ISSUE 3 TobaccoTimes Spring 2013 DPH Use Prevention and Control Program

In this issue

Tobacco Use in the Military p.1

Point of Sale Impact p.2

DMHAS Tobacco Enforcement Program p.3 Tips from Former Smokers II Protecting Pets p.4

CDC is building on the success of the Tips cam- paign by launching a new Tobacco Use in Uniform Many service members did not use tobacco until round of advertisements. they entered the service. Over one third of cur- The new campaign fea- Tobacco use has a detrimental effect on our mili- rent smokers in the military stated they started to smoke after joining. A DoD survey shows tures additional health tary. Tobacco affects military readiness and the health of their personnel and families, and places a some of the reasons why service members stat- conditions including huge burden on the Department of Defense (DoD) ed they began : are available chronic obstructive pul- and the Veteran’s Administration (VA) health care at many places on installations and that makes monary disease [COPD], system. The DoD spends an average of $1.6 billion it easy to smoke, most of their friends smoke, to asthma in adults, smoking dollars per year due to tobacco-related medical ex- relax, and to relieve stress and boredom. -related complications in penses. a person with diabetes Tobacco use has detrimental effects on military and population groups There has been a long history of tobacco use in the personnel. Tobacco use reduces a service including American Indi- military. Although smoking occurred in previous member’s physical fitness and endurance. Ser- an/Alaska Native and Les- wars, tobacco companies really began targeting vice members who use tobacco have higher bian, Gay, Bisexual, and servicemen during World War I, stating that smok- absenteeism rates, lower productivity, drop out of basic training, are more likely to sustain inju- Transgender that were ing was a way to deal with the situations occurring around them and to boost morale. Cigarettes were ries and have poorer vision then non-tobacco not included in the first included in the rations given to servicemen in 1918 users, all of which compromise troop readiness. Tips campaign. The cam- and remained a part of the rations until 1975. paign also includes an ad TRICARE (the health care system for military focused on the effects of Tobacco use among active duty U.S. service per- personnel and their families) now covers cessa- secondhand smoke expo- sonnel is at a much higher rate than the general tion services. These services include group and sure as well as an emo- public. The smoking rate for active duty personnel individual counseling, cessation medications tional cessation ad. is 30.6% versus 20.6% for the general public. The and access to print and online cessation materi-

rate of use for smokeless tobacco is 13.6%. The als without a co-pay. TRICARE will cover two smoking rate for veterans is lower at 19.7%, alt- quit attempts per year with the option of a 3rd hough 70% of veterans reported using tobacco at attempt with pre-authorization. some time in their life. Smoking rates among de- For more information, go to TRICARE or TRI- ployed service members is the highest at more than CARE’s web-based cessation program: Quit 50%. Tobacco, Make Everyone Proud. The website Tobacco use is correlated with pay grade and rank. program includes online tools, personalized quit Smoking is highest among enlisted members with plans and live chat services. Services are avail- lower pay grades and rates are lowest among offic- able for both active military and veterans. ers. Tobacco use can cost as much as 10% of an

enlisted member’s salary.

