Focus Area 2: Reduce Illness, Disability and Death Related to Tobacco Use and Secondhand Smoke Exposure

Defining the Problem

Tobacco addiction is the leading preventable cause of morbidity and mortality in New York State (NYS) and in the United States.15 Cigarette use, alone, results in an estimated 440,000 deaths each year in the United States, and 25,000 deaths in NYS.16 There are estimated to be 570,000 New Yorkers afflicted with serious disease directly attributable to their smoking. The list of illnesses caused by tobacco use is long and contains many of the most common causes of death. These include many forms of cancer, including lung and oral; heart disease; stroke; chronic obstructive pulmonary disease and other lung diseases.17.

The economic costs of tobacco use in NYS are staggering. Smoking-attributable health care costs are $8.2 billion annually, including $3.3 billion in annual Medicaid expenditures. In addition, smoking-related illnesses result in $6 billion in lost productivity.18 Reducing tobacco use has the potential to save NYS taxpayers billions of dollars every year.

Although there have been substantial reductions in adult smoking in NYS, some tobacco use disparities have become more pronounced over the past decade. Smoking rates did not decline among low-socioeconomic status adults and adults with poor mental health.19

This plan proposes a comprehensive program of interventions built upon evidence-based strategies from the Centers for Disease Control and Prevention's Best Practices for Comprehensive Tobacco Control Programs20 and The Guide to Community Preventive Services.21 Interventions include media and counter-marketing, cessation and other activities to maximize the prevention and reduction of tobacco use among minors and adults. This plan envisions a tobacco-free society for all New Yorkers and interventions that work to eliminate morbidity and mortality caused by tobacco use.

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Goals, Objectives and Interventions

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Goal #2.1: Prevent initiation of tobacco use by New York youth and young adults, especially among low socioeconomic status (SES) populations.

Objective 2.1.1:
By December 31, 2017, decrease the prevalence of any tobacco use (cigarettes, cigars, smokeless tobacco) by high school age students by 30% from 21.2% (2010) to 15.0%. (Data source: NY Youth Tobacco Survey) (PA Tracking Indicator)
Objective 2.1.2:
By December 31, 2017, decrease the prevalence of cigarette smoking by adults ages 18-24 years by 17% from 21.6% (2011) to 18%. (Data source: NY BRFSS) (PA Tracking Indicator)
Objective 2.1.3:
By December 31, 2017, increase the number of municipalities that restrict tobacco marketing (including banning store displays, limiting the density of tobacco vendors and their proximity to schools) from zero (2011) to 10. (Data Source: Community Activity Tracking, CAT)

Interventions for Consideration

  1. Increase Tobacco Control Program funding to the CDC-recommended level, utilizing revenue from NYS tobacco excise tax to fund a comprehensive tobacco control program, as resources become available. (Best Practices for Comprehensive Tobacco Control Programs [Best Practices]; 2011 Independent Evaluation Report of the New York Tobacco Control Program)
  2. Use media and health communications to highlight the dangers of tobacco, promote effective tobacco control policies and reshape social norms. (CDC Winnable Battles [CDC WB]; Guide to Community Preventive Services [Community Guide]; The Role of the Media in Promoting and Reducing Tobacco Use)
  3. Pursue policy action to reduce the impact of tobacco marketing in lower-income and racial/ethnic minority communities. (Healthy People 2020 [HP2020]; CDC WB)
  4. Keep the price of tobacco uniformly high by regulating tobacco company practices that reduce the real price of cigarettes through discounts. (HP 2020)
  5. Increase community interventions, especially in disadvantaged urban neighborhoods and rural areas. (Best Practices)

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Goal #2.2: Promote tobacco use cessation, especially among low SES populations and those with poor mental health.

