Transcript Tobacco Control - Iowa Cancer Consortium

Dreams become reality
- success with tobacco control means
success with cancer control
Christopher Squier
College of Dentistry
University of Iowa
The presentation will:

review the relationship between tobacco and cancer

discuss the elements of tobacco control

celebrate our successes in tobacco control and describe
the challenges that remain

Tobacco use is the single most preventable
cause of cancer

Approximately 30% of all cancer is related to
tobacco use and this rises to 80% for lung and
oral cancer
Types of exposure to tobacco

Voluntary



Smoking
Smokeless – snuff and chewing tobacco
Involuntary

secondhand smoke
Why does tobacco cause cancer?
Because of what is in it – carcinogens

Smoke contains




Strong carcinogens (polycylic aromatic hydrocarbons e.g. benthanthracene)
Weak carcinogens (nitrosamines e.g. NNN, NNK)
Co-carcinogens (catechols)
Unburned (smokeless) tobacco contains

Weak carcinogens (nitrosamines e.g. NNN, NNK)
Why does tobacco cause cancer?
Because of where it goes
Into the mouth, airways and lungs
and then into the bloodstream
Cancers related to smoking


Lung cancer
Laryngeal cancer

Oropharyngeal cancer
Esophageal cancer

Other cancers

–
–
–
–
–
–
bladder
pancreas
kidney
stomach
cervix
breast?
Aero-digestive cancers represent the
majority of cancers related to smoking
(clear evidence of causality)
Other forms of tobacco exposure

Smokeless tobacco

Secondhand smoke
Smokeless tobacco
Recent data suggests that:

The risk of oral cancer from the use of chewing tobacco
and snuff is relatively low*
Chewing tobacco 1.2 (1.0-1.4)*
Moist snuff
1.0 (0.8-1.2)

The risk from dry snuff is high (but this is rare in the US)
Dry snuff

5.9 (1.7-20)
There may be a risk of pancreatic cancer associated with use of Swedish ‘snus’
* Relative risk and confidence limits; data from Rodu, B et al., Harm Reduct J. 3, 37,2006
Secondhand Smoke – why is it harmful?
Sidestream (secondhand) smoke has been shown to be more
carcinogenic than mainstream smoke (Ninth Report on Carcinogens,
U.S. Department of Health and Human Services Public Health Service National
Toxicology Program 2001)
You don’t get the benefit of the filter!
Cancers related to secondhand smoke exposure
Deaths from secondhand smoke *
~50,000 per year
SIDS
SIDS
431
Lung Cancer
4,400
Other cancers related
to SHS exposure;
– nasal
–breast
–cervix
–bladder
Ischaemic Heart Disease
46,150
*Attributable Risks Associated with ETS; Proposed Identification of Environmental Tobacco Smoke as a Toxic Air
Contaminant, California Environmental Protection Agency, March 2005
Tobacco Control is a three-legged stool
Effective
smokefree
legislation
Comprehensive
tobacco control
programs
$
Significant
taxation of
tobacco
In Iowa we have two of the legs in place!
Calls up 3x!
$
Effective
smokefree
legislation
Comprehensive
tobacco control
programs
Significant
taxation of
tobacco
TUPC budget
doubled!
SHS and Smokefree Legislation


We need comprehensive legislation to protect employees – it is
not about customers who can go elsewhere but about safe
workplaces for workers who cannot!
This is a public health not a business decision – we don’t leave
clean food preparation to the whims of the business owner,
why should we leave smokefree workplaces?
SHS and Smokefree Legislation
How do we get it?

State-wide legislation is very attractive but it is
easily corrupted by the tobacco lobby– everyone
wants an exception (casinos, bars, restaurants)

Local control brings
-
•
local debate and community change
ease of enactment; policy makers responsive to local wishes
ease of enforcement
Most of the states that have achieved state-wide legislation
have started with local control e.g. Illinois
The goal for the coming session
-repeal pre-emption
-gain local control
With your help we can do it!