances Byramflorence that include restrictions on m e n d e n h a l l Crystal Springs mageeShubuta e l e c t r o n i c c i g a r e t t e s Fayette w e s s o n Georgetown Laurel brookhavenmonticellocollinse l l i s v i l l e Prentiss bassfield state line Partial Smoke-free SumrallPetal communities Woodville hattiesburg leakesville in Mississippi centreville New Augusta l u m b e r t o n • August 6, 1996 | West • October 2007 | Greenville Wiggins lucedale • November 15, 2007 | McComb • June 3, 2010 | Goodman poplarville • January 10, 2008 | Summit • October 5, 2010 | Rienzi p i c ay u n e • May 1, 2008 | Gulfport • June 2 011 | Olive Branch Moss Point • July 31, 2008 | Walls • June 6, 2012 | Vaiden pascagoula • January 6, 2010 | Columbus • July 3, 2014 | Gautier Diamondhead

2016 • mississippi tobacco data

Source: June 2016 100% Smoke-Free Communities in Mississippi Factsheet | Mississippi Tobacco Data page forty-five | Annual Report 2016 100% Smoke-free communities key year local ordinances date implemented % of ms pop. protected in Mississippi 2002 | metcalfe | september 3rd | 0.03% t i m e l i n e d a t a {

2002 | metcalfe | september 3rd | 0.03% 2010 | pearl | september 1st | 19.68%

2005 | mayersville | september 16th | 0.05% 2010 | jonestown | october 13th | 19.72%

2006 | starkville | may 20th | 0.89% 2011 | okolona | april 15th | 19.81%

2006 | tupelo | october 5th | 2.08% 2011 | centreville | april 17th | 19.86%

2006 | mantachie | november 4th | 2.12% 2011 | flowood | may 4th | 20.15%

2006 | oxford | november 16th | 2.84% 2011 | marks | july 14th | 20.20%

2007 | hattiesburg | january 1st | 4.41% 2011 | calhoun city | september 1st | 20.26%

2007 | hernando | march 8th | 4.92% 2011 | brookhaven | november 17th | 20.68%

2007 | aberdeen | march 22nd | 5.10% 2011 | new albany | december 1st | 20.97%

2007 | mathiston | april 15th | 5.13% 2011 | byram | december 10th | 21.36%

2007 | ridgeland | july 19th | 5.94% 2011 | rolling fork | december 15th | 21.42%

