This document provides information about tobacco prevention and control efforts in West Virginia. It begins with an agenda for a tobacco prevention conference, and then provides data on tobacco use rates in WV, how tobacco use affects health and costs the state billions. It discusses how the tobacco industry targets vulnerable groups and spends heavily on marketing. It argues for increased tobacco taxes and prevention funding to improve public health.

1. 9
Thursday, November 16, 2012
Tobacco Prevention and Opening Remarks
9:05 am – 9:30 am
Control Remains Important Presented by
Bruce W. Adkins, Director
in West Virginia: Division of Tobacco Prevention,
WV Bureau for Public Health
Let’s NOT forget about SPIT!!!
West Virginia Smokeless
Tobacco Conference
November 29th, 2012
Stonewall Resort
in Roanoke, West Virginia

2. © 2005 WV DHHR/DTP

3. Full Moon Over
Yeager Airport,
Charleston, WV
11-28-12
Photo by
Charleston Gazette
Photographer
Tim Hindman

6. Tobacco Use Affects
EVERYONE’S Game…
© 2009 WV DHHR/DTP

7. © 2009 WV DHHR/DTP
Tobacco use is the single most preventable cause of
death in the United States, causing heart and lung
diseases, cancers, and strokes.

8. Secondhand Tobacco
Smoke is not Safe at
ANY Exposure Level!
This is especially true
for infants and young
children who are more
adversely affected by
Secondhand Smoke.
© 2012 WV DHHR/DTP
© 2012 WV DHHR/DTP

9. © 2009 WV DHHR/DTP
Nicotine is as addictive as heroin and cocaine.
Young people who use tobacco are more likely to use
alcohol and other drugs.

10. Tobacco
Hurts Your
Heart
• A tobacco users
heart rate is a few
beats faster per
minute than a
non-users heart
© 2009 WV DHHR/DTP
beat.

11. Tobacco Use Hurts Endurance

12. Tobacco Use Is Against The Rules!
© 2009 WV DHHR/DTP

13. Spit Tobacco is not a
Safe Alternative!
Use of smokeless
tobacco causes
increased illness, tooth
decay, gum
disease, and pre-
cancerous lesions in the
mouth.
© 2009 WV DHHR/DTP

14. The Tobacco
Industry
Isn’t Going
Anywhere…

15. Never Trust the Industry
They’re Big and Strong and
ALWAYS Lurking Out There
Somewhere!

16. Data tells us…
• The 2012 WV adult smoking
rate is 23.9 percent.
(from 2012 WV Adult Tobacco Survey or WVATS)
• Males = 25.6 percent
• Females = 23.1 percent
• 434,000 WV residents

17. Data tells us…
• The 2010 WV adult smoking rate
for those impoverished* is 40.9%.
*Low SES = Annual household income < $25K and <= HS diploma
**from 2010 WV Behavioral Risk Factor Surveillance Survey (BRFSS)
• Males = 45.9 percent
• Females = 36.5 percent
• 109,000 WV residents

18. Data tells us…
• The 2010 WV adult smoking rate
for those impoverished* is 40.9%.
*Low SES = Annual household income < $25K and <= HS diploma
**from 2010 WV Behavioral Risk Factor Surveillance Survey (BRFSS)
• This prevalence continues to increase!
(34.5% in 2001).

19. Data tells us…
• The 2010 WV adult smoking rate
for those aged 18 – 34 is 35.8%.
*from 2010 WV Behavioral Risk Factor Surveillance Survey (BRFSS)
• Males = 35 percent
• *Females = 36.7 percent
• 138,000 WV residents

20. Research and Program Evaluation tells us:
• The prevalence of current cigarette smoking
has significantly declined among WV high
school students (38.5% in 2000 to 22.4% in 2011)
• And current cigarette smoking has decreased
among WV middle school students (18.1% in
2000 to 8.3% in 2011). *from 2011 WV Youth Tobacco Survey

21. Research and Program Evaluation tells us:
• The prevalence of “never having smoked a
cigarette, not even 1-2 puffs” has significantly
increased among both high school students
(25.7% in 2000 to *50.5% in 2011)
• And middle school students (53.1% in 2000 to
75.1% in 2011). *from 2011 WV Youth Tobacco Survey

22. ST Research tells us:
• Smokeless tobacco is mostly used among
men, young adults, and those with a high
school education or less, also in some states
(like WV) with higher smoking rates.
• Smokeless tobacco is now being marketed
by tobacco companies as a substitute for
smoking tobacco users. *Especially when
at a place that doesn’t allow smoking.

