Bureau of Tobacco Free Florida’s Statement Regarding Electronic Cigarettes and Youth

Tallahassee, Fla. – In April 2014, the U.S. Food and Drug Administration (FDA) publicly released a draft of its proposed rule – commonly called a “deeming document” – seeking to regulate electronic cigarettes and other electronic nicotine delivery systems. The Florida Department of Health is pleased with the release of the long-overdue proposed rule regarding e-cigarettes, and we remain mindful of the ongoing discussion regarding e-cigarettes in the Florida legislature. The Bureau of Tobacco Free Florida looks forward to additional clarity on the marketing, manufacturing and sale of these products.

The emergence of e-cigarettes (also known as vapors, vaporizers, vape pens, hookah pens, electronic hookahs, e-hookahs, vape pipes, and electronic cigars) has triggered a flood of questions and considerable discussion regarding the risks they pose to children and teens. Until e-cigarettes are deemed safe and of acceptable quality by a competent national regulatory body, the Bureau of Tobacco Free Florida advises consumers not to use these products. Even then, youth should never use these products as nicotine in any form, including e-cigarettes, is unsafe for anyone under age 18.[1],[2]  Parents must be vigilant about e-cigarette use by their children, and need to protect young children from exposure to all forms of nicotine.

In addition to their potentially harmful effects, Tobacco Free Florida is concerned that e-cigarettes may become a tool to hook youth and young adults on nicotine, a highly addictive chemical.[3],[4],[5] Youth in the state are increasingly using e-cigarettes at an alarming rate.[6] Among Florida high school students, one in five has tried e-cigarettes and current e-cigarette use has doubled – from 5.4 percent in 2013 to 10.8 percent in 2014.[7] Current use is described as using e-cigarettes at least once during the past 30 days.[8]

Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction, and lead to sustained tobacco use.[9] Nicotine is highly addictive.[10] Adolescents are more sensitive to nicotine and more easily addicted than adults.[11] Because the adolescent brain is still developing, nicotine use during adolescence can disrupt the formation of brain circuits that control attention, learning and susceptibility to addiction.[12]

E-cigarette companies are using the same strategies previously employed by the tobacco industry to effectively market cigarettes to youth. Many e-cigarette brands offer products in fruit and candy flavors – such as cotton candy and gummy bear – that are especially enticing to youth. It is illegal to sell e-cigarettes to Florida minors (under age 18), yet many of these products are available online, at mall kiosks or at local retailers, making them easily accessible to youth. While most tobacco products have faced marketing restrictions for decades, there has been a notable increase in the marketing of e-cigarettes, from TV commercials to billboards and music festival sponsorships.

The e-cigarette industry is unregulated; therefore, there are no product standards or laws requiring child-resistant packaging on bottles and cartridges of liquid nicotine. As a result, the number of calls to poison centers involving e-cigarette liquids containing nicotine rose from one per month in September 2010 to 215 per month in February 2014, according to a CDC study published April 3, 2014.[13] The number of calls per month involving conventional cigarettes did not show a similar increase during the same time period. More than half of the calls to poison centers due to e-cigarettes involved young children under age 5.[14] Exposure to nicotine by swallowing or contact with the skin can result in nausea and vomiting, as well as respiratory arrest, seizures or even death.[15] One teaspoon of liquid nicotine could be lethal to a child, and smaller amounts can cause severe illness, often requiring trips to the emergency room, according to the American Association of Poison Control Centers.[16] Less than a tablespoon, at high concentrations, can kill an adult.[17]

There are additional important questions about e-cigarettes that remain unanswered, such as:

  • Are e-cigarettes attracting youth that would not have otherwise used a tobacco product?
  • Are e-cigarettes a youth gateway to nicotine addiction and use of other tobacco products?
  • Does the alarming increase in e-cigarette use among youth and their accessibility have the potential to renormalize smoking?
  • What is the health impact of young people ingesting large amounts of nicotine via these products?
  • What are the effects of exposure to vapor by non-e-cigarette users, especially youth?
  • What is the potential impact for using these devices for other chemicals, especially illicit drugs?

E-cigarette advocates believe it is better for youth to use e-cigarettes instead of conventional cigarettes. Tobacco Free Florida considers this claim highly dangerous and poor public health policy, as youth should not be using any products that contain nicotine.[18],[19]

What the Public Health Community Has Said About Electronic Cigarettes

“We want parents to know that nicotine is dangerous for kids at any age whether it’s an e-cigarette, hookah, cigarette or cigar. Adolescence is a critical time for brain development.”[20]
– Tom Frieden, Director of the Centers for Disease Control and Prevention (CDC)

“Because liquid nicotine comes in a variety of bright colors and in flavors like cotton candy and gummy bear, it is no surprise that it has found its way into the hands of children, with tragic results; late last year, a one-year-old boy died after accidentally swallowing the highly toxic substance. Liquid nicotine poisoning is a public health crisis that is preventable, and warrants immediate action from our federal government.”[21]
– Sandra G Hassink, MD, FAAP, president, American Academy of Pediatrics

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References

[1] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014

[2] England, L. et al. Nicotine and the Developing Human: A Neglected Element of the E -cigarette Debate. Am J Prev Med. 2015 Mar 7. [Epub ahead of print].

[3] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014

[4] U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010

[5] National Institute on Drug Abuse. Research Report Series: Tobacco Addiction. Bethesda (MD): National Institutes of Health, National Institute on Drug Abuse, 2009

[6] Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2014

[7] Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2014

[8] Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2014

[9] “E-cigarette Use Triples among Middle and High School Students in Just One Year.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Apr. 2015. Web. 18 July 2015.

[10] USDHHS. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA.: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

[11] U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.

[12] England, L. et al. Nicotine and the Developing Human: A Neglected Element of the E -cigarette Debate. Am J Prev Med. 2015 Mar 7. [Epub ahead of print].