(Also, see: Focus Area – Prevent Substance Abuse and Other Mental, Emotional and Behavioral Disorders)

Objective 2.2.1:
By December 31, 2017, increase the number of unique callers to the NYS Smokers' Quitline by 22% from 163,428 (2011) to 200,000 annually. (Data source: NYS Smokers' Quitline Annual Report)
Objective 2.2.2:
By December 31, 2017, decrease the prevalence of cigarette smoking by adults ages 18 years and older:
  • By 17% from 18.1% to 15.0% among all adults. (Data Source: NYS BRFSS) (PA Tracking Indicator)
  • By 28% from 27.8% (2011) to 20.0% among adults with income less than $25,000. (Data Source: NYS BRFSS) (PA Tracking Indicator; Health Disparities Indicator)
  • By 17% from 29% (2011) to 24% among adults who report poor mental health.
    (Data source: NY Adult Tobacco Survey) (PA Tracking Indicator; Health Disparities Indicator)
Objective 2.2.3:
By December 31, 2017, increase the utilization of smoking cessation benefits among smokers who are enrolled in Medicaid Managed Care by 141% from 17% (2011) to 41%
(Data source: Medicaid) (PA Tracking Indicator; Health Disparities Indicator

Interventions for Consideration

  1. Use health communication to increase the impact and utilization of the NYS Smoker's Quitline, particularly among disparate populations. (Best Practices)
  2. Help health care organizations and providers establish policies, procedures and practices to facilitate the delivery of tobacco dependence treatment, consistent with the Public Health Service Clinical Practice Guidelines, with a focus on Federally Qualified Health Centers and behavioral health providers. (HP 2020; CDC WB; Community Guide; Treating Tobacco Use and Dependence; Treating Tobacco Use and Dependence: 2008 Update)
  3. Advocate for expanded Medicaid and other health plan coverage of tobacco dependence treatment counseling and medications. (HP 2020)
  4. Promote smoking cessation benefits among Medicaid beneficiaries and providers. (HP 2020; CDC WB)

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Goal #2.3: Eliminate exposure to secondhand smoke.

Objective 2.3.1:
By December 31, 2017, decrease the percentage of adults who report being exposed to secondhand smoke during the past seven days by 28% from 27.8% (2009) to 20%. (Data source: NY Adult Tobacco Survey)
Objective 2.3.2:
By December 31, 2017, increase the number of local housing authorities that adopt a tobacco-free policy for all housing units from 3 (2012) to 12. (Data source: Community Activity Tracking, CAT)

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Interventions for Consideration

  1. Promote smoke-free policies in multi-unit housing, including apartment complexes, condominiums and co-ops, especially those that house low-SES residents. (HP 2020; CDC WB; Community Guide
  2. Increase the number of smoke-free parks, beaches, playgrounds, college and hospital campuses, and other public spaces. (HP 2020; CDC WB; Community Guide)
  3. Advocate with organizational decision makers, conduct community education, and use paid and earned media to increase community knowledge of the dangers of secondhand smoke exposure. (HP 2020; CDC WB)

Interventions by Level of Health Impact Pyramid

Focus Area 2: Reduce illness, disability and death related to tobacco use and secondhand smoke exposure
Levels of Health Impact Pyramid*Interventions
Counseling and Education
  • Use media and health communications to highlight the dangers of tobacco and motivate tobacco users to quit.
  • Ensure media communications target those with highest tobacco use.22
  • Provide cessation counseling and education through the NYS Smokers' Quitline.
Clinical Interventions
  • Deliver tobacco dependence treatment, with a focus on federally qualified health centers and behavioral health.
  • Promote cessation benefits to Medicaid beneficiaries and providers.
  • Expand health plan coverage of tobacco treatment counseling and medications.
Long-Lasting Protective Interventions
  • Increase Tobacco Control Program funding to the CDC-recommended level as resources become available.
  • Conduct community interventions, with a focus in disparate areas.
  • Strengthen media to increase impact and utilization of the NYS Smokers' Quitline.
  • Advocate with organizational decision makers, conduct community education, and use paid and earned media to increase community knowledge of the dangers of exposure to secondhand smoke.
Changing the Context to Make Individuals' Decisions Healthy
  • Use media and health communications to promote effective tobacco control policies and reshape social norms.
  • Keep the price of tobacco uniformly high by regulating tobacco company practices that reduce the real price of cigarettes through discounts.
  • Promote smoke-free multi-unit housing policies.
  • Increase smoke-free outdoor spaces.
Socioeconomic Factors
  • Develop and implement community-led, place-based interventions targeted to address the social determinants of health in identified high-priority vulnerable communities.

