Tobacco 101
Barry Sharp, MSHP, CHES
Texas Department of State Health Services
Tobacco = Problem
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Nationally – One person dies every 72
seconds from a tobacco related cause.
Texas – One person dies every 22
minutes from a tobacco related cause.
1,140 youth take up smoking every
day; one third of them will die from
their habit.
Tobacco = Problem

In Comparison,
– Every two and a half days, tobacco’s
death toll on Americans equals the
number of deaths from the terrorist
attacks on September 11, 2001.
– In 2006, alcohol-related car wrecks
claimed the lives of 1,677 Texans.
Tobacco kills more Texans each month.
Texas Preventable Deaths,
2001
Tobacco Use
Overweight/Obesity
Alcohol
Auto Accidents
Drugs
Suicide
DWI
Homicide
AIDS
Fire
24,899
18,649
11,132
3,736
2,851
2,214
1,607
1,405
1,052
218
Tobacco use will remain the leading cause of
preventable illness and death in this Nation
and a growing number of other countries until
tobacco prevention and control efforts are
commensurate with the harm caused by
tobacco use.
David Satcher, MD, PhD
Former U.S. Surgeon General
Reducing Tobacco Use, A Report
Of the Surgeon General - 2000
Tobacco 101
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Prevalence
Tobacco – Products & Chemistry
The Tobacco Industry
Health Effects
Tobacco Laws
Pro-Health Initiatives
The Awareness Class
Best Practices for Schools
Tobacco’s Human Toll
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9.5% middle school students smoke.
24.7% of high school students smoke.
18.1% of adults smoke.
Deaths in Texas from smoking:
– 24,200 adults each year
– 503,000 youth alive today will die prematurely from
smoking
– 2,660 to 4,720 adults, children and babies die from
diseases caused by secondhand smoke and
pregnancy smoking
Tobacco’s Economic Toll

Texas Economic costs:
–
–
–
–
–
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$1.6 billion in Medicaid
$5.83 billion overall health costs
$10.3 million in fire loss
$11.7 million in highway trash cleanup
$6.44 billion in lost productivity
State and federal tax burden from smokingcaused government expenses - $630 per
household
Each pack of cigarettes sold costs the United
States $10.28 in health care related costs and lost
productivity.
Big Tobacco’s Spending

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$13.36 billion – tobacco industry
marketing expenditures nationwide in
2005.
$884.7 million – estimated portion spent
in Texas for marketing in 2005.
– $37.63 for every Texas resident
– $28.05 every second

$254,500 – political contributions, ‘01-’06
– 1 of 2 U.S. Senators from Texas
– 23 of 32 U.S. Representatives from Texas
Middle School Tobacco Use
35
30
25
Any Tobacco
Cigarettes
Smokeless
Cigars
Pipes
20
15
10
5
0
1998
1999
2001
2006
High School Tobacco Use
45
40
35
30
Any Tobacco
Cigarettes
Smokeless
Cigars
Pipes
25
20
15
10
5
0
1998
1999
2001
2006
Boys vs. Girls
60
50
40
1998
1999
2001
2006
30
20
10
0
Middle
School
Boys
Middle
School
Girls
High
School
Boys
High
School
Girls
Tobacco Use by Race
40
35
30
25
20
15
10
5
0
1998
White MS
1999
Black MS
2001
Hispanic MS
2006
Asian MS
Tobacco Use by Race
50
40
30
20
10
0
1998
White HS
1999
Black HS
2001
Hispanic HS
2006
Asian HS
Tobacco Use by DSHS Region
35
30
25
20
15
10
5
0
Reg. Reg. Reg. Reg. Reg. Reg. Reg. Reg.
1/2
3
4/5
6
7
8
9/10 11
1998 MS
1999 MS
2001 MS
2006 MS
Tobacco Use by DSHS Region
50
40
30
20
10
0
Reg. Reg. Reg. Reg. Reg. Reg. Reg. Reg.
1/2
3
4/5
6
7
8
9/10 11
1998 HS
1999 HS
2001 HS
2006 HS
Tobacco Use by Grade
50
40
30
20
10
0
6th
7th
8th
9th
10th 11th 12th
Grade Grade Grade Grade Grade Grade Grade
1998
1999
2000
2001
2006
Texas Synar Rates
Federal Tobacco Sales Inspection
60
50
40
30
20
10
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
How Youth Get Tobacco
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Methods used by middle school students:
–
–
–
–
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Gave someone else money to purchase
Borrowed from someone willing to share
Stole (often from parents)
Other (i.e. Internet)
Methods used by high school students:
–
–
–
–
Gave someone else money to purchase
Borrowed
Bought in store & not asked for ID
Other (i.e. Internet)
Youth Cessation
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More than half of youth smokers:
– Tried to quit in the past 12 months
– Want to completely stop smoking
– Tried to quit at least twice
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About 8 of 10 current youth smokers:
– Think they would be able to quit smoking if they
wanted.