[13] U.S. Centers for Disease Control and Prevention (CDC). Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February 2014. MMWR 2014; 3(13);292-293. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6313a4.htm> [accessed 2014 Apr 24].

[14] U.S. Centers for Disease Control and Prevention (CDC). Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February 2014. MMWR 2014; 3(13);292-293. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6313a4.htm> [accessed 2014 Apr 24].

[15] Stanton Glantz, Child Resistant Packaging of Electronic Cigarette Devices and Refill Liquid to Prevent Child Poisoning, Center for Tobacco Control Research & Education (July 8, 2014), http://tobacco.ucsf.edu/child-resistant-packaging-electronic-cigarette-devices-and-refill-liquid-containerscontaining-nicot.

[16] American Association of Poison Control Centers  (AAPCC). “American Association of Poison Control Centers Urges Government Liquid Nicotine Regulation in Wake of Child Death.” 12 Dec. 2014. Press Release. Last Accessed 24 July 2015. http://www.aapcc.org/press/37/

[17] The New York Times Editorial Board. “Lethal Liquid Nicotine,” The New York Times. 24 March 2014. Web. Last Accessed 24 July 2015. http://www.nytimes.com/2014/03/25/opinion/lethal-liquid-nicotine.html

[18] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014

[19] England, L. et al. Nicotine and the Developing Human: A Neglected Element of the E -cigarette Debate. Am J Prev Med. 2015 Mar 7. [Epub ahead of print].

[20] “E-cigarette Use Triples among Middle and High School Students in Just One Year.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Apr. 2015. Web. 18 July 2015.

[21] American Academy of Pediatrics (AAP). AAP Statement on FDA’s Announcement on Protecting children from Liquid Nicotine. 30 Jun 2015. https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Statement-on-FDA%E2%80%99s-Announcement-on-Protecting-Children-from-Liquid-Nicotine.aspx


Bureau of Tobacco Free Florida’s Statement Regarding Electronic Cigarette Use Among Adults

Tallahassee, Fla. – In April 2014, the U.S. Food and Drug Administration (FDA) publicly released a draft of its proposed rule – commonly called a “deeming document” – seeking to regulate electronic cigarettes. The Florida Department of Health is pleased with the release of the long-overdue proposed rule regarding electronic-cigarettes, and we remain mindful of the ongoing discussion regarding e-cigarettes in the Florida legislature. The Bureau of Tobacco Free Florida looks forward to additional clarity on the marketing, manufacturing and sale of these products.

The emergence of electronic cigarettes and other electronic nicotine delivery systems (also known as vapors, vaporizers, vape pens, hookah pens, electronic hookahs, e-hookahs, vape pipes, and electronic cigars) has triggered a flood of questions and considerable discussion regarding their safety and ability to help smokers quit. While the makers of e-cigarettes claim they are safe, there is uncertainty as to the impact e-cigarette use might have on one’s health and the extent to which they are a viable alternative to conventional cigarettes.

Until e-cigarettes are deemed safe and of acceptable quality by a competent national regulatory body, the Florida Department of Health’s Bureau of Tobacco Free Florida advises consumers not to use these products. According to preliminary analysis from FDA, e-cigarette samples found detectable levels of known carcinogens and toxic chemicals.[1] Additionally, chemicals that are harmful or may be harmful have been found in some e-cigarettes, according to various studies. These substances include traces of metal, volatile organic compounds and nitrosamines, which are carcinogenic. The levels tend to be lower than in conventional cigarettes, but there is no way to be certain because e-cigarettes are not yet regulated.[2] There are more than 460 brands on the market, which vary widely in chemicals used[3] and in the amount of nicotine they deliver.[4] Furthermore, these products have simply not been around long enough to determine their long-term health effects.

Using e-cigarettes while continuing to smoke conventional cigarettes, which is referred to as dual use, is also a concern. It appears that e-cigarettes are likely being used as a way to circumvent smoke-free laws.[5] The Centers for Disease Control and Prevention (CDC) estimates that three out of four adult e-cigarette users are still smoking conventional cigarettes as well.[6] Dual use is not an effective way to safeguard your health,[7] as smoking even a few conventional cigarettes a day is harmful.[8],[9]

According to FDA, e-cigarette makers cannot legally claim that an e-cigarette product “helps stop or reduce the cigarette urge,” “helps stop or reduce smoking,” or similar claims that it is a smoking deterrent drug product.[10] Yet, many e-cigarette companies violate this restriction, raising concern that they are not interested in public safety. It is also worrisome that e-cigarette companies fought against treating e-cigarettes as drug-delivery devices, a standard that proven smoking cessation products (like the patch and gum) have met. Products that have met such requirements are required to submit clinical trials to FDA to prove they are safe and effective. It appears e-cigarette companies want to be able to make cessation claims without having to prove those claims.

There are additional important questions about e-cigarettes that remain unanswered, such as:

  • Do e-cigarettes encourage former smokers, and current smokers who are trying to quit, to reignite their nicotine addiction?
  • To what extent are current smokers using e-cigarettes and continuing to smoke conventional cigarettes (“dual use”), thereby negating any potential health benefits – if any – of using e-cigarettes?
  • By using e-cigarettes inside places where they wouldn’t have normally smoked, current and former smokers may be increasing the amount of nicotine they are consuming. Consequently, could e-cigarettes increase a person’s nicotine dependence?
  • Are current smokers using e-cigarettes to quit, or to circumvent smoke-free indoor air laws?
  • How are e-cigarettes affecting people who have never smoked?
  • What are the effects of exposure to e-cigarette aerosol (commonly called vapor) by non-e-cigarette users?

Without sufficient scientific evidence from credible sources and without regulations from a national regulatory body, Tobacco Free Florida cannot endorse e-cigarettes.

