Massachusetts Reduces Number of Youth Who Smoke
In 2015, 15.1% of all U.S. adults (nearly 40 million people) aged 18 years and over were current cigarette smokers.1 A 2012 Surgeon General’s report noted that nearly 9 out of 10 cigarette smokers first tried smoking by age 18, and 99% first tried smoking by age 26.2,3 Each day in the U.S., more than 3,200 youth aged 18 years or younger smoke their first cigarette, and an additional 2,100 youth and young adults become daily cigarette smokers.2 In 2015, Massachusetts had an estimated 708,000 adults who were current smokers.4 Additionally, 28,100 (7.7%) of high school students were current smokers and 2,800 kids (aged under 18) became new daily cigarette smokers.5
To address tobacco use in their state over the past 20 years, the Massachusetts Tobacco Cessation and Prevention Program (MTCP) has worked to educate residents and decision makers across Massachusetts on effective strategies to reduce tobacco use and its impact.6 Located within the Massachusetts Department of Public Health, MTCP uses a comprehensive approach combining evidence-based policy and programs to address tobacco use. MTCP’s efforts include youth programs, quit-smoking support, tobacco sales regulation enforcement, health systems improvement, and smoke-free workplace and multi-unit housing initiatives.7
MTCP provides free and confidential telephone counseling services through the Massachusetts Smokers’ Helpline to help Massachusetts residents quit smoking and using tobacco products. The Helpline provides advice on medications, in-person coaching, and assistance in determining whether individual insurance covers cessation services.8 Additionally, MTCP has established the QuitWorks program, a free, evidence-based referral service that enables clinicians to refer patients who use tobacco to the Helpline.9The Helpline averages approximately 9,000 callers per year, including those who call directly and individuals referred through QuitWorks,8 and almost 66,000 patients have been referred through QuitWorks since it launched in April 2002.10 Among patients who used QuitWorks, 86% said that their healthcare provider increased their motivation to quit using tobacco.11
Other MTCP initiatives focus on smoke-free environments, including housing, the workplace, and public spaces. MTCP has worked with community partners to raise awareness about the dangers of secondhand smoke and the health benefits of smoke-free policies in multi-unit buildings.12 Additionally, MTCP and their partners provide education on the benefits and challenges of establishing smoke-free housing through training and technical assistance for landlords and managers to implement policies.12
A central component of MTCP’s efforts is to reduce the tobacco industry’s influence on youth at the local level through informing local regulations and other policies. The most effective policies increase the price of tobacco, limit its availability, and decrease youth exposure to tobacco products. As youth smoking rates in Massachusetts have declined due to higher prices and restrictions in youth access, the tobacco industry has responded with new products.13 In 2011, the rate of tobacco product use other than cigarettes was 16.8% among high school students.13 That is higher than the rate of cigarette use. To address this issue, in 2008, MTCP partnered with Health Resources in Action to develop and implement a youth initiative entitled “The 84.” The initiative is a statewide movement of high school students who work to educate peers and adults about the tobacco industry’s marketing tactics, create local and statewide change to reduce the influence of tobacco on communities, survey youth about their perception of pricing and availability of tobacco products, and promote social norms messaging around tobacco use. Currently, there are approximately 100 chapters across Massachusetts working in high schools or community-based organizations to implement these efforts. The 84 represents the 84% of Massachusetts youth who did not smoke when the movement began. As of today, 92% of Massachusetts youth do not smoke cigarettes.14
Furthermore, MTCP funds community partnership programs that build the capacity of communities to implement tobacco policies, interventions, and communications initiatives; and municipal health departments to implement local policies and conduct surveillance and enforcement. MTCP’s guidance for local municipalities includes recommendations by local municipalities regarding evidence-based tobacco regulations that restrict the sale of flavored tobacco products and electronic cigarettes; prohibit the sale of tobacco in pharmacies; regulate single cigar sales; and cap the number of tobacco retailers allowed in a municipality.15 For example, after a 53% increase in revenue on cigars sold in Massachusetts (2006-2009), municipalities began implementing regulations to set the minimum price of single cigars to $2.50 and require multi-packs of cigars to be sold for at least $5.00. A 2014 survey of approximately 70% of tobacco retailers in the state indicated that compliance to these policies was strong. In the 65 surveyed communities with the policy, 85% of retailers did not sell single cigars under $2.50. Additionally, the survey indicated that 71% of retailers in communities without a pricing policy sold single cigars, compared to 45% of retailers in communities with a pricing policy.16 As of September 2016, 131 municipalities in Massachusetts have implemented a pricing policy. Additionally, youth use of cigars has decreased in Massachusetts from 14.3% in 2011 to 10.4% in 2015,17 contributed to in part by the pricing policy that discourages youth purchase and use.
MTCP will work to educate residents and decision-makers on effective strategies to reduce tobacco use and its impact throughout the state of Massachusetts. The program will continue to implement and evaluate smoke-free initiatives, including smoke-free housing. Currently, MTCP is evaluating the impact of the smoke-free housing policy on resident tobacco use, exposure, and health outcomes. Furthermore, the program will continue to take a comprehensive approach to tobacco prevention and cessation programming throughout the state by shifting their focus to disparities. MTCP will build on the evidence around tobacco use and exposure by disparate populations through focus groups and research collaborations; adapt population-based strategies to engage and address disparate populations that are burdened by tobacco use and exposure; conduct surveillance on the retail environment, pricing, and behaviors to identify emerging trends in tobacco industry tactics and changes in tobacco use and disparities; and advance the science behind tobacco prevention and cessation intervention and policies.
Massachusetts Tobacco Cessation and Prevention Program
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