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Cancer Plan: Tobacco
In November 1998, Maine and 45 other states across the country successfully sued the tobacco industry for the recovery of Medicaid health care costs attributed to tobacco use. As a result, it is estimated that Maine has received approximately $50 million per year through the Master Settlement Agreement.
Over the past four years, Maine has ranked number one in the nation for its exemplary use of tobacco settlement funding on tobacco prevention, cessation and treatment programs. Through the Partnership For A Tobacco-Free Maine (PTM), the state tobacco prevention and control program, and its many collaborative partners, Maine has made significant strides in reducing tobacco use.
Highlights include:
- Increasing taxes on cigarettes to two dollars a pack.
- Decreasing overall consumption of cigarettes by 28% in six years.
- Decreasing youth smoking rates.
- Increasing the number of work places with smoke-free policies.
Tobacco use is the biggest risk factor for lung cancer, Maine’s leading cancer killer, and is directly related to almost 30% of all cancer deaths. In the United States, adult smokers lose an average of 13 years of life because of the negative consequences of smoking. In Maine, lung cancer incidence and mortality rates are higher than the rest of the United States (Figures 6 & 7). It is estimated that 1,030 Mainers will be diagnosed with lung cancer in 2006, and 960 will die of this disease.
Figure 6. Maine Lung Cancer Incidence Rates, 1995-2002
Source: Maine Cancer Registry Program and Surveillance Epidemiology and End Results Program
Figure 7. Age-Adjusted Lung Cancer Mortality Rates, 1995-2002
Source: National Center for Health Statistics
Adult Tobacco Use
For lung cancer incidence to decline, efforts must continue to reduce tobacco initiation rates and increase cessation rates in Maine. In 2004, almost a quarter of Maine adults smoked. There are several groups of adults that are more likely to smoke than others, including 18-24 year olds, MaineCare recipients, and adults without insurance.35 Additionally, men are more likely to smoke than women.
Youth Tobacco Use
It is estimated that every day, over 3,800 Maine youth under 18 try smoking cigarettes for the first time. There is evidence that few people initiate their smoking behavior after their teenage years, and that in the United States, nearly 90% of adult smokers began smoking before the age of nineteen.36 With children and adolescents being the only groups in the United States and in Maine continuing to initiate smoking in large numbers, it is clear that youth prevention and cessation efforts should continue to be strengthened.
The good news is that Maine’s youth smoking rates are decreasing (Figures 8 & 9).
Highlights include:
- A statistically significant decline in the percentage of middle school and high school students that have ever tried smoking.
- A decrease in the percentage of high school students who are current smokers (2001 – 26.9%; 2004 – 22.6%).37
The bottom line, though, is that one in five Maine high school students are current smokers; therefore, it is imperative that future activities and resources focus on preventing Maine’s youth from smoking.
Goal: To reduce the initiation of tobacco use, to increase the number of people who successfully quit using tobacco, and to reduce exposure to secondhand smoke.
Objective 1: Reduce the proportions of Maine adults aged 18 and older who use tobacco products to 18% by 2010.
Baseline: 21% of adults are current smokers [have smoked 100 cigarettes in their lifetime and smoke now], BRFSS, 2004.
Strategies
- Implement and maintain community-based tobacco prevention and control initiatives throughout Maine.
- Advocate for maximum funding to address tobacco and tobacco-related chronic disease through the Fund for Healthy Maine and other sources.
- Promote voluntary policies that reduce exposure to secondhand smoke at home.
- Determine and promote effective messages and culturally appropriate communication methods regarding smoking and cessation for disparate populations.
- Increase the availability of cessation resources for disparate populations.
- ncrease the number of college campuses with 24/7 tobacco-free policies (See Appendix A for definition).
Objective 2: Reduce cigarette smoking among pregnant and postpartum women to 15% by 2010.
Baseline: 6% of women smoke during the last three months of pregnancy and 21% smoke after pregnancy, PRAMS data, 2003.
Strategies
- Increase implementation of health care professional-based education and patient counseling resources for pregnant women.
- Advocate for accessible, affordable, and proven cessation resources statewide for pregnant and postpartum women.
Objective 3: To reduce tobacco use of 9 – 12th graders to 15% and 6-8th graders to 5.5% by 2010.
Baseline: 16.2% for 9-12th graders and 7.5% for 6-8th graders, MYRBS, 2005.
Strategies
- Implement evidence-based community programs statewide that include teacher training and parental involvement.
- Engage youth in developing and implementing tobacco control interventions.
- Increase to 100% the number of Maine schools who have implemented Comprehensive School Health Education and have a Coordinated School Health Program.
- Increase to 100% the number of school districts in Maine who have adopted 24/7 tobacco- free policies (See Appendix A for definition).
- Provide accessible, affordable and proven cessation programs for youth in and out of school.
- eek funding for the development of a statewide, age appropriate, web-based interactive tobacco treatment resource.
- Continue to implement a statewide media campaign to counter pro-tobacco influences, increase pro-health messages and deglamorize use.
- Advocate for enforcement of laws that restrict minors’ access to tobacco products.
- Develop and promote parental education for racial and ethnic minorities, such as school parent advisory committees and local community meetings.
- 10. Increase the number of policies adopted and enforced to make outdoor recreation areas tobacco-free environments.
Objective 4: To increase the proportion of adults who receive advice to quit smoking annually from a health care professional by 2010.
Baseline: 80.6%, BRFSS, 2002.
Strategies:
- Continue to work with health care professionals to develop systems to increase the number of patients who receive brief advice, counseling, and pharmacotherapy from medical professionals.
- Continue to provide training and resources for health care and social service professionals on tobacco cessation.
- Advocate for and promote insurance coverage for adult tobacco treatment, including coverage of individual and group counseling and proven medications.
- Increase the number of worksites that provide employee tobacco treatment services onsite or through other means.
- Increase the number of hospitals that assess and refer patients for cessation therapy at point of contact.
Objective 5: Reduce involuntary exposure to secondhand smoke (SHS) for all Maine residents by 2010.
Baseline: 87% of workplaces do not allow smoking in any work areas, BRFSS, 2002; 67% of adults do not allow smoking in their home, BRFSS, 2000.
Strategies:
- Advocate for the closing of loopholes in state and local policies, including voluntary policies that restrict smoking in public places in Maine.
- Promote voluntary policies that reduce the involuntary exposure to secondhand smoke at home.
- Increase parental awareness of the harmful effects of SHS on children.
- Increase enforcement of and monitor compliance with existing clean indoor air laws.
- Increase the number of worksites that exceed the state worksite tobacco laws and completely prohibit smoking on buildings or on grounds.
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