Nicotine
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Naturally occurring addictive substance.
Created by nature as an insecticide.
(Commercial use banned by EPA.)
Enters the blood stream and travels to
brain in less than 10 seconds.
Affects brain cells responsible for
memory and mood control.
Stays active for 20 - 40 minutes.
Nicotine
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Immediate Effects:
– Increased heart rate
– Blood vessels
constrict
– Lower skin
temperature
– “Head rush”
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Long-term Effects:
– High blood pressure
– Blockage of blood
vessels
– Reduced
effectiveness of
immune system
– Wrinkling of skin
Effects on the Brain
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Dopamine – pleasure, appetite suppression
Norepinephrine – arousal, appetite
suppression
Acetylcholine – arousal, cognitive
enhancement
Vasopressin – memory improvement
Serotonin – mood modulation, appetite
suppression
Beta-endorphin – reduction of anxiety and
tension
What do tobacco companies
think of kids?
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Philip Morris: “Today’s teenager is tomorrow’s
potential regular customer….”
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RJ Reynolds: “…the 14-18 year old group is
an increasing segment of the smoking
population. RJR-T must soon establish a
successful new brand in this market .…”
What do tobacco companies
think of kids?
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Brown & Williamson: “Kool’s stake in the 16-
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Lorillard Tobacco: “The base of our business is
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U.S. Tobacco: “Cherry Skoal is for somebody
to 25-year-old population segment is such that
the value of this audience should be accurately
weighted and reflected in current media
programs . . . all magazines will be reviewed
to see how efficiently they reach this group.”
the high school student.”
who likes the taste of candy, if you know what
I’m saying.”
Tobacco Marketing
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Tobacco companies spent $13.36
billion on U.S. advertising in 2005.
– $25,419 per minute
– $423.64 per second
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DSHS marketing budget for 2006
– $1.5 million for settlement area
– $730,000 for statewide media
$4.24 per minute (total for both campaigns)
 7 cents per second (total for both campaigns)
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Tobacco Marketing
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During the 22-minute interval between the
deaths of Texans from tobacco-related
causes, the tobacco industry will spend
more than $37,000 in Texas to make their
products appealing in order to replace
their dying customers.
How’s that as a reward for customer
loyalty?
Tobacco Marketing
16000000
14000000
12000000
10000000
8000000
6000000
4000000
2000000
0
Expenditures (Dollars in Thousands)
1963
1965
1970
1975
1980
1985
1990
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
U.S. Cigarette Consumption
(In billions of individual cigarettes)
700
600
500
400
300
200
100
0
1963-2005
Does Marketing Work?
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81.3 percent of youth (12-17) smokers
prefer Marlboro, Camel and Newport –
three heavily advertised brands.
Marlboro, the most heavily advertised
brand, constitutes almost 50 percent of
the youth market but only about 40
percent of smokers over age 25.
Youth recall seeing tobacco ads almost
3:1 over adults.
Marlboro Man - Altria
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Most successful and longest running
campaign in tobacco advertising history.
Honored by AdWeek as one of the top
campaigns of the past century.
Campaign originated in early 1960s.
Images of masculinity and rugged
individualism appeal to adolescents
struggling to define themselves.
Originally marketed as a woman’s
cigarette.
Joe Camel – R.J. Reynolds
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Introduced in 1988. Voluntarily
removed from market in 1997.
During campaign, Camel’s share of
the children’s cigarette market
increased from less than 1% to
more than 32% by 1993.
Joe Camel was as familiar to 6year-olds as Mickey Mouse.
Internet Marketing
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In 2000, there were 40 web sites selling
tobacco. By 2002, the number ballooned
to 200 U.S. and 200 foreign web sites.
Most sellers fail to pay taxes.
Most do not enforce or ignore age
requirements.
Texas and Maine regulate tobacco sales
over the Internet; New York and
Connecticut ban it completely.
Health Effects – Short Term
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Shortness of breath
Smell in hair and clothes
Discolored teeth and skin
Avoided by non-smokers
Financial costs (Pack/day = $1,700+)
Health Effects – Long Term
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Cancers of the lung, larynx, oral
cavity, pharynx, esophagus,
bladder, pancreas, uterine, cervix
and kidney
Heart Disease
Cerebrovascular Accidents (stroke)
Chronic Bronchitis
Emphysema
Cessation
Smoking cessation is more cost effective
than other commonly provided clinical
preventive services, including
mammography, colon cancer
screening, PAP tests, treatment of mild
to moderate hypertension and
treatment of high cholesterol.
Benefits of Quitting
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Begin within 20 minutes of quitting.
Within 1 year, risk of heart disease is
half that of a smoker.