2007 | greenwood | august 16th | 6.46% 2012 | monticello | january 18th | 21.48%

2007 | kosciusko | november 1st | 6.70% 2012 | canton | january 19th | 21.93%

2007 | amory | november 1st | 6.94% 2012 | georgetown | march 12th | 21.94%

2007 | corinth | november 6th | 7.44% 2012 | duncan | april 5th | 21.96%

2007 | flora | december 13th | 7.50% 2012 | anguilla | april 27th | 21.98%

2007 | petal | december 20th | 7.86% 2012 | durant | may 3rd | 22.06%

2008 | ecru | march 12th | 7.89% 2012 | verona | may 3rd | 22.17%

2008 | pontotoc | may 1st | 8.09% 2012 | arcola | may 10th | 22.18%

2008 | collins | june 6th | 8.17% 2012 | shuqualak | may 31st | 22.19%

2008 | clinton | august 14th | 9.02% 2012 | booneville | june 1st | 22.49%

2008 | laurel | december 4th | 9.65% 2012 | new augusta | june 12th | 22.51%

2009 | grenada | april 8th | 10.09% 2012 | moss point | june 14th | 22.97%

2009 | hollandale | december 3rd | 10.17% 2012 | sumner | july 5th | 22.98%

2010 | meridian | february 18th | 11.51% 2012 | alligator | july 5th | 22.98%

2010 | batesville | march 4th | 11.76% 2012 | forest | september 6th | 23.17%

2010 | bassfield | march 10th | 11.77% 2012 | florence | september 19th | 23.28%

2010 | prentiss | april 17th | 11.80% 2012 | ethel | november 1st | 23.33%

2010 | madison | june 3rd | 12.65% 2012 | indianola | november 7th | 23.67%

2010 | crystal springs | june 15th | 12.82% 2012 | cary | december 8th | 23.68%

2010 | jackson | july 1st | 18.54% 2013 | moorhead | january 11th | 23.75%

2010 | wesson | july 1st | 18.60% 2013 | wiggins | january 17th | 23.91%

2010 | belzoni | july 1st | 18.67% 2013 | lucedale | february 1st | 24.01%

2010 | lumberton | july 3rd | 18.74% 2013 | baldwyn | july 5th | 24.12%

2010 | sumrall | july 3rd | 18.80% 2013 | plantersville | july 6th | 24.16%

amended definition of smoking to created a new ordinance that original ordinance include e-cigarettes within original ordinance. prohibited e-cigarette use in places where included e-cigarettes. original ordinance prohibited smoking.

Source: June 2016 100% Smoke-Free Communities in Mississippi Factsheet | Mississippi Tobacco Data

Annual Report 2016 | page forty-six 100% Smoke-free communities key year local ordinances date implemented % of ms pop. protected in Mississippi 2002 | metcalfe | september 3rd | 0.03% t i m e l i n e d a t a {

2013 | pascagoula | july 18th | 24.90% 2015 | courtland | april 2nd | 29.31%

2013 | morton | october 31st | 25.01% 2015 | drew | april 2nd | 29.37%

2013 | magee | november 19th | 25.16% 2015 | walnut grove | april 3rd | 29.44%

2013 | walnut | december 5th | 25.19% 2015 | pittsboro | may 5th | 29.44%

2013 | woodville | december 30th | 25.22% 2015 | brandon | june 3rd | 30.22%

2014 | bruce | january 1st | 25.28% 2015 | fayette | june 11th | 30.27%

2014 | friars point | january 8th | 25.32% 2015 | brooksville | july 2nd | 30.31%

2014 | itta bena | january 16th | 25.39% 2015 | state line | july 2nd | 30.33%

2014 | farmington | february 20th | 25.46% 2015 | pickens | july 2nd | 30.37%

2014 | louisville | april 3rd | 25.67% 2015 | eden | august 13th | 30.37%

2014 | mendenhall | april 4th | 25.76% 2015 | macon | september 17th | 30.46%

2014 | duck hill | april 9th | 25.79% 2015 | saltillo | september 18th | 30.62%

2014 | weir | april 10th | 25.81% 2015 | holly springs | october 1st | 30.88%

2014 | noxapater | may 1st | 25.82% 2015 | louise | october 1st | 30.88%

2014 | sledge | june 4th | 25.84% 2015 | lyon | october 2nd | 30.89%

2014 | coahoma | july 3rd | 25.85% 2015 | lexington | october 11th | 30.95%

2014 | picayune | july 17th | 26.21% 2015 | shaw | october 30th | 31.01%

2014 | southaven | august 4th | 27.94% 2015 | ellisville | november 5th | 31.16%

2014 | crawford | september 2nd | 27.96% 2015 | shubuta | december 2nd | 31.18%

2014 | beulah | september 4th | 27.98% 2016 | diamondhead | january 2nd | 31.45%

2014 | isola | september 4th | 28.00% 2016 | coldwater | march 3rd | 31.51%

2014 | clarksdale | september 10th | 28.57% 2016 | leakesville | march 3rd | 31.54%

2014 | poplarville | november 5th | 28.66% 2016 | cruger | april 6th | 31.55%

2014 | senatobia | november 20th | 28.93% 2016 | artesia | may 5th | 31.56%

2015 | iuka | january 1st | 29.03%

2015 | nettleton | february 5th | 29.09%

2015 | sidon | february 5th | 29.11%

2015 | charleston | march 7th | 29.18%

2015 | tutwiler | april 2nd | 29.30%

amended definition of smoking to created a new ordinance that original ordinance include e-cigarettes within original ordinance. prohibited e-cigarette use in places where included e-cigarettes. original ordinance prohibited smoking.

