Tobacco Use
Why This Measure?
Everyone knows that tobacco use poses a significant health risk. In Montana, one out of every five deaths is tobacco-related. (Montana BRFSS 1993) Smoking is the cause cited for 87% of lung cancer deaths. (HP 2000) There are more tobacco-related deaths than deaths from traffic crashes, alcohol and drugs, homicides, suicides, and AIDS combined. (BRFSS, Smoke Free Air, 1995-1996) The list of ailments facing adult smokers — heart disease, periodontal disease, and respiratory ailments, in addition to cancer — clearly illustrates the impact of smoking on people’s health and well-being.
Lead Indicator Montana Adult Tobacco Use
Source: Montana BRFSS 1998
Missoula County Population Estimates (July 1998) By Age and Gender (useful in translating percentages and rates into actual numbers in certain age categories, or vice versa).Trend Same Data Rating Availablevv Reliablevv Relevantvvv
Related Measures Alcohol Use, Heart Disease, Birth Weight,
High School Completion, Protective Factors, Health, Children, Youth, Families How are we doing?Not well. Nationally, of course, we have seen significant reductions in cigarette smoking, from about 40% in 1965 to nearly half that 30 years later. The smoking rate is about the same in Missoula (22% +/- 2%) as it is in the state as a whole and the state rate of smoking has been holding steady for five years. The percent of teens now smoking regularly in Missoula is might be slightly less than the state as a whole, but represents a significant new population addicted to tobacco.
Treatment of Tobacco Dependence / Cessation
Nearly half of Missoula smokers who have smoked at least 100 cigarettes in their lives (48.2%) have quit smoking (Missoula BRFSS 1997).
Missoula Programs
Quit for Life: Open to all tobacco users, begins the first Thursday of every month, includes five classes over a three week period, 5:30 – 7:00 pm on Tuesdays and Thursdays, location alternates monthly between Partnership Health Center downtown and Community Medical Center, $25.00 for all sessions, low income scholarships available, call UM Wellness Center to register, 243-2027
Be Tobacco Free: Available at the Health Dept for WIC clients, two ½ hour sessions each month, call WIC at 523-4740
Tobacco Awareness Program (TAP): An eight session program for high school students who want to quit using tobacco, usually held during the school day, ask your high school principal if there is a TAP program at your school
In addition to the above formal programs many counselors, hypnotherapists, acupuncturists, and naturopath and medical doctors work with clients to stop using tobacco.
In 1993 in Montana, 14% of adult males used smokeless tobacco. This is twice the national average (Montana BRFSS 1995).
Montana’s high school youth also use chewing tobacco and snuff at nearly twice the national rate. The good news is that in 1997 the percentage of Montana students reporting such use decreased from 23% in 1995 to 21%.
Percent of Montana high school students who
reported using chewing tobacco or snuff in the
30 days prior to the survey, by gender
Source: Montana Youth Risk Behavior Surveys
Highlights from a 1996 student survey at the university:
v
77% had tried smoking.v
44% of the men and 44% of the women reported smoking at least one cigarette a day during the past 30 days.v
60% of the freshmen reported smoking at least one cigarette a day during the past 30 days.(NCHRBS Survey 1996)
See Youth Substance Use Measure for additional related information.
Missoula Youth Use (Oct. 1998)
Have you ever smoked cigarettes? Percent Occasions 8th Msla 8th Mt. 10th Msla 10th Mt 12th Msla 12th Mt Never 55 51 39 37 31 29 Once or twice 21 20 19 19 18 18 Not regularly 11 13 14 16 17 20 Regularly in past 7 7 11 10 13 11 Regularly now 5
10 16 17 21 22
Source: Montana Prevention Needs Assessment Oct. 98 (Missoula data from Missoula County Public Schools) Among addictive behaviors, cigarette smoking is the one most likely to become established during adolescence. Approximately 80% of persons who use tobacco begin before the age of 18 (USDHHS 1994). People who begin smoking at an early age are more likely to develop severe levels of nicotine addiction than those who start later. Tobacco use is also associated with alcohol and illicit drug use, and is generally the first drug used by young people who enter a sequence of drug use (MCCHD, Tobacco Free Missoula).