For tobacco users looking for a proven-effective way to quit, the best plan is to talk to your health care provider or seek help from an evidence-based resource, like Tobacco Free Florida. Additionally, there are nicotine replacement therapies (NRTs) and other quit aids that are approved by FDA to help tobacco users quit. These include: FDA-approved over-the-counter NRTs like the patch, gum and lozenges;[11] FDA-approved prescription NRTs such as the nicotine inhaler and nasal spray;[12] and FDA-approved prescription non-nicotine medications.[13],[14] “FDA-approved” means that these quit aids have gone through clinical trials that prove they are safe and effective.

Floridians who want to quit tobacco have access to Tobacco Free Florida’s 3 Free & Easy Ways to Quit. These evidence-based services provide free FDA-approved NRT, like the patch or a combination of the patch and gum, when medically appropriate and while supplies last. This combined approach of NRT and counseling can double your chances of quitting. Tobacco Free Florida’s 3 Ways to Quit include:

  • CALL: Talk to a Quit Coach who can help you quit tobacco. Call 1-877-U-CAN-NOW (1-877-822-6669).
  • CLICK: Online help quitting tobacco is only a few clicks away. Visit tobaccofreeflorida.com/webcoach
  • COME IN: Looking for local face-to-face help? Find classes near you at tobaccofreeflorida.com/ahec or call 1-877-848-6696.

Tobacco Free Florida will update its recommendations regarding e-cigarettes as the body of scientific evidence strengthens, and as regulations are made by a competent national regulatory body such as FDA.

What the Public Health Community Has Said About Electronic Cigarettes

“The increased use of e-cigarettes by teens is deeply troubling. Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.”[15]
– Tom Frieden, Director of the Centers for Disease Control and Prevention (CDC)

“This is an unproven device and we know very little about its long-term health effects. E-cigarettes are probably less harmful than combustible cigarettes, [but] we don’t have data to say that and can’t talk about long-term effect.”[16]
– Jennifer Pearson, PhD, MPH, Research Investigator at the Schroeder Institute for Tobacco Research and Policy Studies at Legacy

“If the marketers of the electronic cigarette want to help smokers quit, then they need to conduct clinical studies and toxicity analyses and operate within the proper regulatory framework. Until they do that, WHO cannot consider the electronic cigarette to be an appropriate nicotine replacement therapy, and it certainly cannot accept false suggestions that it has approved and endorsed the product.”[17]
– Douglas William Bettcher Director the Department for Prevention of Noncommunicable Diseases, World Health Organization (WHO)

Although the use of e-cigarettes is often referred to as vaping, the term is a misnomer because the products emit an aerosol — a dense fog of liquid droplets — and not a vapor. Very small particles in the aerosol “can penetrate deep into the lungs,” making the presence of toxic chemicals in the aerosol potentially hazardous.[18]
– Michele Bloch, Chief of the National Cancer Institute’s (NCI) Tobacco Control Research Branch

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References

[1] U.S. Food and Drug Administration. Summary of Results: Laboratory Analysis of Electronic Cigarettes Conducted By FDA. Silver Spring, MD. U.S. Department of Health and Human Services. U.S. Food and Drug Administration. Page Last Updated 2014 Apr 23. <http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm173146.htm> [accessed 2014 Apr 24].

[2] Cheng T. Chemical Evaluation of Electronic Cigarettes. Nicotine & Tobacco Research 2014;23,ii11–7. 23 May 2014. http://www.ncbi.nlm.nih.gov/pubmed/24732157 [accessed 18 Aug 2015].

[3] British Medical Journal. Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. (12 May 2014). < http://tobaccocontrol.bmj.com/content/23/suppl_3/iii3.full>

[4] World Health Organization (WHO). Questions and answers on electronic cigarettes or electronic nicotine delivery systems (ENDS). (10 Jul 2013). http://www.who.int/tobacco/communciations/statements/electronic_cigarettes/en/index.html

[5] U.S. Food and Drug Administration (FDA).  Transcript for FDA’s media briefing on electronic cigarettes (July 22, 2009). available at: http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm

[6] King, Patel, Nguyen, and Dube. Trends in Awareness and Use of Electronic Cigarettes among U.S. Adults, 2010 -2013 Nicotine Tob Res ntu191 first published online September 19, 2014 doi:10.1093/ntr/ntu191

[7] Centers for Disease Control and Prevention . “Transcript for CDC press briefing: CDC launches powerful new ads in “Tips From Former Smokers” campaign.” 26 March 2015. Web. Last Assessed 24 July 2015. http://www.cdc.gov/media/releases/2015/t0326-tips.html

[8] Bjartveit K, Tverdal A. Health Consequences of Smoking 1-4 Cigarettes per Day. Tobacco Control 2005; 14(5):315-20.

[9] Tverdal A, Bjartveit K. Health Consequences of Reduced Daily Cigarette Consumption. Tobacco Control. 2006; 15(6): 472–80. 10 FDA 101

[10] U.S. Food and Drug Administration. E-Cigarette Direct, LLC 9/8/10. Warning Letter. Silver Spring, MD. U.S. Department of Health and Human Services. U.S. Food and Drug Administration. Page Last Updated 2010 Sept 9 <http://www.fda.gov/ICECI/ComplianceActionsandActivities/WarningLetters/2010/ucm225178.htm> [accessed 2014 Apr 24].

[11] Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Froelicher ES, Healton CG, et al. Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice GuidelinesExternal Web Site Icon. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2008

[12] Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Froelicher ES, Healton CG, et al. Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice GuidelinesExternal Web Site Icon. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2008

[13] Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Froelicher ES, Healton CG, et al. Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice GuidelinesExternal Web Site Icon. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2008

[14] U.S. Food and Drug Administration The FDA Approves Novel Medication for Smoking Cessation. FDA Consumer, 2006. Page Last Update: 2013 Apr 8 <http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108651.htm> [accessed 2014 Apr 24].

[15] U.S. teen use of e-cigarettes doubled, CDC reports.” Reuters, 5 Sept. 2013. < http://www.reuters.com/article/2013/09/05/us-usa-health-e-cigarettes-idUSBRE9840X820130905> [accessed 2014 Apr 24].