Within 5 years, risk of cancers of lung,
mouth and esophagus are half that of
a smoker.
Within 15 years, risk of heart disease
is that of a non-smoker.
Withdrawal Symptoms
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Withdrawal Symptoms can include:
– Nervousness
– Irritability, anger and frustration
– Lack of concentration
– Depression
– Increased appetite and weight gain
– Insomnia, restlessness
The Texas Tobacco
Players
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Texas Department of State Health Services
– Mental Health & Substance Abuse Services
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Tobacco settlement initiative
Statewide programs for prevention & control
Synar inspections
Alcohol, tobacco and other drugs prevention & treatment
Comptroller of Public Accounts
– Cigarette & tobacco retailer permits/taxes
– Enforcement & criminal investigation
– Grants to law enforcement agencies
Texas Department of State
Health Services Tobacco Staff
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Region 1 – Panhandle
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– Sherri Scott, Canyon
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Region 6/5 – Southeast
Texas
– Debbie Melecio, Houston
Region 8 – South Texas
– Rick Meza, San Antonio
Region 4/5 – East Texas
– Lana Herriman & Dreka
Strickland, Tyler
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– Sylvia Barron & Lance
Starzyck, Temple
Region 2/3 – North Texas
– Betty Boenisch, Arlington
Region 7 – Central Texas
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Region 9/10 – West Texas
– Becky Zima & Sandra
Herrera, El Paso
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Region 11 – Rio Grande
Valley
– Martha Gonzalez,
Harlingen
Legislative Interventions
While prevention is always the best
method, and is a key focus of the Texas
Department of State Health Services
and other anti-tobacco advocates, kids
are still using tobacco products.
The Texas Legislature in the 1990s passed
two major bills aimed at curbing tobacco
abuse by minors.
Tobacco at Schools
Education Code, Section 38.006 (passed 1995)
The board of trustees of a school district shall:
1) Prohibit smoking or using tobacco products at
a school-related or school-sanctioned activity
on or off school property;
2) Prohibit students from possession of tobacco
products at a school-related or schoolsanctioned activity on or off school property.
3) Ensure that school personnel enforce the
policies on school property.
Selling Tobacco
Health & Safety Code, Section 161.081-161.087
Tax Code, Sections 154.111, 154.121, 154.1142-154.1143,
154.504, 155.0592 – 155.0593 ( Passed 1899, Modified
1989, 1997)
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Maintains existing penalty for store clerks
who sell tobacco to a minor.
Photo identification to verify anyone
under the age of 27.
Specified signage to include language that
it is both illegal to sell to a minor and for
minors to purchase tobacco.
Selling Tobacco (cont’d.)
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Restricts vending machines and self service sales
to places not open to those under the age of 18.
Prohibits the giveaway of free samples and
coupons to anyone under 18.
Prohibits the sales of cigarettes of less than 20
per package.
Requires a fee for a retail permit to sell tobacco.
Penalty for violations is $500 to $1,000,
suspension or revocation of permit.
Requires employers to train employees on
tobacco laws.
Advertising Tobacco
Health & Safety Code, Section 161.122 (Passed 1997)
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Outdoor advertising is prohibited within
1,000 feet of a church or school.
(Measured along roadways/property
lines from sign.)
Cigarette advertising is in limbo due to
Supreme Court ruling in Lorrilard
Tobacco Co. et al v. Reilly, Attorney
General of Massachusetts, et al.
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Texas Tobacco Settlement prohibits
tobacco billboards since June 24, 1998.
Minor Possession
Health & Safety Code, Section 161-252-161.254 (Passed
1997)
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Possession and consumption of
tobacco products is Class C
misdemeanor.
Consequences:
– Fine of up to $250;
– 8-hour tobacco awareness class;
– 8-12 hours of community service;
– 6 month loss or delay of driver’s
license.
Additional Efforts
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Texas Tobacco Settlement Initiative
– Comprehensive tobacco prevention and control
effort in Southeast Texas
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Community coalition building and technical
assistance
– TDH regional staff throughout the state
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State level partnerships with other
stakeholders agencies seeking synergistic
outcomes through collaborative efforts
Recent Developments
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Increase in the state cigarette tax to $1.41
per pack
Increased compliance with youth tobacco
laws (7.2% Synar buy rate for 2006)
Increased number of local secondhand
smoke ordinances across state
Statewide smoking ban proposed (but not
passed)
2006 U.S. Surgeon General’s report on
involuntary exposure to secondhand smoke
New Direction
th
From the 80 Legislature
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Create competitive statewide grant program
allowing health departments and school districts
in communities statewide to apply for funds.
Dedicate $3 million in tobacco settlement funds
to the Texas Education Agency for tobacco
education in schools statewide.
Dedicate $1 million for smokeless tobacco
prevention in rural communities.
