Tobacco use—in all its forms—is an issue of high concern in Alaska, as indicated by Health Assessment Survey respondents noting it as a significant challenge in the state. There are also notable disparities in prevalence rates in tobacco use between Alaska Native/American Indian people and non-Native people in Alaska. The HA2020 plan had two leading health indicators measuring tobacco use rates for adults and adolescents. Improvement was made on both indicators for all Alaskans. The HA2030 team decided to keep tobacco objectives in the plan to continue the progress being made and set new targets to address emerging tobacco trends.
The Behavioral Risk Factor Surveillance System (BRFSS) and the Youth Risk Behavior Surveillance System are the main data sources for the adult and adolescent tobacco use objectives. HA2030 contains updated these two objectives to address all tobacco products listed in the YRBS (cigarette use, smokeless tobacco use, electronic vapor product use, Iqmik use and Cigar use) and BRFSS (cigarette use, smokeless tobacco use (including Iqmik) and electronic vapor product use). The updated HA2030 language, “other tobacco products”, is used for both objectives to cover the rapidly changing and emerging tobacco products and trends for both adolescents and adults.
Minimum legal age for tobacco laws specify an age below which the purchase or public consumption of tobacco is illegal, often 18, 19, or 21. Some states have age restrictions for sales but have not passed laws setting a minimum consumption age. Initiatives to increase the age to 21 are often referred to as ‘Tobacco 21.’ Estimates indicate 95% of adult smokers began smoking before age 21 (CTFK-Minimum tobacco age).Regulations that restrict tobacco marketing limit promotion, placement, flavoring, or pricing of tobacco products. Regulations can restrict point-of-sale (POS) advertising, signs, and displays (Robertson 2015), require minimum package sizes (e.g., no less than 20 cigarettes), and written warnings for tobacco products (CTFK-FDA 2010). Regulations can also prohibit sales in health-oriented facilities such as pharmacies (PHLC-Tobacco in pharmacies), prohibit daytime advertising, limit the number, size, or location of ads posted by businesses (PHLC-Tobacco advertising), and prohibit print ads in child-oriented newspapers and magazines (CTFK-FDA 2010). The federal Family Smoking Prevention and Tobacco Control Act regulates sales of cigarettes and smokeless tobacco. State and local governments can further restrict promotions and pricing of cigarettes and smokeless tobacco (CTFK-FDA 2010) and restrict sales and promotion of other tobacco products such as cigars, cigarillos, and pipe tobacco (Farley 2017), but may not restrict advertising content (CTFK-FDA 2010).Taxes at the federal, state, or local level can increase the price consumers pay for tobacco. Revenue generated from tobacco taxes may fund tobacco prevention and control interventions.
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Quitlines provide behavioral counseling to tobacco users who want to quit. Cessation specialists schedule follow-up calls after the specialist or tobacco user makes initial contact using a proactive quitline; reactive quitlines rely solely on tobacco users to make future contact. Some quitlines provide additional interventions such as mailed materials, web-based support, text messaging, or tobacco cessation medications (CG-Tobacco use). Many quitlines offer services in multiple languages (NAQC-US)Tobacco cessation therapies such as nicotine replacement therapy (NRT) and individual, group, and telephone counseling often include out-of-pocket costs for patients. Efforts to increase affordability of cessation therapies can include eliminating patients’ out-of-pocket expenses or reducing patients’ expenses by eliminating co-payments, limits on duration of treatment, prior authorization, or annual limits on quit attempts (CG-Tobacco use). As of 2016, the US Food and Drug Administration (FDA) has approved nine therapies for tobacco cessation: individual counseling, group counseling, nicotine patches, nicotine gum, nicotine lozenges, nicotine nasal sprays, nicotine inhalers, Bupropion, and Varenicline (CDC-MMWR-DiGiulio 2016).
Mass media campaigns use television, print, digital or social media, radio broadcasts, or other displays to share messages with large audiences (Cochrane-Carson-Chahhoud 2017). Tobacco-specific campaigns educate current and potential tobacco users about the dangers of tobacco and often include graphic portrayals or emotional messages to influence attitudes and beliefs about tobacco use (CG-Tobacco use).
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Smoke-free policies for indoor areas prohibit smoking in designated enclosed spaces. Private sector smoke-free policies can ban smoking on worksite property or restrict it to designated, often outdoor, locations. Smoke-free state laws and local ordinances can establish standards for all workplaces, designated workplaces, and other indoor spaces. Policies can be comprehensive, prohibiting smoking in all areas of workplaces, restaurants, and bars, or limit smoking to designated areas via partial bans (Cochrane-Frazer 2016). Restrictions may also extend to adjacent outdoor areas (CG-Tobacco use). Some local governments cannot enact smoke-free measures due to state preemption legislation (Grassroots Change).Smoke-free multi-unit housing policies prohibit smoking in apartments, duplexes, and similar residences. Policies can apply to both common areas and individual units, and often include adjacent outdoor areas. Private sector rules apply to privately owned rental properties and owner-occupied units such as condo complexes; state and local ordinances apply to public and subsidized housing. Non-smoking residents of multi-unit housing are often exposed to secondhand smoke (SHS) in their homes from other units or common areas (Snyder 2016). The US Surgeon General indicates there is no risk-free level of SHS exposure (US DHHS SG-Smoking 2014). Residents, especially children, can also be exposed to thirdhand smoke (tobacco residue on surfaces and furnishings), in their home (Bartholomew 2015, Matt 2011).
Provider reminder systems remind or encourage health professionals to support tobacco cessation among their patients. Such systems can include provider trainings, organizational protocols or referral processes, financial remuneration for providers, and materials such as self-help pamphlets and pharmacotherapy (e.g., nicotine replacement therapy (NRT)) (Rosseel 2012). A 2013 survey suggests that physicians are more likely to advise quitting than to discuss cessation strategies or medications (NCQA 2013).Quitlines provide behavioral counseling to tobacco users who want to quit. Cessation specialists schedule follow-up calls after the specialist or tobacco user makes initial contact using a proactive quitline; reactive quitlines rely solely on tobacco users to make future contact. Some quitlines provide additional interventions such as mailed materials, web-based support, text messaging, or tobacco cessation medications (CG-Tobacco use). Many quitlines offer services in multiple languages (NAQC-US)
Because youth and adults continue to be heavily exposed to pro-tobacco media, advertising, and promotion, public education campaigns are needed to prevent tobacco use initiation and to promote cessation (CDC, Best Practices, 2014). Mass media campaigns use television, print, digital or social media, radio broadcasts, or other displays to share messages with large audiences (Cochrane-Carson-Chahhoud 2017). Tobacco-specific campaigns educate current and potential tobacco users about the dangers of tobacco and often include graphic portrayals or emotional messages to influence attitudes and beliefs about tobacco use (CG-Tobacco use).
Taxes at the federal, state, or local level can increase the price consumers pay for tobacco. Revenue generated from tobacco taxes may fund tobacco prevention and control interventions. Some local governments cannot enact such measures due to state preemption legislation (CG-Tobacco use).
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