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Tobacco, Substance Abuse and Sexually Transmitted Diseases

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Tobacco, Substance Abuse and Sexually Transmitted Diseases Chapter 7: Preventable Risks to Health – Tobacco, Substance Abuse and Sexually Transmitted Diseases Scanning electronic micrograph of HIV-1 budding from cultured lymphocytes. Source: CDC Public Health Image Library, C. Goldsmith, P. Feorino, E. Palmer, W. McManus Tobacco obacco is the number one preventable cause of death in the United State and kills more than 443,000 people each year.1 With more than 7,000 toxic chemicals found in a cigarette, it is irrefutable that tobacco use will damage the body, compromise the immune T 2 system and cause premature death. Ninety percent (90%) of all lung cancer deaths are caused by smoking.3 Lung cancer, ischemic heart disease, chronic obstructive pulmonary disease, and strokes are the leading causes of death due to cigarette smoking In the United States (Figure 7.1). In New Hampshire in 2007, the data continues to be dismal with 1,764 premature deaths from smoking-related illnesses and an additional 200 deaths from second-hand smoke.4 Figure 7.1 U.S. Deaths and Smoking An individual does not have to smoke to be negatively affected by it. Involuntary exposure to secondhand smoke can cause disease and death.5 Secondhand smoke is the sidestream smoke from the end of a cigarette and the smoke in the air that is exhaled from someone smoking.6 Approximately, 46,000 premature deaths from heart disease in non-smokers are caused by secondhand smoke and 3,400 lung cancer deaths a year are attributed to secondhand smoke.7 There is no amount of secondhand smoke exposure that is risk-free. Other types of tobacco products that are most commonly used in the United States are snuff and chewing tobacco.8 Smokeless tobacco is comprised of over 28 carcinogens and can cause Nashua Community Health Assessment Page 7 - 2 oral, esophageal, and pancreatic cancers.9 In the United States, 3.5% of adults (18 years and older) and 6.1% of high school students use smokeless tobacco.10 The economic costs of tobacco in the United States are devastating. From years 2002 to 2004, it was reported that $96 billion were direct medical costs of smoking and $97 billion was associated with lost productivity.11 In New Hampshire, $1.4 billion in direct medical costs are attributed to smoking annually.5 The cost and tax on tobacco products have a direct relationship on sales. Nationally, the average cost of cigarettes is $5.33 a pack and the tax is approximately $2.19.4 However, in New Hampshire the average retail price is $4.19 and tax is approximately $1.08.4 Smoking Cessation Each year, thousands of people attempt to quit tobacco and try several different strategies. In the United States, nearly 17 million people try to quit smoking every year. However, only 1.3 million of these smokers are successful.12 According to the Behavioral Risk Factor Surveillance System (BRFSS), 52.9% (CI54.3-61.7%) of New Hampshire adult regular smokers have quit for one or more days in the past twelve months. Also, nearly 58.7% of all NH smokers are seriously considering quitting in the next six months. Of the smokers that have seen a medical provider in the last 12 months, 40.1% (CI33.9-46.3%) received a recommendation to begin nicotine replacement therapies, 31.7% (CI25.9-37.6%) identified a specific quit date, 25.4% (CI 19.9-30.9%) were provided with educational materials and 20.1% (CI 15.1-25.3%) received a recommendation to take a smoking cessation class, seek counseling or call a quitline.4 According to the Centers for Disease Control and Prevention (CDC), 2.1% of New Hampshire residents called the quit line in the past year compared to the national average of 2.8% . Figure 7.2 Percentage of NH Smokers Calling the Quitline Source: CDC Adults and Tobacco In 2009, the CDC reported that 20.6% of U.S. adults over the age of 18 are current smokers, 23.5% are males and 17.9% are females. Smoking continues to be a public health concern as the decline of cigarette smoking has stalled over the past five years.4 Nashua Community Health Assessment Page 7 - 3 In New Hampshire, the number of adult smokers has slowly declined from 25.3% in year 2000 to 18.7% in 2006. However, in 2007 the number of current NH smokers increased slightly to 19.3%.4 According to Healthy People 2020, the goal over the next 10 years is to reduce illness, disability, and death related to tobacco use and secondhand smoke exposure. The national objective is to reduce cigarette smoking rates for adults 18 years and older from 20.6% to 12%. Although Nashua is better than the national average at 17% of adults smoking, Nashua does