[16] Mann, D. “Are E-Cigarettes Here to Stay?” WedMD. 2012 July 20. <http://www.webmd.com/smoking-cessation/news/20120720/are-e-cigarettes-here-to-stay> [accessed 2014 Apr 24].

[17] O’Leary. “Marketers of electronic cigarettes should halt unproved therapy claims.” World Health Organization (WHO). 2008 Sept 19. http://www.who.int/mediacentre/news/releases/2008/pr34/en/ [accessed 2015 Aug 18].

[18] National Cancer Institute (NCI). “Debate, Research on E-Cigarettes Continue.” 2014 Dec 11. Web http://www.cancer.gov/news-events/cancer-currents-blog/2014/e-cigarettes [[accessed 2015 Aug 18].


How to Talk to Your Kids About Tobacco

For decades, young people sneaking a cigarette or dip in the backyard out of their parents’ sight was dismissed as a rite of passage. Unfortunately, these exact moments are when tobacco use begins and for far too many kids leads to a lifetime of addiction. It may seem difficult to talk with your kids about tobacco, especially when it seems there are so many other dangers out there.

However, the conversation can’t wait because nine out of 10 smokers start by age 18.[1] Every day, more than 3,200 youth (younger than 18 years of age) try smoking for the first time and 2,100 youth and young adults become regular addicted smokers.[2]

Here are some tips to help you prepare for a conversation:

  • If you smoke, the best thing you can do for your own health and your child’s health is to quit. Research shows that kids who have a parent who smokes are more likely to smoke and to be heavier smokers at young ages.[3] However, the good news is that when parents quit smoking, their kids become less likely to start smoking and more likely to quit if they already smoke.[4]
  • Address the problem, don’t ignore it. Despite what kids might have you believe, studies show that parents can have a significant impact on their kid’s behavior, such as whether or not to use tobacco products.[5]
  • Become involved in your kids’ lives and social schedules. Young people whose friends use tobacco are more likely to use tobacco themselves to try to fit in. Meanwhile, kids who do well in school and participate in structured, extra-curricular activities are less likely to be susceptible to smoking.[6]
  • Educate yourself about e-cigarettes, even if you don’t use them yourself. With the growing trend of youth using e-cigarettes, here are some important things you should know:
    • In Florida, the number of high school students who were current e-cigarette users has increased from 2013 to 2015.[7]
    • One in three Florida high school students has tried an e-cigarette.[8]
    • In 2014, for the first time, more Florida teens used e-cigarettes than any other tobacco product.[9]
    • Here are some tips for protecting youth from the dangers of e-cigarettes:
      • Don’t leave liquid nicotine unattended, at all. Nicotine is a strong poison that can cause serious illness or death if swallowed. Even in very small amounts.
      • Kids can order tobacco and e-cigarettes online, so check deliveries to your home and check your credit cards for unexpected charges.
      • Check their backpacks to know what they are bringing home.
      • E-cigarettes typically won’t make clothes smell of tobacco smoke. If you don’t smell tobacco on them, don’t assume they aren’t using products with nicotine.
      • Some e-cigarettes require charging, so check to see what devices are being charged or if you see an unusual plug.
  • Back up the conversation with facts they can relate to. Tobacco use remains the leading preventable cause of death in the United States[10] and here are some quick facts that can help sway the conversation in your favor to prevent them from using tobacco.
    • Tobacco use is responsible for about 480,000 deaths a year in the U.S.[11] That’s about one in five deaths annually, and more than 1,300 deaths every day.
    • On average, smokers die at least 10 years earlier than non-smokers.[12]
    • For every person who dies from smoking, about 30 more people suffer from one or more serious illnesses caused by smoking.[13]
    • Because the adolescent brain is still developing, nicotine use during adolescence can disrupt the formation of brain circuits that control attention, learning and susceptibility to addiction.[14]
    • Most teens are not able to quit due to the addicting properties of nicotine. In fact, only one in three young smokers will quit, and one of those remaining smokers will die from tobacco-related causes.[15]
    • Nicotine is highly addictive.[16] The pathway for addiction to nicotine is similar to those for heroin and cocaine.[17]
    • While smoking-related diseases usually occur years after a person starts, smoking has immediate effects on the body.[18] Early cardiovascular damage is seen in most young smokers; those most sensitive die very young.[19]
    • Smoking also reduces lung function and retards lung growth. Teens who smoke are not only short of breath today, but they also may end up as adults with lungs that will never grow to full capacity. Such damage is permanent and increases the risk of chronic obstructive pulmonary disease.[20]
    • There are more than 7,000 chemicals in cigarette smoke, at least 250 are toxic and about 70 are known to cause cancer.[21]

These numbers are powerful, and so are real-life stories. If you know someone who died or is suffering because of tobacco use, share their story with your kids. Create a world where seeing people smoke or use other tobacco products is the exception, not the norm.

Learn how you can get involved in your community by visiting www.tobaccofreeflorida.com/getinvolved.

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[1] U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

[2] U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014.

[3] Gilman, SE, et al., “Parental Smoking and Adolescent Smoking Initiation: An Intergenerational Perspective on Tobacco Control,” Pediatrics 123(2): e274-e281, February 2009. Bauman, K, et al., “Effect of parental smoking classification on the association between parental and adolescent smoking,” Addictive Behaviors 15(5):413-22, 1990. See also, Osler, M, et al., “Maternal smoking during childhood and increased risk of smoking in young adulthood,” International Journal of Epidemiology 24(4):710-4, August 1995.

[4] Farkas, A, et al., “Does parental smoking cessation discourage adolescent smoking,” Preventive Medicine 28(3):213-8, March 1999.

[5] Newman, I, et al., “The influence of parental attitude and behavior on early adolescent cigarette smoking,” Journal of School Health 59(4):150-2, April 1989. See also, Distefan, J, et al., “Parental influences predict adolescent smoking in the United States, 1989-1993,” Journal of Adolescent Health 22:466-74, 1998.