The Impact of Point of Sale Ads

With the Master Settlement er the youth prevalence rate. Agreement, the Tobacco Indus- Schools that do not have any try was left with fewer venues to retailers within walking distance advertise and promote their had an average 11.9% youth products. The Family Smoking prevalence rate. Schools with Prevention and Tobacco Con- one to five retailers within walking trol Act further restricts adver- distance had a 13.6% prevalence tising and placement of prod- rate. And, schools that had five ucts. However, Point of Sale or more retailers within walking (POS) advertising is still a very distance of the school had a large and powerful form of ad- prevalence rate of 15.1%. vertising for the Tobacco In- POS advertising is big dustry. Tobacco POS advertising also increases craving among smok- business for the tobacco Point-of-sale tobacco ers and lowers the companies and a powerful Exposure to POS -World Health Organization advertising consists likelihood of success- tool. It promotes initiation, tobacco advertising, of the displaying and ful quit attempts. promotes daily consump- including product advertising of tobac- tion and discourages quit- displays, influences co products inside, Tobacco displays cue ting. youth smoking, outside, and on the cravings in current increases impulse For more information on property of retail users. Studies have tobacco purchases the effects of advertising, sales outlets, includ- found that pictures of and undermines to conduct a store audit or ing advertising on cigarettes increase the quitting attempts. to discuss tobacco adver- functional items such craving for tising with store owners go as counter mats and among nicotine- to CounterTobacco.org change cups. deprived smokers (those who have not smoked recently) and (information and data from “Retail Tobacco Companies spend non-nicotine deprived smokers. Landscape for Tobacco Products” Trend to Watch $1M per hour at POS to market, Smokers also notice the display, presentation, CDC Office on Smoking advertise and promote ciga- which prompts an impulse buy and Health Surveillance and Evalua- Although the number of rettes and smokeless tobacco. even if they are trying to quit. cigarettes consumed in Many products are placed at the United States has For every 1 person who eye level and near products that Studies have also found the clos- declined, there has been dies from tobacco use, an- youth are interested in purchas- er someone who is trying to quit an increase in use of oth- other 20 suffer from one or ing. Studies have found an as- lives to a tobacco retailer, the er tobacco products. sociation between the exposure lower the odds of their success in more serious illness. These include chewing to POS tobacco promotion and quitting. tobacco, moist snuff, e- smoking initiation. cigarettes, cigars, and CT QUITLINE SUCCESS AT 7- little cigars/. Exposure to advertising MONTH FOLLOW-UP increases the likelihood that youth The CDC's Morbidity and  83% of respondents had made at least will start to smoke. Mortality 2012 Weekly one serious quit attempt since Report indicates that The more promotions there are enrollment. from 2000 to 2011 ciga- in stores, such as sales, the  27% had been quit for 30 days or more. rette consumption de- more likely that youth already creased by 32.8%, how- occasionally smoking will in-  34% had been quit for 7 days or more. ever, consumption of oth- crease their consumption level.  Of those with a reported history of mental health condi- er tobacco products in- tions, 26% had been quit for 30 days or more. creased by 123.1% dur- Studies have found that the ing the same period. higher the density of tobacco  96% reported being satisfied or very satisfied with Quit- retailers near schools, the high- line services.

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Around Spotlight on…. the DMHAS Tobacco Prevention and World

Enforcement Program Alabama - The Universi- Virtually all new users of to- among individuals under the violation ty of Alabama Medical bacco products are under age of 18 by requiring states to within an Center, Alabama’s larg- 18, the minimum legal age to enact and enforce laws prohib- 18-month est employer, an- purchase tobacco products iting any manufacturer, retailer, period. nounced that all new in Connecticut. Efforts to or distributor from selling or Under the TPEP Police Partner- hires will have to be to- prevent tobacco use among distributing tobacco products to ship Program, Synar Investigators bacco free. full article minors across the state are individuals under the age of 18. conduct unannounced inspections implemented by the Depart- The ultimate goal of the in collaboration with municipal and ment of Mental Health & Ad- amendment is to reduce the state law enforcement to ensure North Dakota — Voters diction Services (DMHAS) number of tobacco outlets sell- that criminal aspects of the law are approved a ballot meas- enforced. A criminal violation of Tobacco Prevention and En- ing to minors to no more than ure to prohibit smoking the law results in a fine imposed by forcement Program (TPEP). 20 percent. in bars, restaurants, and a judge of not more than $200 for The CT Synar Tobacco other workplaces includ- Connecticut has enacted, and the 1st offense and up to $500 for Compliance Program, CT ing motels, private nurs- continues to enforce, laws that any subsequent offenses within an FDA Tobacco Compliance ing homes, cabs, and Inspection Program, and the prohibit the sale and distribu- 18-month period. public transportation. full CT Tobacco Merchant and tion of tobacco products to indi- The Synar Amendment further re- article Community Education Initia- viduals under 18 years of age. quires that states conduct unan- tive all function under the The Department of Revenue Services (DRS) is the enforce- nounced inspections of a random umbrella of TPEP. Vermont – A new law ment and licensing agency of sample of tobacco vendors each prohibits the sale of elec- CT Synar Tobacco tobacco products. Throughout year to assess the annual retailer tronic cigarettes to per- Compliance Program: the year, Synar Investigators violation rate and submit a report sons under the age of conduct unannounced retailer to the federal Secretary of Health 18, strengthens re- In July 1992, Congress en- inspections to ensure ongoing and Human Services. Connecti- strictions on the display acted the Synar Amendment compliance with State laws. cut’s retailer violation rate has of e-cigarettes, and re- as part of the Alcohol and DMHAS then forwards retailer dropped from 70% in 1997 to quires that some little Drug Abuse and Mental violation inspection data to 12.1% in 2012. cigars be sold in packag- Health Administration Reor- DRS for administrative action. ganization Act (P.L.103- DRS civil penalties range from CT FDA Tobacco Compliance es of 20 or more. full arti- 321). The Synar Amend- $300 for the 1st violation, and Inspection Program: cle ment is aimed at decreasing up to $750 and suspension of In June 2009, President Barack access to tobacco products the dealer’s license for a 3rd continued on pg.5 Brazil — Brazil’s smok- ing rate dropped by half Quick Facts & Stats due to the implementa- Mental Illness and Smoking smoke live below the poverty line. tion of several strong policies.  In CT, 17.8% of adults have been diag-  In the U.S., 1 in 3 adults full article with mental illness smoke nosed with a mental illness.