Source: June 2016 100% Smoke-Free Communities in Mississippi Factsheet | Mississippi Tobacco Data page forty-seven | Annual Report 2016 r e d u c i n g th e h e a lth a n d eco n o m i c bu r d e n o f to bacco { s m o k e - f r e e l a w s }

The Starkville & Hattiesburg Heart Attack Studies r e d u c t i o n s i n h e a r t a t t a c k a d m i s s i o n s f o l l o w i n g t h e implementation o f l o c a l s m o k e - f r e e o r d i n a n c e s

JanuarY 2012

• s t a r k v i l l e | 2 7 . 7 % r e d u c t i o n i n h e a r t a t t a c k

a d m i s s i o n s , c o s t s a v i n g s o f $ 2 8 8 , 2 7 0 .

• hattiesburg | 1 3 . 4 % r e d u c t i o n i n h e a r t a t t a c k

a d m i s s i o n s , c o s t s a v i n g s o f $2,367,909.

Starkville implemented a comprehensive smoke-free ordinance that prohibited smoking inside of all indoor public places on May 20, 2006. Seven months later, Hattiesburg implemented a similar comprehensive ordinance on January 1, 2007.

Findings from controlled observational studies demonstrate that hospital admissions for heart attacks in both Starkville and Hattiesburg decreased substantially following the implementation of the smoke-free ordinances. Moreover, the observed decrease in these communities was much higher than that observed in control communities that did not have a smoke-free ordinance.

robert mcmillen, phd | anna hill, mpp, mph | nell valentine, ms | robert collins, md

2 0 mississippi Source: January 2012 Starkville & TobaccoHattiesburg Heart Attack Data Studies Factsheet | Mississippi Tobacco Data 1 2 p. 41 TobaccoAnnual Report Report | MTD 2016 2016 | page forty-eight 2015 Mississippi Social Climate Survey of Tobacco Control s u p p o r t f o r s m o k e f r e e a i r | a p r i l 2 0 1 6

Results from the most recent Social Climate Survey demonstrate strong support for smoke-free air in Mississippi.

More than three-quarters of Mississippi adults (77.3%) favor a state law prohibiting smoking in most indoor places, including workplaces, public buildings, offices, restaurants, & bars.

Only 18.6% of Mississippi adults oppose a state law.

61.9% of smokers support a state law as opposed to 2015 only 32.3% who are opposed. Republicans (78.3%) and Democrats (80.0%) are ms equally supportive of a state law. Would you favor or oppose a law in Mississippi prohibiting smoking in scs most public places, including workplaces, offices, restaurants, and bars? -tc 4.1% ] ] 18.6% Favor a Smoke-Free Law

Oppose a Smoke-Free Law

77.3% Neither

Source:2016 2015 Mississippi • Socialmississippi Climate Survey of Tobacco tobacco Control Mississippi data Tobacco Data

page forty-nine | Annual Report 2016 a p a t h t o p r o t e c t e d june 2016

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As of June 21, 2016, 123 municipalities If every Mississippi municipality passed a The only way to protect all Mississippians in Mississippi have implemented comprehensive, comprehensive smoke-free ordinance, only is to pass a state-wide comprehensive smoke-free ordinances. These ordinances 55% of Mississippians would be protected. The smoke-free law. {protect 32% of Mississippi. {{ rest live in rural areas outside of municipalities. { { mstobaccodata.org designed by: miranda robertson Source: June 2016 100% Smoke-Free Communities in Mississippi Factsheet Mississippi Tobacco Data

Annual Report 2016 | page fifty surveillance & evaluation

The Office of Tobacco Control implements an annual surveillance and evaluation system, as recommended by the CDC’s Best Practices, to monitor and provide short- term, intermediate, and long-term intervention outcomes. The data is used to influence program and policy direction, ensure accountability, and demonstrate effectiveness.

Collecting baseline data related to each objective and performance indicator is critical to ensuring that program-related effects can be clearly measured. Surveillance and Evaluation services are provided by the Mississippi State University (MSU) Social Science Research Center (SSRC).