[6] Resnick, M, et al., “Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health,” Journal of the American Medical Association 278(10):823-32, 1997. See, also, Kellam, S, et al., “Targeting early antecedents to prevent tobacco smoking: Findings from an epidemiologically based randomized field trial,” American Journal of Public Health 88(10):1490-95, October 1998.

[7] Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2015.

[8] Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2014.

[9] Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2014.

[10] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

[11] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

[12] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

[13] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

[14] England, L. et al. Nicotine and the Developing Human: A Neglected Element of the E -cigarette Debate. Am J Prev Med. 2015 Mar 7. [Epub ahead of print].

[15] U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012.

[16] USDHHS. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA.: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

[17] U.S. Department of Health and Human Services. The Health Consequences of Smoking: Nicotine Addiction. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1988. DHHS Publication No. (CDC) 88-8406.

[18] American Academy of Pediatrics October 1998 Child Health Month Report: The Risks of Tobacco Use: A Message to Parents and Teens; Milam, JE, “Perceived invulnerability and cigarette smoking among adolescents,” Addictive Behaviors 25(1):71-80, January-February 2000.

[19] U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012.

[20] U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012.

[21] Centers for Disease Control and Prevention (US); National Center for Chronic Disease Prevention and Health Promotion (US); Office on Smoking and Health (US). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2010.


Feeling Stressed?

You May Want to Put Out That Cigarette

Ask Floridians why they’re lighting up and one answer you commonly hear is that smoking relieves stress. You know the dangers of smoking and the benefits of quitting, but the false sense of relaxation from a cigarette can be reason enough to keep puffing, especially when you’re stressed or under pressure.

Smoking isn’t just harsh on your body; it’s cruel to your brain. You may think you’re feeling calmer and less stressed during and right after a cigarette, but it’s just an illusion. In reality, your body is experiencing quite the opposite effect. Smoking increases your blood pressure and heart rate, tenses your muscles, contracts blood vessels, and reduces your blood oxygen level.[1],[2]Basically, smoking increases the stress level of your body.

The usual stress in your everyday life, when combined with a chemical addiction to nicotine, heightens stress instead of lowering it. Smokers need nicotine to maintain normal mood and suffer tension and stress between cigarettes.[3],[4] When you quit, nicotine withdrawal and recovery symptoms may feel unpleasant. But these are common and only temporary.

Moreover, the health consequences of smoking are enough reason to feel stressed. About half of long-term smokers die from diseases caused by their tobacco use.[5] For every person who dies from tobacco use, about 30 suffer with at least one smoking-related illness.[6] Cigarette smoking can cause 16 different types of cancers and can cause lung diseases including COPD, emphysema and bronchitis. Smoking can also cause coronary heart disease, the leading cause of death in the U.S, and can lead to stroke.[7]

Dealing with Stress

Here are some tips on dealing with stress:

  • Take a break. Even if it’s just for a few minutes, take a healthy break from what you’re doing whether you’re at home or at work.
  • Deep breathing. Instead of inhaling toxic smoke, try fresh air. Step outside and take slow deep breaths. Close your eyes and then breathe in through your nose and out through your mouth. You will feel your body relax.
  • Exercise. Get moving to increase endorphins, the body’s feel-good chemicals, which naturally boost your mood. Exercise also decreases stress hormones. Even a short walk will help you to reduce your stress and improve your health. Exercising can also help you quit smoking and make it easier to quit.
  • Take care of yourself. Especially during stressful times of the year, it’s important to take good care of yourself. Remember to eat healthy balanced meals, drink lots of water, and get enough sleep.
  • Make time for yourself. Sometimes it’s difficult to follow tips one through four with a hectic schedule. Keep your days organized and on track, whether it’s with a to-do list, a planner or whatever works for you.

If you’re interested in quitting, visit tobaccofreeflorida.com/quit.

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[1] Institute of Medicine. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. Washington: National Academy of Sciences, Institute of Medicine, 2009.

[2] U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.

[3] Parrott, A. C, & Gamham, N. J. (1998). Comparative mood states and cognitive skills of cigarette smokers, deprived smokers and nonsmokers.Human Psychopharmacology, 13, 367-376.

[4] Parrott, A. C, Garnham, N. J., Wesnes, K., & Pincock, C. (1996). Cigarette smoking and abstinence: Comparative effects upon cognitive task performance and mood state over 24 hours. Human Psychopharmacology,11, 391-400.

[5] U.S. Department of Health and Human Services. A Report of the Surgeon General: How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.

[6] Centers for Disease Control and Prevention.Cigarette Smoking-Attributable Morbidity—United States, 2000. Morbidity and Mortality Weekly Report 2003;52(35):842–4.

[7] U.S. Department of Health and Human Services. The Health Consequences of Smoking —50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.


How Does Smoking Damage Your Heart?

Heart disease is the leading cause of death in the United States.[1] About every 25 seconds, someone in the U.S. will have a coronary event. And every minute, someone will die from a coronary event.[2] Smoking is a major cause of  heart disease for both men and women.

Breathing tobacco smoke causes changes in your blood. Your triglyceride level rises, and your “good cholesterol” level falls. The chemicals in tobacco smoke also prevent your body from repairing damaged places in the lining of your arteries. Clots are more likely to form in a damaged artery.[4]

Smoking is one cause of dangerous plaque buildup inside your arteries. Plaque is made of cholesterol and scar tissue. It clogs and narrows your arteries. This can trigger chest pain, weakness, heart attack, or stroke. Plaque can rupture and cause clots that block arteries. Completely blocked arteries can cause sudden death.[4]

Tobacco  smoke poses a serious risk, even to nonsmokers. Secondhand smoke causes nearly 34,000 premature deaths from heart disease each year in the U.S. among nonsmokers.[5] Inhaling someone else’s tobacco smoke could be enough to block arteries and trigger a heart attack in someone whose arteries are silently clogged.[4] Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25 to 30 percent.[6]

While cigarette smoking alone can increase the risk of heart disease, when coupled with other factors like high blood pressure, unhealthy cholesterol levels, inactivity, poor diet, family history and obesity, the risk is greatly increased.[7] Even young smokers are at risk. Smoking during adolescence and young adulthood causes early damage to the abdominal aorta, the large artery that carries oxygen-rich blood from the heart through the abdomen to major organs. Young adults who have only been smoking for a few years can show signs of narrowing of this large artery.[8]

What happens to my heart if I quit smoking?