23. Data tells us…
• The 2012 WV adult male
smokeless tobacco use rate is
15.5 percent. (from 2012 WVATS)
• Females = 2+ percent

24. Dual Tobacco Use in West Virginia
There are many
tobacco users in
West Virginia hooked
on TWO very
different types of
tobacco products…

25. Data tells us…
• The 2012 WV adult dual*
tobacco use rate is 11.4 percent.
(from 2012 WV Adult Tobacco Survey)
• Dual Use = “smokers who also report frequent
smokeless tobacco product use.”

26. First Warning Sign of Cancer?

27. Chewing/Spit
Tobacco

28. SNUS
• Originated in Sweden
• No need to spit
• Easy to conceal
• Nicotine rush, no tar
• Refrigerated to help
freshness

29. Marlboro Snus

30. Skoal Snus

31. Camel SNUS
Not a safe alternative to
smoking!

34. Data tells us…
• The 2012 WV rate of smokers
who also use snus is 9.7 percent.
(from 2012 WVATS)
• Males = 17 percent
• Females = 2.7 percent !

38. Social Networking Sites

39. Point of Purchase

42. © 2010 WV DHHR/DTP

43. • It is undeniable that ANY and ALL
tobacco use is habituating,
addictive, and causes disease and
even death!
© 2008 WV DHHR/DTP

44. Some things never change…
The Washington Post -1994 Tobacco executives
swear to tell the
truth at a 1994
congressional
hearing…
ALL denied any
knowledge that
nicotine was
addictive nor that
their products
were harmful!
© 2006 WV DHHR/DTP

45. Social Injustice… ??
When access to certain basic rights,
such as good health, education, and
fair and equal treatment, has been
distributed unevenly or denied to
certain groups, the problem
becomes an issue of social justice.

46. “The tobacco industry has succeeded in addicting those who
have the least information about the health risks of smoking,
the fewest resources, the fewest social supports, and the least
access to cessation services. The link between smoking and low
income and lower levels of education cannot be over
emphasized. Tobacco is not an equal-opportunity killer.”
- Dr. Cheryl Healton, American Legacy Foundation President; 2010.

47. Appalachia

48. Hancock
West Virginia
Brooke
Adult Smoking Prevalence
Ohio By County, 2008 - 2010
Marshall
Wetzel Monongalia
Morgan
Pleasants Tyler Marion Berkeley
Preston
Mineral Jeff-
Taylor erson
Dodd- Harrison Hampshire
Wood Ritchie ridge
Barbour Tucker Grant
Wirt Hardy
Lewis
Cal- Gilmer Upshur
houn
Mason Jackson
Randolph
Roane
Braxton Pendleton
Putnam Webster
Cabell Kanawha Clay
Nicholas Pocahontas
15 – 19.9%
Lincoln
Wayne 2 counties
20 – 24.9%
Boone Fayette
Greenbrier 15
Mingo
Logan 25 – 29.9% 23
Raleigh
Wyoming Sum- 30 – 34.9% 12
mers Monroe
35 – 39.9% 2
Mercer
McDowell 40%+ 1

49. © 2010 WV DHHR/DTP

50. “Tobacco-related illnesses are not only significant public
health and social justice issues in our State, but tobacco use
also must be interpreted as a heavily-impacting cost factor
to West Virginia’s businesses. There are substantial tobacco-
related business climate problems and costs to every
employer in the State.”
Bruce W. Adkins, Director
WVBPH Division of Tobacco Prevention