Surveillance efforts are designed to measure and detail progress toward goals using numerous primary and secondary data sources. These data sets include the:

Mississippi Youth Tobacco Survey Youth Risk Behavior Surveillance System Mississippi University Student Survey of Tobacco Control Mississippi Social Climate Survey of Tobacco Control Behavioral Risk Factor Surveillance System

The Tobacco Control Unit of the MSU SSRC administers the following surveys:

Mississippi Social Climate Survey of Tobacco Control Mississippi Youth Tobacco Survey Mississippi University Student Survey of Tobacco Control

In addition, this unit maintains a website that serves four primary functions:

Serves as a repository for reports, slides, and fact sheets generated by the evaluation and surveillance efforts, and provides supporting links and references for tobacco control data Serves as an interactive programmatic data collection mechanism for evaluation efforts Contains a data query module that allows visitors to generate interactive tables from primary data Contains several interactive charts that provide vivid illustration of the profound changes states have experienced after raising their state cigarette tax or passing statewide smoke-free laws.

The recent Surveillance and Evaluation Report, along with other state specific tobacco control surveillance and evaluation data, can be accessed at www.mstobaccodata.org.

page fifty-one | Annual Report 2016 appendix I (tobacco control advisory council)

The Mississippi Tobacco Control Advisory Council consists of 13 members who are appointed by state and university officials. The Mississippi Tobacco Control Advisory Council has maintained an active role in the development and implementation of the programs within the Office of Tobacco Control.

TOBACCO CONTROL ADVISORY COUNCIL

Name Location Affiliation/Appointment Berthold “Bert” Beisel, MD Columbia Governor Appointment

Dr. Dorthy C. Browne Jackson Jackson State University/School of Health Sciences/ College of Public Service “Bob” K. Collins, MD MS State University American Lung Association Appointment

Nancy Collins, Senator District 6 Lee, Pontotoc State Senate/ Lieutenant Governor

Diane C. Peranich, District 121 Harrison State House of Representatives/ Representative Speaker of the House Mike Moore, Attorney Flowood Attorney General Appointment

Christine Philley Jackson State Superintendent of Public Education Appointment Gena Vail New Albany MS Nurses Association/ Lt. Governor Appointment Jericho Bell Jackson University of Mississippi Medical Center Appointment Michael Forster, PhD Hattiesburg University of Southern MS Appointment

* Vacant council positions are being reviewed and reappointed.

Annual Report 2016 | page fifty-two appendix II (mississippi tobacco-free coalitions)

f i s c a l a g e n t c o u n t y / c o u n t i e s

A d a m s C o u n t y C o a l i t i o n f o r C h i l d r e n a n d Yo u t h Adams, Jefferson, and Franklin Aiming for Healthy Families A lcor n , Tippa h , P re nt iss, a nd Tishom i ngo American Lung Association, Southeast Chapter Hancock, Jackson, Pearl River, and Harrison Caffee Caffee & Associates Forrest, Jones, Perry, Covington, Smith, Lamar, and Marion Community Educational Support Systems of MS Wayne, Clarke, and Jasper Delta Health Alliance Coahoma, Tunica, Bolivar, Sunflower, Quitman, and Tallahatchie Montgomery Institute Noxubee, Kemper, and Neshoba Grenada County School District Grenada, Yalobusha, and Calhoun Innovative Behavioral Services Lauderdale, Newton, Hinds, Rankin, Scott, and Simpson Lawrence County School District Lawrence, Jefferson Davis, and Walthall Washington County Planning Department Washington, Sharkey, and Issaquena Mississippi Community Education Center Montgomery, Choctaw, Webster, Claiborne, Warren, Attala, Winston, and Leake Family Resource Center of Northeast MS Oktibbeha, Lowndes, Clay, Lee, Monroe, Chickasaw, and Itawamba National Council on Alcoholism and Drug Copiah and Lincoln Dependence Northeast Mississippi Healthcare Union, Benton, and Marshall New Beginning Ministries George, Green, and Stone North Delta Planning and Development District Panola, Lafayette, and Pontotoc Partnership for a Healthy Mississippi Madison, Yazoo, Holmes, Leflore, Carroll, Humphreys, Pike, Amite, and Wilkinson Olive Branch Family YMCA Desoto and Tate

page fifty-three | Annual Report 2016

Mississippi State Department of Health Tobacco Control