Within 12 hours, the level of poisonous carbon monoxide in the body from cigarettes returns to normal. In other words, the benefits of quitting begin immediately.[9] After one year, your risk of heart attack is half that of a continuing smoker’s risk.[4] Fifteen years after quitting, your risk of coronary heart disease is that of a nonsmoker’s.[10]

 


[1] Heron MP, Hoyert DL, Murphy SL, Xu JQ, Kochanek KD, Tejada-Vera B.Deaths: Final data for 2006. National Vital Statistics Reports. 2009;57(14). Hyattsville, MD: National Center for Health Statistics.

[2] Roger V, Go, A, Lloyd-Jones, D, et al. Heart disease and stroke statistics—2011 update. a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation2011;123:e1-e192.

[3] American Heart Association. Cigarette Smoking and Cardiovascular Disease. http://www.americanheart.com/presenter.jhtml?identifier=4545

[4] U.S. Department of Health and Human Services. A Report of the Surgeon General: How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010

[5] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014

[6] U.S. Department of Health and Human Services. Let’s Make the Next Generation Tobacco-Free: Your Guide to the 50th Anniversary Surgeon General’s Report on Smoking and Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014

[7] WebMD.Smoking and Heart Disease. Last Reviewed: Sept. 15, 2014. www.webmd.com/smoking-cessation/quit-smoking-heart#sthash.gwtJWtU0.dpuf

[8] U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006

[9] U.S. Department of Health and Human Services. The Health Consequences of Smoking: Nicotine Addiction: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1988

[10] Tobacco Control: Reversal of Risk After Quitting Smoking. IARC Handbooks of Cancer Prevention, Vol. 11. 2007. p 11


Fact Sheet: Tobacco Free Florida Program

Includes facts about how tobacco impacts the state and how Tobacco Free Florida has helped many Floridians quit tobacco.

Click to download ; Haz clic para descargar

Powerful Anti-Smoking Ad Campaigns Work

Hard-hitting anti-smoking media campaigns effectively raise awareness about the serious toll that tobacco use takes on one’s health and the many lives it affects. In the United States, tobacco use is responsible for about 480,000 deaths each year.[1] For every person who dies, about 30 more people suffer with at least one serious illness from smoking.[2]

Smoking also affects the numerous nonsmokers exposed to hundreds of toxic chemicals in secondhand smoke. Since 1964, 2.5 million nonsmokers have died from exposure to secondhand smoke.[3]

Can a graphic and emotional ad on TV really make a difference?

The Florida Department of Health’s (FDOH) Tobacco Free Florida campaign uses aggressive ads that show the human impact of smoking as part of a comprehensive program. FDOH and the Bureau of Tobacco Free Florida (BTFF) select ads that have run in other states and countries and that have had a demonstrated positive effect on inspiring people to seek help in quitting smoking.

Tobacco Free Florida has seen encouraging results in reducing tobacco use in the state. The adult cigarette smoking rate in Florida was at 16.8 percent in 2013. That was below the 2013 national average of 19 percent.[4] Florida’s adult cigarette smoking rate decreased by 13 percent – from 19.3 percent in 2011 to 16.8 percent in 2013. Another positive sign is the increased number of people served by Tobacco Free Florida’s 3 Ways to Quit, which are free and evidence-based resources that include the Florida Quitline, Web Coach and in-person classes via the Florida Area Health Education Centers (AHEC). For example, from July 2013 through June 2014, more than 93,100 Floridians used one of the 3 Ways to Quit.[5]

Furthermore, Florida has seen great progress in reducing cigarette use among youth. Since Tobacco Free Florida began airing hard-hitting ads in 2010, the state’s youth cigarette smoking rate has been cut by about half – from 8.3 percent in 2010 to 4.3 percent in 2014 among Floridians ages 13-17.[6] The state had one of the lowest high school cigarette smoking rates in the country at 7.5 percent in 2014. That was below the national average of 9.2 percent in the equivalent 2014 national survey.[7] The decrease in smoking among young people in Florida is an encouraging indication of the effectiveness of our tobacco control program.

Strong evidence proves that graphic, hard-hitting anti-tobacco ads work, and those that arouse strong negative emotions perform better than those that do not. Hard-hitting media campaigns are not only effective at promoting quit attempts, they also reduce youth initiation.[8]