51. Smoking-related worker
productivity losses total
$1.1 billion annually in
WV.

52. Annual
preventable
costs total
$4,600 for
each
smoker in
WV!

53. Estimated Annual
Added Costs
for each WV
cigarette smoker
equals:
in direct health care costs
$2,767 in future worker productivity losses
*only includes those losses related to mortality

54. The Tobacco
Industry
Isn’t Going
Anywhere…

55. Coming to a school or town near you…
Emerging Tobacco Products

56. Where does tobacco ‘ethically’ fit into public health?

57. Tobacco and Business*
• Tobacco products are unlike any
other traded product: they are
uniquely harmful and therefore
require special rules to ensure
that business practices do not
stimulate tobacco use.
*Campaign for Tobacco Free Kids

58. Dealing with Tobacco as a
Business Issue
• Only commercial product that,
when used as directed, kills;
• Taxation, retailer regulations, and public
smoking restrictions do help, but most
often fall far short in adequately
addressing public health concerns and
health and occupational costs to society.

59. Cigarette & OTP Tax Increases
are a Recommended Best Practice
“Federal, state, and local taxes that raise prices on
tobacco products improve public health by reducing
initiation, prevalence, and intensity of tobacco use
among young people.”
“For every 10 percent increase in cigarette prices, it is
estimated there is a 3 – 5 percent reduction in overall
cigarettes consumed, especially in youth and young adults.”
Source: 2012 Surgeon General’s Report
On Tobacco Use in the U.S. (pg. 809-810)

60. Cigarette Taxes in Appalachia
*National Average Tax is $1.50 per pack
$4.65
$1.60
$1.25 $2.00
55c
60c
30c*
45c
57c
68c 43c 37c

61. Chas, WV - 11-26-12

62. Chas, WV - 11-26-12

64. Chas, WV - 11-26-12

65. The Tobacco Industry:
Why A ‘Public Health Bad Guy’?
• Defective product produced for five decades after
Surgeon General’s Reports on health effects;
• Continue to manipulate nicotine and product contents;
• Basic principles of business ethics violated;
• Shifted advertising resources to take advantage of
loopholes in legal settlements;
• Commissioned economic research to show the benefit
to society of dying early;
• Attempted to distort science and risk (IARC Report on
Passive Smoking);
• Supported smuggling as a marketing tool.

66. Who are
the
top two
PACs in
the U.S.
Congress
?????

67. Industry manipulation??
‘Future funding for tobacco prevention programs, &
any other tobacco-related legislation or regulation,
remain highly influenced by corporate practices of the
tobacco industry, which include vast marketing
campaigns, political contributions, and lobbying
efforts against public health regulations. These tobacco
industry practices actually promote chronic disease.’
Source: American Journal of Public Health, How the Tobacco Industry
Defeated the Clinton Health Plan and Why it Matters Now. Tesler and Malone.
2010 July; 100(7): 1174 - 1188.

68. Tobacco Marketing, Spending as a
Social Justice Issue in West Virginia
It is estimated by the Federal Trade
Commission that the tobacco industry
spends about $133 million annually to
promote tobacco products in West Virginia.
In contrast, our Division of Tobacco Prevention
is allocated $7 million annually to counter the
industry and prevent tobacco use.

69. One Truth about TODAY’S Politics
• In SFY12, West Virginia's State
spending for tobacco prevention
($5.65M) amounted to 4.7% of the
estimated $124 million in tobacco-
generated revenue the State collected.
CDC recommends that WV’s spending
on tobacco prevention and cessation
be at $28 million per year…

70. Charleston Marriott
Charleston, WV
"The incestuous relationship between
government and big business thrives
in the dark.“ – Jack Anderson

73. http://www.bebetternetworks.net/wvquitline_home.html

75. Contact Information:
Bruce W. Adkins, Director
Division of Tobacco Prevention
West Virginia Bureau for Public Health
350 Capitol Street, Room 514
Charleston, WV 25301-3715
304-356-4203
Bruce.W.Adkins@wv.gov
Our division’s website:
www.wvdtp.org
© 2006 WV DHHR / DTP

76. ??? QUESTIONS ???
COMMENTS…
*Credit to Betsy McKay (Atlanta Bureau Chief of the Wall Street Journal)