Addressing Disparities in Tobacco Use & Cessation:

Challenges and Opportunities

Jacqui Drope Managing Director

Global Cancer Prevention

November 2016

The ACS Center for Tobacco Control: Fighting Disparities

• The Center’s overarching priority is to combat tobacco-related disparities in communities suffering from disproportionately higher tobacco use rates and disproportionate incidence of tobacco-caused morbidity and mortality, such as:

• Low socioeconomic status (SES) • Behavioral and substance abuse disorders • Lesbian, gay, bisexual, and transgender (LGBT) • Racial/ethnic minorities • Homeless

Benefits of Cessation

10 years of life gained back

6 years of life gained back

4 years of life gained back

QUIT BY AGE

50

QUIT BY AGE

60

QUIT BY AGE

40

Smokers Want to Quit

• 70% of smokers want to quit

• Fewer than 5% of those who try to quit smoking succeed

Smoking Among Vulnerable Groups

• High prevalence of combustible tobacco use among vulnerable populations

• Low quit rates

• Need to consider less harmful options and new products to enhance long-term cessation success

Three Populations Smoke at Highest Rates in U.S.

• The poor (>8 million smokers below poverty level)

• The least educated (>22 million smokers with a high school education, or less)

• Those with co-morbid mental health or addictive disorders smoke 40% of all cigarettes

Pharmaceutical Nicotine Replacement Therapies: Benefits

• Safe to use

• Use of NRT approximately doubles the likelihood of quitting

• Use of a combination of NRT products has been shown to increase cessation rates compared to use of a single product

NRT: Disadvantages

• Slow nicotine delivery

• Cost considerations • Misconceptions about health risks

• Developed to be cessation aids rather

than long-term alternatives to smoking

• Strict product regulation

• Lack of wide availability

• Questions about long-term effectiveness

Smokeless Tobacco

• Used around the world in a wide variety of forms

• Carcinogenic and chemical compounds vary considerably depending on the type of product and manufacturing process

• Low nitrosamine smokeless tobacco products less harmful compared to conventional cigarettes

Smokeless Tobacco: Swedish Style Snus

• Sweden is the world leader in

reducing smoking prevalence and smoking-related mortality and morbidity

• Research does not support the belief that widespread use of snus or smokeless tobacco is a gateway to smoking among youth

Electronic Nicotine Delivery Systems (ENDS)

• Devices that do not burn or use tobacco leaves

• Some contain nicotine; some do not

• The main constituents of the solution, in addition to nicotine when nicotine is present, are propylene glycol and flavouring agents

• ENDS solutions and emissions contain other chemicals, some of them considered to be toxicants

ENDS Efficacy for Cessation?

Continuum of Risk

Source: Nutt, DJ et al (2014). Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res, 20, 218-225

Synthesis

• NRTs are safe alternatives to smoking but have led to limited

long-term success in cessation

• Evidence supports that ENDS are less harmful than combustible tobacco

• Smoking marginalized to vulnerable populations who have a

difficult time quitting or are unwilling to quit

• Majority of smokers will likely continue combustibles without acceptable less harmful alternatives

• Continuum of risk associated with nicotine-containing products

• We need to figure out how best to start communicating this

continuum better so that smokers make informed decisions

Contact Us

ACS Center for Tobacco Control ACStobaccocenter@cancer.org

Cliff Douglas, J.D. Vice President, Tobacco Control Director, Center for Tobacco Control American Cancer Society Cliff.Douglas@cancer.org

Jacqui Drope Managing Director, Global Cancer Prevention and Early Detection American Cancer Society Jacqui.Drope@cancer.org