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Telebriefing Transcript
MMWR Update about Smoking with
Dr. Terry Pechacek

December 13, 2001

CDC MODERATOR: Good morning. I want to thank everyone for calling into this MMWR update. As you know, the topics that we will be discussing are the two articles that appear specifically regarding tobacco. I also wanted to take a moment and point out the other two articles that are in the MMWR, for your information, the first one being valley fever following attendance at the World Championship of Model Airplane Flying in Kern County, California, in October 2001. The main message in this piece is persons who attended this event and developed symptoms, specifically a flu-like illness with fever, chest pain, cough, malaise, chills, night sweats, pain and rash, should seek appropriate medical care.

The other article is an update on progress toward polio eradication in the Eastern Mediterranean region, looking at January 2000 through September 2001. This region includes Pakistan, Afghanistan, Somalia, and Sudan. If you have questions about those two particular articles, please call the press office and the Division of Media Relations at CDC at [404] 639-3286. Also keep in in mind that information discussed in the teleconference is embargoed until 4:00 p.m. today.

This teleconference will be thirty minutes, and, also, a full transcript of the teleconference will be available later on today on the Web site at, and also the teleconference will be Webcast today at 4:00 p.m. on the Web site in a listen-only mode.

And now I'd like to introduce Dr. Terry Pechacek, who is the associate director of Science for the CDC Office of Smoking and Health. He will be the speaker today. I'll take a moment and spell his name for you. His first name is T-e-r-r-y. Second name, Pechacek, is P-e-c-h-a-c-e-k. And, again, he's the associate director of Science for CDC's Office of Smoking and Health.

Dr. Pechacek.

DR. PECHACEK: Good morning, or I guess it's starting to be almost afternoon.

With this release of data, we are fulfilling what was established in 1996, that cigarette smoking preference has become a nationally-notifiable condition, and the other new things about today today is the releasing data on metropolitan areas, not just states. We have been reporting on states for a number of years.

As is well-recognized, tobacco use, particularly cigarette smoking, is the leading preventable cause of death in the United States, but the health consequences extend beyond smokers to nonsmokers, and involuntary exposure to environmental tobacco smoke, or secondhand smoke, also creates a large amount of health risk and consequence as well, and we're reporting on both of these issues.

The findings of these studies suggest that very few states and metropolitan areas have met the Healthy People 2000 goal of 15 percent prevalence for adult smoking. This is a goal that we are tracking as a nation but encouraging all states and local areas to also track progress toward.

Now we also have set a goal for healthy people for the year 2010, and that goal is 12 percent. While we find that few states have met the goal for 2000, we feel that this 2010 goal is very attainable, if all states would implement the tobacco control program according to the guidelines contained in CDC's best practices for comprehensive tobacco control programs, and the National Association of County and City Health Official Program and Funding Guidelines, similarly, for comprehensive local tobacco control programs.

These, along with Surgeon General reports, and our other CDC recommendations, provide detailed recommendations on what works, and we know what kind of strategies work and we know that these need to be comprehensive and involve social, educational, clinical, economic and regulatory strategies.

Our data show that if these effective strategies were well-financed and implemented in a comprehensive fashion, we could see declines in smoking prevalence that would enable all states to reach this 2010 goal.

While we will be happy to talk about individual states, we want to focus on the overall kind of nature of this, and I'll be happy to take questions on the overall aspects of the study, or individual states or metropolitan areas as may be your interest.

CDC MODERATOR: All right. We're going to open up to questions.

AT&T MODERATOR: Thank you, and, once again, ladies and gentlemen, if you do have a question at this time, please press the one on your touchtone phone. You'll hear a tone indicating you've been placed in queue. You may remove yourself from queue at any time by depressing the pound key.

Once again, if you have a question, please press the one.

We do have a question from the line of Neil Sherman with Health Scout. Please go ahead.

QUESTION: I notice in the report on the metropolitan areas, that San Francisco is not included. Is there a reason?

DR. PECHACEK: The metropolitan areas were selected based on sample sizes available to us, and that have a minimum of 3,000--excuse me--300 in each of the sites, and so we're basing it solely on available sample size.

AT&T MODERATOR: Our next question is from Paul Munoz with CBS TV. Please go ahead.

QUESTION: Yes. Specifically, how was the study conducted and when was it conducted?

DR. PECHACEK: Well, these are two different reports. Let me talk about, first of all, the 2000 report on states. That is based upon a state-based random digit telephone survey that is actually ongoing, year by year, and this is data that was collected between January and December of the year 2000, and each state maintains this system in coordination with CDC.