* Frieden T., "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595

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Interventions and Activities by Sector

Changes can be made across all sectors to reduce illness, disability and death related to tobacco use and secondhand smoke exposure. Below are examples of how your sector can make a difference.

Healthcare Delivery System

  • Adopt tobacco-free outdoor policies.
  • Implement the US Public Health Services Guidelines for Treating Tobacco Use.
  • Use electronic medical records to prompt providers to complete 5 A's (Ask, Assess, Advise, Assist, and Arrange).
  • Facilitate referrals to the NYS Smokers' Quitline.
  • Increase Medicaid and other health plan coverage of tobacco dependence treatment counseling and medications.
  • Promote smoking cessation benefits among Medicaid providers.
  • Create universal, consistent health insurance benefits for prescription and over-the-counter cessation medications.
  • Promote cessation counseling to people with disabilities.

Employers, Businesses, and Unions

  • Support and adopt tobacco-free outdoor policies.
  • Educate community leaders and policymakers on the problems of youth smoking.
  • Educate community leaders and policymakers on the impact of tobacco marketing on youth smoking.
  • Offer health plan coverage of tobacco dependence treatment, counseling and medications.
  • Promote NYS Smokers' Quitline.

Media

  • Highlight dangers of tobacco through public service announcements.
  • Promote effective tobacco control policies through media.
  • Use earned media to promote education on youth smoking and the impact of tobacco marketing.
  • Eliminate onscreen use of tobacco products.
  • Adopt tobacco-free policies.

Academia

  • Conduct research to support evidence-based approaches.
  • Help identify emerging best practices.
  • Evaluate Tobacco Control Program initiatives.

Community-Based Health and Human Service Agencies

  • Implement tobacco-free outdoor policies.
  • Conduct public education activities to create an environment for policy change.
  • Promote smoking cessation benefits among Medicaid beneficiaries.
  • Conduct community interventions, with a focus in disparate areas.
  • Promote NYS Smokers' Quitline.
  • Promote tobacco dependence treatment through partnerships with independent living centers.

Other Government Agencies

  • Promote smoking cessation benefits among Medicaid beneficiaries.
  • Promote smoking cessation among people with mental health disabilities through partnerships with the NYS Office of Mental Health.
  • Adopt tobacco-free outdoor policies.
  • Promote NYS Smokers' Quitline.

Governmental (G) and Non-Governmental (NG) Public Health

  • Promote smoking cessation benefits among Medicaid beneficiaries. (G) (NG)
  • Promote NYS Smokers' Quitline. (G) (NG)
  • Adopt tobacco-free outdoor policies. (G)
  • Educate policymakers about the problem of youth smoking. (G)
  • Educate policymakers about the impact of tobacco marketing on youth smoking. (G)
  • Advocate policies that reduce the impact of tobacco marketing. (NG)

Policymakers and Elected Officials

  • Increase Tobacco Control Program funding to the CDC-recommended level as resources become available.
  • Pursue policy action to reduce the impact of tobacco marketing.
  • Pursue policy action to increase tobacco-free outdoor spaces.
  • Keep price of tobacco uniformly high.
  • Expand Medicaid coverage of medications and type of provider eligible for reimbursement for tobacco dependence treatment.

Communities

  • Mobilize advocates to create a demand for tobacco-free policies.
  • Mobilize advocates to support increased funding.
  • Increase awareness of the problem of youth smoking.
  • Increase awareness of the impact of tobacco marketing on youth smoking.

Philanthropy

  • Strengthen evidence-based tobacco use prevention, cessation and media initiatives.
  • Promote media campaigns with hard-hitting cessation messages.
  • Promote NYS Smokers' Quitline.

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