30 day smoking frequency Percent Occasions 8th Msla 8th Mt. 10th Msla 10th Mt 12th Msla 12th Mt Not at all 86 80 71 68 64 62 <1/day 9 10 10 12 11 12 1--5/day 3 6 8 9 12 12 1/2 pack/day 1 2 4 5 6 7 1 pack/day or more 1 2 6 5 6 7 Big Tobacco (Marketing, Tobacco Settlements)
- In 1996, 47% of the tobacco industry's $5.1 billion advertising budget went to retailer incentive programs. This includes payments for prime shelf space, volume discounts, and in-store displays (AJPH, vo.89 No.10, Oct.1999).
- In 1999 the State of Montana settled its lawsuit against the tobacco companies for $67 million dollars. Of this, $7 million has been allocated for Tobacco Prevention and Control over two years. Funds are expected to be available beginning June 2000. This money will be used to expand the state’s comprehensive tobacco use prevention program.
Environmental Tobacco Smoke Ordinance
In June of 1999 the Missoula City Council, County Commissioners, and Board of Health passed the "Smoking in Indoor Places of Employment and Public Places" ordinance effective in Missoula and within a five mile radius of the city. The ordinance was created to protect the public from the serious carcinogenic (causing cancer) and other toxic health effects of secondhand tobacco smoke. As of September 15, 1999, most public places and places of employment must provide a smoke-free indoor environment. On December 14, 1999 the ordinance becomes effective in restaurants. Businesses with a liquor license are exempt in the areas of their establishments where alcohol service is primary.
Missoula Tobacco Use Prevention Plan October 1999 - May 2000Maintain and enhance Missoula's tobacco use prevention network
Tobacco-free Missoula Quit for Life marketing team ETS (environmental tobacco smoke) team and ad hoc committee Tobacco Education Team Local email list serve Quarterly newsletter Decrease public and workplace exposure to ETS
- Help businesses comply with city ordinance
- Respond to ordinance complaints/violations
- Publish quarterly ETS articles in Foodline
- Provide health education and prevention activities for youth
- School-based tobacco education for 5th graders
- Coordinate implementation of TEG/TAP in high schools
- Tobacco presentations at National Youth Sports Camp
- Presentations in Insight program (court mandated for youth)
- Work with Msla Indian Center and Title VII program to outreach to Native American population
- Assist with Social Norming project
- Reduce underage access to tobacco products
- Provide clerks with RATS (Responsible Alcohol and Tobacco Sales) training
- Merchant mailings suggesting pro-active tobacco sales policies
- Assist with state and FDA compliance checks
- Publish compliance check results
Promote cessation among youth and adults
- Assist with implementation of TAP program in high schools
- Establish community-wide tobacco cessation program offered monthly
- Improve client access to pharmacological aids for cessation
- Improve referrals through medical and health professionals
Decrease social acceptability of tobacco use
- Operation Store Front
- Media campaign to broadcast community response to tobacco issues
- Announce events in Around Missoula
- Parent brochure on preventing tobacco addiction in young people
- Enhance anti-tobacco culture in middle and high schools, use social norming
Increase enforcement of existing laws
CDC Recommended Goals
- Lobby and assist local police in issuing citations
- Help develop high school tobacco policies
- Prevent the initiation of tobacco use among young people
- Promote quitting among young people and adults
- Eliminate nonsmokers' exposure to environmental tobacco smoke
- Identify and eliminate disparities among Native Americans, women of childbearing age, and male users of smokeless tobacco
Merchants in Missoula County did not fair so well in the August 1999 compliance check. Nearly half of all merchants, selected by random drawing, sold tobacco to a minor. When compliance checks occurred more regularly in 1996 and 1997, compliance rates increased with each inspection (MCCHD, Tobacco Free Missoula). Over half of the Missoula high school students who reported buying their own cigarettes in 1997 said they were not asked to show proof of age (YRBS 1997)
Beginning in 1999 the State of Montana will recheck half of non-compliant businesses thirty days after they violate the initial check. In the year 2000 the FDA will conduct compliance checks on all Missoula County establishments that sell tobacco. Federal penalties are stiffer than state fines.
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