The Evidence

  • According to a report published in The Lancet medical journal in September 2013, the Centers for Disease Control and Prevention’s (CDC) 2012 Tips From Former Smokers (Tips) campaign motivated 1.6 million smokers to make a quit attempt. More than 100,000 U.S. smokers will remain quit as a result of the 2012 campaign. An estimated 6 million nonsmokers talked with friends and family about the dangers of smoking.[9] Several Tips ads were chosen by FDOH and BTFF to run in Florida.
  • During March 4–June 23, 2013, CDC conducted its second annual Tips campaign. During the campaign, the average weekly numbers of calls and website visitors increased by 75 percent and almost 38-fold, respectively, compared with the 4 weeks before the campaign, and quickly decreased almost to pre-campaign levels once the campaign ended. This suggests that the campaign led to 151,536 additional quitline calls and nearly 2.8 million additional unique Tips website visitors above pre-campaign levels.[10] Several of these Tips ads were also chosen by FDOH and BTFF to run in Florida.
  • Studies show that emotionally evocative media campaigns featuring graphic images of smoking-related diseases are effective in motivating smokers to quit.[11],[12],[13],[14]
  • According to a study published in June 2010, ads that utilize a why-to-quit strategy with graphic images of the physical consequences of smoking and ads that use testimonials of personal loss from smoking were perceived as more effective among smokers than other ad categories.[15]
  • Campaigns that show the serious health consequences linked to smoking to motivate adults to quit have also been associated with prevention of smoking uptake among youth.[16]
  • Studies indicate that sad or frightening ads that are highly emotional and feature the serious health consequences of tobacco use score significantly higher among adults on perceived effectiveness compared to ads that are funny or neutral.[17]
  • In one study, smokers who reported being exposed to more highly emotional and personal testimonial ads were more likely to quit smoking at follow-up.[18]
  • Meta-analyses on the use of fear appeals in health campaigns conclude that fear appeals are most effective when accompanied by equally strong efficacy messages, such as information to call a quitline for help and support to quit.[19]
  • In New York, researchers found that graphic television ads were strongly associated with higher call volume to a quitline from 2001 to 2009.[20] Two of those ads, Reverse the Damage – Heart Attack and Reverse the Damage – Lung Cancer were chosen by FDOH and BTFF to run in Florida.
  • The Australia National Tobacco Campaign, which featured graphic hard-hitting ads depicting the negative health consequences of smoking, found that the campaign achieved high rates of recall and recognition, was appraised favorably by smokers, contributed to new learning about smoking and health, and increased agreement with campaign-related attitudes.[21],[22] Furthermore, even though the campaign was not targeted at teenagers, the vast majority of adolescents were aware of the campaign and thought it was relevant to them.[23] These ads, Artery and Sponge were chosen by FDOH and BTFF to run in Florida.

To view some of Tobacco Free Florida’s ads, please visit www.tobaccofreeflorida.com/multimedia-tv-spots.

___________________________________________________________________________________

[1] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

[2] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

[3] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

[4] Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Prevalence and Trends Data, 2013. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

[5] Professional Data Analysis

[6] Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2014.

[7] Centers for Disease Control and Prevention (CDC). Tobacco Use Among Middle and High School Students—United States, 2011–2014. MMWR Morbidity and Mortality Weekly Report 64(14);381–385. 16 April 2015

[8] National Cancer Institute, The role of the media in promoting and reducing tobacco use. Tobacco\ Control Monograph No. 19. NIH Pub. No. 07-6242, 2008, USDHHS, National Institutes of Health, National Cancer Institute: Bethesda MD.

[9] McAfee T, Davis KC, Alexander Jr RL, Pechacek TF, Bunnell R. Effect of the first federally funded US antismoking national media campaign. Lancet 2013; September 9

[10] Centers for Disease Control and Prevention. Impact of a national tobacco education campaign on weekly numbers of quitline calls and website visitors–United States, March 4-June 23, 2013. MMWR Morb Mortal Wkly Rep. 2013 Sep 20;62(37):763-7.

[11] Community Preventive Services Task Force. Reducing tobacco use and secondhand smoke exposure: mass-reach health communication interventions. Atlanta, GA: Task Force on Community Preventive Services; 2013. Available at http://www.thecommunityguide.org/tobacco/massreach.htm

[12] National Cancer Institute. The role of the media in promoting and reducing tobacco use. Tobacco control monograph no. 19. Bethesda, MD: US Department of Health and Human Services, National Cancer Institute; 2008. Available at http://www.cancercontrol.cancer.gov/tcrb/monographs/19/index.htm

[13] Durkin S, Brennan E, Wakefield M. Mass media campaigns to promote smoking cessation among adults: an integrative review. Tob Control 2012;21:127–38.

[14] Farrelly, M, Mann N, Watson K, Pechacek T. The influence of television advertisements on promoting calls to telephone quitlines. Health Educ Res 2013;28:15–22.

[15] Davis, K. C., Nonnemaker, J. M., Farrelly, M. C., Niederdeppe, J. Exploring differences in smokers’ perceptions of the effectiveness of cessation media messages. Tob. Control 2010;0:tc.2009.035568v1-tc.2009.035568

[16] Wakefield, M.A., B. Loken, and R.C. Hornik, Use of mass media campaigns to change health behaviour. Lancet, 2010. 376(9748): p. 1261-71.

[17] Biener, L., Anti-tobacco advertisements by Massachusetts and Philip Morris: what teenagers think. Tob Control, 2002. 11 Suppl 2: p. ii43-6.

[18] Durkin, S.J., L. Biener, and M.A. Wakefield, Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups. Am J Public Health, 2009. 99(12): p. 2217-23.

[19] Witte, K. and M. Allen, A meta-analysis of fear appeals: implications for effective public health campaigns. Health Educ Behav, 2000. 27(5): p. 591-615.

[20] Farrelly, M.C., et al., Promoting calls to a quitline: quantifying the influence of message theme, strong negative emotions and graphic images in television advertisements. Tob Control, 2011. 20(4): p. 279-84.

[21] Tan, N., M. Wakefield, and J. Freeman, Changes Associated with the National Tobacco Campaign: Results of the Second Follow-up Survey. , Canberra, Editor 1999, Commonwealth Department of Health and Aged Care.

[22] Wakefield, M., J. Freeman, and J. Boulton, Changes Associated with the National Tobacco Campaign: Pre and Post Campaign Surveys Compared. , Canberra, Editor 1999, Commonwealth Department of Health and Aged Care.

[23] White, V., et al., Do adult focused anti-smoking campaigns have an impact on adolescents? The case of the Australian National Tobacco Campaign. Tob Control, 2003. 12 Suppl 2: p. ii23-9.

 


Why Smoking is Especially Bad If You Have Diabetes

Smoking and Diabetes

What Is Diabetes?