Produce resource list identifying best practice and
evidence-based interventions for use by
organizations receiving state appropriated funds.
New Direction
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DSHS and grantees must use only best
practice or evidence-based tobacco
prevention, cessation, and enforcement
interventions.
DSHS or its contractor must notify
Comptroller’s tobacco law enforcement
grantees and local sheriff’s departments in
writing when Synar violations occur during
the annual survey.
DSHS must prepare a report on the
progress of the program to the legislature.
Texas Youth Tobacco
Awareness Program
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Goal is behavior modification, not
punishment
Intended for 14-17 year olds
Program delivered in 8 hours in four
two-hour sessions over two weeks
Small Class size, 20 participants
maximum (10-12 ideal)
Sessions are activity oriented
Risk Reduction
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Secondary prevention
– Gain knowledge and skill with each session

Awareness and behavioral disruption
– Challenges participants to make changes in
tobacco use behaviors
– Meets mandate of Senate Bill 55
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Focus is on long-term cessation
TYTAP Students
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About 20% of the youth say their
primary supplier of tobacco is their
parents. They also state that parents can
be a big help in quitting.
Social support is essential for youth
desiring to quit. They need
encouragement and understanding from
a variety of social sources.
TYTAP Students
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Many youth are engaging in a variety
of risky behaviors, not just tobacco
use. Drawings and writings in the
workbooks indicate a substantial
number are involved in poly-drug use,
including alcohol & illegal drugs.
Some have indicated suicide fantasies
and evidence of depression.
How does enforcement
affect your community?

A study of tobacco enforcement in
Illinois showed:
– Enforcing tobacco laws led to a decrease in
youth tobacco abuse and retail sales.
– Enforcing tobacco laws led to a decrease in
other drug offenses.
– Enforcing tobacco laws led to a decrease in
overall juvenile crime.
Guidelines for School
Health Programs
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CDC’s Guidelines for School Health Programs
to Prevent Tobacco Use and Addiction.
– Prohibit tobacco use at all school facilities and
events.
– Encourage and help students and staff to quit
using tobacco.
– Provide developmentally appropriate instruction
in grade K-12 that address social and
psychological causes of tobacco use.
Guidelines for School
Health Programs
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CDC’s Guidelines continued:
– Provide developmentally appropriate
instruction in grade K-12 that address
social and psychological causes of
tobacco use.
– Part of a coordinated school health
program.
– Reinforced by community efforts.
Guidelines for School
Health Programs
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Policy: Develop and enforce school
policy developed in collaboration with
all stakeholders.
– Prohibit tobacco use
– Prohibit tobacco advertising
– Students receive instruction
– Access to cessation programs
– Help violators quit rather than punish
Guidelines for School
Health Programs
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Instruction: Short & long term
negative physiologic and social
consequences, social influences, peer
norms and refusal skills.
– Decrease social acceptability
– Understand why people start and
identify more positive activities
– Developed skills in assertiveness, goal
setting, problem solving and resisting
pressure from media and peers.
Guidelines for School
Health Programs
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Curriculum: Provide prevention
education in grade K-12
– Instruction should begin in
elementary and intensify in
middle/junior high when exposure
to older students increases initiation
rates.
– Reinforce throughout high school
years.
Guidelines for School
Health Programs
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Training: Provide program-specific
training on tobacco use prevention for
teachers. The training should include
reviewing curriculum, modeling
instructional activities, and providing
opportunities to practice implementing
lessons. Well trained peer leaders can
be an important adjunct to teacher-led
instruction.
Guidelines for School
Health Programs
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Family Involvement: Involve parents
or families in supporting school-based
programs to prevent tobacco use.
– Promote discussions at home about
tobacco use by assigning homework
and projects that involve families.
– Encourage parents to participate in
community efforts to prevent tobacco
use and addiction.
Guidelines for School
Health Programs
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Tobacco-Use Cessation Efforts:
Support cessation efforts among
students and school staff who use
tobacco. Schools should provide
access to cessation programs that help
students and staff stop using tobacco
rather than punishing them for
violating tobacco use policies.
Guidelines for School
Health Programs
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Evaluation: Assess the tobacco use
prevention program at regular
intervals. Schools can use CDC’s
Guidelines for School Health Programs
to Prevent Tobacco Use and Addiction
to assess whether they are providing
effective policies, curricula, training,
family involvement and cessation.
Summary
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Tobacco by itself is a dangerous, addictive and
deadly substance.
Youth tobacco use is tied to a number of
major short and long term health hazards,
including substance abuse.
Enforcement can lead to getting youth help
with tobacco abuse and other health threats.
Solutions involve all community partners and
institutions coming together in a collaborative
and comprehensive approach.
Questions?
Discussion?
All Tobacco Deaths Are
Preventable
Barry Sharp, MSHP, CHES
www.dshs.state.tx.us/tobacco