not meet the Healthy People 2020 target of 12%. In Nashua, 43.9% (CI 38.8-49%) of adults have smoked in their lifetime and 17% (CI 12.1-22%) are current smokers (Figure 7.3). Similarly, the 2010 Nashua Community Health Survey (2010 NCHS) states that during the past 30 days, 17% of residents said they smoked cigarettes on one or more days. In addition, survey results showed that if a family member or friend does smoke and wants to quit, 58% would tell them to speak to a doctor, 11% would reference the NH Quitline, 6% would tell them to seek a private counselor or therapist and 25% would tell them to see help from other agencies or medical providers (Figure 7.4).15 Figure 7.3 Current Smoker and Ever Smoker, 2008 & 2009 50% 40% 30% Percent 20% 10% 0% Current Smoker Ever Smoker Nashua NH w/out Nashua Source: NH DHHS, BRFSS For more information on smoking cessation, call the state quitline at 1- 800-TRY TO STOP (1-800-879-8678) or visit http://www.trytostopnh.org. Nashua Community Health Assessment Page 7 - 4 Figure 7.4 Sources of Assistance for Quitting Smoking If a friend or family member wanted to quit, where would you tell them to go to get help? 75% 60% 45% 30% 15% 0% Private NH Quitline Other Doctor Counselor/ Therapist Source: 2010 Nashua Community Health Survey Source: Shauna Vautier, Nashua High School Photography Project Nashua Community Health Assessment Page 7 - 5 Youth and Tobacco Tobacco use is often initiated during the middle and high school years with approximately 80% of adult smokers starting before the age of 18. Each day in the United States, 3,450 youth between the ages of 12 and 17 smoke their first cigarette. Among these young adults, nearly 850 sustain the habit and become regular smokers each day. Other health risks that are associated with high school age smoking are drug use, alcohol use and risky sexual behavior.13 In the State of New Hampshire, the 2009 Youth Risk Behavioral System (YRBS) was completed by 1,493 students in 53 public high schools. In the survey, students were asked about tobacco use and highlights of this data include (not Nashua specific): • 20.8% have smoked cigarettes on one or more of the past 30 days, • 8.4% have used chewing tobacco, snuff, or dip on one or more of the past 30 days, 13.8% were males and 2.6% were females, • 4.2% think they are at no risk to harming themselves if they smoke 1 or more packs of cigarettes a day, • 66.4% think it’s very wrong or wrong for someone their age to smoke cigarettes.16 According to the 2004 Pregnancy Risk Assessment and Monitoring System conducted by the CDC, 13% of U.S. women smoked cigarettes throughout the last three months of their pregnancy. Of these smokers, 52% said they smoked 5 or less cigarettes a day, 27% smoked six to ten cigarettes and 21% smoked 11 or more cigarettes a day.14 For more information on smoking and maternal health go to Chapter 3. "Cigarette smoking is clearly identified as the chief, preventable cause of death in our society." - C. Everett Koop, former Surgeon General For more information on Tobacco Prevention and Control for the Greater Nashua Region, visit www.nashuanh.gov and go to the Nashua Division of Public Health and Community Services page. Nashua Community Health Assessment Page 7 - 6 Substance Abuse n the United States, alcohol and illicit drug abuse continue to have a negative impact on the health and public safety of communities and the nation. Medical issues such as drug I overdoses, Hepatitis C and HIV infections can be directly linked to the use of illicit drugs such as heroin, cocaine, methamphetamine and non-prescribed pain relief medications. In regard to alcohol abuse, health issues have a significant impact on the public’s health and safety. Liver disease, injuries and deaths caused by drunk driving, as well as other types of accidents and violence also contribute to the high financial and emotional costs of abusing these substances. A 2004 report from the Office of National Drug Control Policy estimated that the overall cost of substance abuse, including loss of productivity and health and crime related costs exceeded $600 billion annually in the United States. These numbers included approximately $181 billion for illicit drug abuse and $235 billion for alcohol abuse.18 Illicit Drug Abuse According to the 2009 Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health (NSDUH), 21.6 million persons aged 12 years or older in the United States admitted to having used an illicit substance over the past month. This number represented 8.7% of the population, and indicates a rise in illicit drug use over the previous year where 15.2 million persons (6.1% of the population) reported using an illicit substance.
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