Diabetes is a group of diseases in which blood sugar levels are higher than normal. Most of the food a person eats is turned into glucose (a kind of sugar) for the body’s cells to use for energy. The pancreas, an organ near the stomach, makes a hormone called insulin that helps glucose get into the body’s cells. When you have diabetes, your body either doesn’t make enough insulin or can’t use the insulin very well. Less glucose gets into the cells and instead builds up in the blood.1

There are different types of diabetes. Type 2 is the most common in adults and accounts for more than 90% of all diabetes cases. Fewer people have type 1 diabetes, which most often develops in children, adolescents, or young adults.2

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How Is Smoking Related to Diabetes?

We now know that smoking causes type 2 diabetes. In fact, smokers are 30–40% more likely to develop type 2 diabetes than nonsmokers. And people with diabetes who smoke are more likely than nonsmokers to have trouble with insulin dosing and with controlling their disease.3

The more cigarettes you smoke, the higher your risk for type 2 diabetes.3 No matter what type of diabetes you have, smoking makes your diabetes harder to control.

If you have diabetes and you smoke, you are more likely to have serious health problems from diabetes. Smokers with diabetes have higher risks for serious complications, including:4

  • Heart and kidney disease
  • Poor blood flow in the legs and feet that can lead to infections, ulcers, and possible amputation (removal of a body part by surgery, such as toes or feet)
  • Retinopathy (an eye disease that can cause blindness)
  • Peripheral neuropathy (damaged nerves to the arms and legs that causes numbness, pain, weakness, and poor coordination)

If you are a smoker with diabetes, quitting smoking will benefit your health right away. People with diabetes who quit have better control of their blood sugar levels.5

For free help to quit, call 1-800-QUIT NOW (1-800-784-8669) or visit CDC.gov/tips. Spanish-speakers can call 1-855-DÉJELO-YA
(1-855-335-3569) or visit CDC.gov/consejos.

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How Can Diabetes Be Prevented?

Don’t smoke. Smoking increases your chance of having type 2 diabetes.4

Lose weight if you are overweight or obese.6

Stay active. Physical activity can prevent or delay type 2 diabetes in adults who are at high risk for the disease.6

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How Is Diabetes Treated?

Diabetes treatment and management can include:7

  • A healthy diet and physical activity program
  • Weight loss (if overweight or obese)
  • Medicines to control blood sugar by helping the body use insulin better
  • Insulin taken by injections or by using an insulin pump
  • Patient education to address problem-solving and coping skills needed to help manage diabetes and its complications
  • Medicines to control cholesterol and blood pressure

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References

  1. Centers for Disease Control and Prevention. Basics About Diabetes [last updated 2012 Sept 6; accessed 2014 May 5].
  2. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes Overview [last updated 2014 Apr 2; accessed 2014 May 5].
  3. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2014 May 5].
  4. U.S. Department of Health and Human Services. A Report of the Surgeon General. How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2014 May 5].
  5. U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2014 May 5].
  6. Centers for Disease Control and Prevention. Diabetes Public Health Resource: Prevent Diabetes [last updated 2012 May 14; accessed 2014 May 5].
  7. Centers for Disease Control and Prevention. Diabetes Public Health Resource: 2011 National Diabetes Fact Sheet [last updated 2011 May 20; accessed 2014 May 5].

On this Page

Bill has diabetes. He quit smoking the day his leg was amputated.

“Having diabetes and being a smoker—my doctors always warned me about the bad things that could happen. Did I listen? No!”

Content provided and maintained by the US Centers for Disease Control and Prevention (CDC). Please see our system usage guidelines and disclaimer.

What Tobacco Free Florida Can and Can’t Do

As a government agency, the Florida Department of Health and the Bureau of Tobacco Free Florida cannot institute or advocate for new laws. We do, however, help inform the public about tobacco’s health risks and dangers, and local Tobacco Free Partnerships in each of Florida’s counties work to pass tobacco policies.

While there is no law banning the sale of tobacco in Florida, there has been steady progress made in strengthening youth prevention, raising prices of tobacco, restrictions on marketing, and protecting the public from secondhand smoke. All of these efforts limit the impact of tobacco use. Part of this is accomplished through statewide legislation such as the Florida Clean Indoor Air Act (FCIAA), which prohibits smoking in all enclosed workplaces, and Florida’s $1 state cigarette tax increase in 2009, which contributed to the overall decline in smokers in the state.

There has also been legal action in Florida against the tobacco industry and laws to protect the state’s comprehensive tobacco education and use prevention program. On August 25, 1997, Florida became the second state in the nation to settle a lawsuit against the tobacco industry. The tobacco lawsuits were intended to punish cigarette makers for decades of fraud and racketeering and to help states pay for the Medicaid and other public health expenses to cover sick smokers. Florida was among three other states – Texas, Mississippi and Minnesota – that settled with the tobacco industry before the Master Settlement Agreement of 1998 between the tobacco industry and the other 46 states, Washington, D.C., Puerto Rico and the Virgin Islands.

In 2006, Florida voters overwhelmingly approved a state constitutional amendment requiring that a percentage of the state’s settlement fund must be used for a comprehensive tobacco education and use prevention program. The funding was used to create Tobacco Free Florida. In 2012, Florida’s adult-smoking rate was at 17.7 percent, well below the national average of 19.6 percent. Further, the smoking rate for high school students in Florida dropped to 8.6 percent in 2013, below the national average of 23.3 percent, and the number of youth who have pledged never to smoke increased from 55 percent in 2006 to 67.7 percent.

Local communities can also strengthen many of their laws. We support these efforts by coordinating with and funding local Tobacco Free Partnerships in every county to provide education on these issues.

If you are interested in helping implement change in your community, we encourage you to get involved with your local Tobacco Free Partnership, which works to make tobacco use less acceptable and tobacco products less accessible to youth. For more information, please visit www.tobaccofreeflorida.com/getinvolved.

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Fact Sheet: Health Care Providers

Includes facts about the importance of health care provider interventions and how providers can Team Up to help patients quit.

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