cigarettes.  In CT, 35% of adults with men- Indonesia – Regulations tal illness smoke cigarettes.  Smoking among U.S. have been issued that adults with mental illness is  Adults with mental illness will require cigarette 70% higher than adults with smoke more cigarettes compared packs to have graphic no mental illness. photographic warnings. to adults without mental illness full article  48% of adults with mental illness who

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sclerosis (hardening arter- Protecting Our ies) from exposure. Guinea pigs, hamsters, mice and oth- Pets er rodents can suffer from Secondhand and thirdhand wheezing, coughing, fatty smoke is just as dangerous to liver disease, and heart dis- animals as it is to humans. ease. Exposure to How to Protect Your Pet symptoms, diarrhea, vomiting, 1-855-DEJELO YA has been associated with cer-  Don’t allow smoking or use cardiac abnormalities, cancer, (1-855-335-3569) tain cancers in dogs and cats; of tobacco products in lymphoma, and death. allergies in dogs; and eye and your home. The CT Quitline now has skin disease and respiratory Cats that are diagnosed with lym- a dedicated telephone  If someone is smoking ask problems in birds. phoma, even with aggressive number for cessation that they smoke outside at Animals lick and groom them- chemotherapy, rarely survive services in Spanish. least 50 feet from any selves often, causing the parti- more than six months. door, window or vent. cles in thirdhand smoke to be Dogs are susceptible to nasal ingested. Secondhand and cancers especially long-nosed  When not at home, do not thirdhand smoke is absorbed in because they have a greater sur- allow anyone to smoke around your pet. the mucous membranes of the face area in their nose which al- mouth and nose of pets causing lows carcinogens to build up.  Look for pet sitters, pet illness and disease. Dogs who are diagnosed with na- daycares and kennels with Pets are also in danger by sal cancer usually do not survive smoke free policies inside drinking water that thirdhand more than one year after diagno- and outside of the building. smoke has settled into, drinking sis.  Keep tobacco and nicotine water that contains cigarette or Some of the health effects of to- products away and out of cigar butts and by eating tobac- bacco smoke exposure seen in reach of curious pets. co products and butts. Eating birds are , respiratory A new free nationwide one to five cigarettes or 1/3 to illnesses, pneumonia, eye and  Don’t leave butts where Asian-language quit one cigar can kill your pet. skin diseases, and heart disease. pets can find them. smoking service. Speak Health effects in pets include,  If you use tobacco, try to with a bi-lingual/ bi- Rabbits are susceptible to athero- breathing problems, asthma quit. 1-800-QUIT-NOW. cultural counselor and receive culturally-tailored cessation resources and Companies Ordered to Tell the Truth help with quitting. In November nies must use in an advertising smoking and secondhand 2012, US Dis- campaign that was discussed smoke, the addictive nature of Chinese (Cantonese trict Court Judge Gladys Kessler in the 2006 ruling. nicotine, the lack of health ben- and Mandarin) : ordered tobacco companies to efits from ‘light’ and ‘low-tar’ 1-800-838-8917 publicly advertise that they have The campaign will be two years cigarettes, and the companies’ Korean: 1-800-556-5564 been purposely deceiving the long and advertisements will be manipulation of cigarette de- American public about their prod- placed in newspapers, on tele- sign and composition to ensure Vietnamese: ucts. In 2006, Judge Kessler vision, on company websites, peak nicotine delivery. Each 1-800-778-8440 found the tobacco companies on cigarette packaging and in corrective statement must in-

guilty of violating civil racketeer- other media venues that the clude the words “a Federal Hours of operation are ing laws and defrauding the tobacco companies have used court has ruled that the De- Monday through Friday from 6 am to 6pm Eastern American public. This latest rul- in the past to advertise their fendant tobacco companies Standard Time. ing details the corrective state- products. The companies must deliberately deceived the ments that the tobacco compa- make corrective statements American public”. about the dangerous effects of

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DMHAS Tobacco Preven- month period to $10,000 for six tion and Enforcement violations within a 48 month pe- tasks include proposing new riod. campaign materials and de- Program, Continued >> signs, guiding the campaign CT Tobacco Merchant and dissemination process, re- Tobacco Times is a Obama signed the Family Smok- Community Education Initia- cruiting youth and tobacco publication of the ing Prevention and Tobacco Con- tive: Connecticut merchants for focus groups, trol Act (Tobacco Control Act) in guiding the development of Department of Public Wheeler Clinic’s Connecticut Health to law. The law provides the au- merchant education trainings, Clearinghouse is the DMHAS thority to the Food and Drug Ad- and recommending other administrator for this initiative. Jewel Mullen, MD, MPH, ministration (FDA) to regulate the helpful strategies to reduce The Connecticut Clearinghouse MPA Commissioner manufacture, distribution, and sales of tobacco products to established the Tobacco Mer- marketing of tobacco products in minors. Renee Coleman -M i t c h el l , order to protect public health na- chant & Community Education MPH Section Chief tionwide. Steering Committee to imple- To participate in the Tobacco ment the activities of the Initia- Merchant & Community Edu- Mehul Dalal, MD, MSc, In July 2011, DMHAS entered tive. The overall goal of the cation Steering Committee MHS Chronic Disease Direc- Steering Committee is to guide contact Aisha Hamid at Con- tor into a partnership agreement with the FDA to enforce the Tobacco and inform the campaign pro- necticut Clearinghouse Contact Us Control Act in CT. The goal is to cess resulting in the most effec- [email protected]. prevent access to tobacco by per- tive campaign materials and Tobacco Use Prevention For more information about sons under the age of 18 and to activities, leading to reductions and Control Program the DMHAS Tobacco Preven- ensure compliance with the ad- in sales of tobacco products to 410 Capitol Avenue, tion & Enforcement Program vertising and labeling regulations youth under 18 throughout the please contact Supervising MS #11 HLS outlined in the Act. state. Hartford, CT 06134-0308 Special Investigator Gregory The Steering Committee is driv- 860-509-8251 Every tobacco retailer in the state Carver at 860-418-6702 or en by a diverse of group of rep- [email protected] will be inspected to verify compli- visit the TPEP website at resentatives from State agen- www.ct.gov/dmhas/tpep. www.ct.gov/dph/tobacco ance with the Tobacco Control cies, community health agen- Act. Should a retailer fail to com- cies, tobacco merchants, pre- Sound Bite ply, the FDA and Connecticut will Program Staff vention professionals, police work together to pursue civil mon- Smoking results in a death agencies, youth and the con- every 6.5 seconds. Sadie Branch ey penalties ranging from $250 Office Assistant venience story industry. Their for two violations within a 12 Ann Kloter Return on Investment Epidemiologist 2 The week of April 1, 2013 was National Public Health Week. In honor of their theme “Public Health is Errol Roberts ROI: Save Lives, Save Money”, here is the Return on Investment for comprehensive tobacco use pre- Health Program Assistant 2 vention and control: Katie Shuttleworth  For every 1,000 youth that are kept from initiating smoking– future health care costs decline by Health Program Associate approximately $16 million dollars. Dawn Sorosiak  For every 1,000 adults who are prompted to quit– future health care costs Epidemiologist 3 decline by approximately $8.5 million. Marian Storch  By following the CDC Best Practice funding guidelines– states can save Health Program Associate 14-20 times the cost of the program implementation in reduced medical Barbara Walsh and productivity costs as well as reduced Medicaid costs. Program Supervisor Source: Campaign for Tobacco Free Kids To submit articles, announcements and events contact Katie Shuttleworth at [email protected] or 860-509-8251 5 DPH is an equal opportunity provider.