The second study is using the similar data from the Behavioral Risk Factors Surveillance System, BRFS, system, state-based system, but it is looking at the prevalence, combining across individual state surveys to look at the 99 metropolitan areas.

AT&T MODERATOR: Our next question is from Emma Hitz with Reuters Health. Please go ahead.

QUESTION: Yes. Hi. I was wondering if you had any suggested reasons for why particular states or metropolitan areas might have a higher rate of smoking than others?

DR. PECHACEK: Well, first of all, we have seen for some time some variance between states, and actually some of these differences are fairly stable year-by-year, which suggests to us that there are broad cultural and social differences.

We know that states such as Utah have religious and social factors that are different, the Mormon religion and the lower overall smoking problems. We also know that in the Western portion of this country, particularly Arizona, California, Oregon, Washington, they both have stronger antismoking policies of clean indoor air legislation and other types of programs in place. So we do tend to see a difference between the Western states and other parts of the country.

But there are many factors we don't fully understand, and one of the things we are encouraging is all states to look at their trends and the patterns within their own state. And where the rates of smoking are high, we see that as an opportunity for great public health benefit of applying what we know works and applying effective tobacco control strategies.

AT&T MODERATOR: The next question is from Ted Vigowski [ph] with Public Broadcasting. Please go ahead.

QUESTION: Dr. Pechacek, very quickly what, of the interventions, impress you the most right now; for instance, the punitive taxation or insurance rebates or patches and other kinds of therapy? What seems to be working the best, at this point in time?

Thank you.

DR. PECHACEK: Our community preventive service guidelines have a, last fall, talked about the specific strategies that work. Raising the price of cigarettes is found to both work for preventing youth and promoting cessation among adults. We also find that sustained mass media advertising campaigns both work to prevent youth, as well as promoting adult cessation, particularly when those adult campaigns are linked with things such as quit smoking telephone lines, proactive quit lines, where people can call in for help. The media is leading those people to those.

Additionally, we find that the clinical-based strategies combining behavioral counseling and pharmaceutical aids, the nonsmoking drugs over-the-counter or from the doctor, are very effective and that programs that decrease barriers to those, and that means providing more insurance coverage and making those more available are something that can have a public health impact. So those are some of the strategies that work.

Additionally, smoking bans are the most effective way to reduce second-hand smoke, and that is one of the other aspects of this report is a nonsmoker's exposure to the completely preventable public health hazard of second-hand smoke, and the most effective strategy in all of our reviews is that total bans are the most cost-effective and effective strategies to do that.

AT&T MODERATOR: We have a question from the line of Miriam Falco with CNN. Please go ahead.

QUESTION: Hi. Based on what you just described on what does work, how does it help the two core groups that are probably the hardest to reach, and that is either the smokers who have absolutely no intention to quit because they're either so addicted or don't know that they're so addicted, and they think they just don't want to quit, and then teenagers, you mentioned that the media can help in spreading a message of how to quit, but then you also have Hollywood movies, television shows with increasing visibility of the characters smoking, which evidently also helps influence young people to start smoking, at least according to an article that came out in the PMJ this week.

So how do you rectify the two hardest things? I mean, I think if you're going to be able to provide the counseling, that means people have to want to--they're taking the first step, but how do you reach the people, what efforts can be done to reach those people who don't think they have a problem?

DR. PECHACEK: Okay. First of all, I'll take them as two separate groups, the adult quitters and then youth prevention.

First of all, with adults who are having a difficult time in quitting and may show less interest in quitting, what are recommended strategies from our Surgeon General's Report and our Community Preventive Task Force recommendation both agree that educating the smoking public is very important and mass media campaigns that provide information and increase motivation to quit are very effective in helping to bring people to easily accessible sources of health, particularly the quit smoking telephone lines that have been very effective in a number of states.

These mass media campaigns are very effective because they do reach the broad audience and reach all smokers, both those who are seeking information, as well as those who may not be stating an interest to quit yet. In the states that are doing these campaigns, they are reaching these harder-to-reach individuals and are very successful in helping them quit.

Secondly, on smoking prevention, again, we have very good data about what works. As I mentioned before for both promoting quitting and helping prevent initiation, raising the price of cigarettes is one of the uniformly most effective strategies, and it is twice as effective with youth. In other words, they are twice as sensitive to the price increase and in discouraging them from starting to smoke.

Secondly, we have very effective media campaigns that are being mounted in a number of states with additionally a nationwide campaign funded by the American Legacy Foundation that focuses on teaching youth why they should be very resistant to all of the allures of tobacco. These campaigns are called truth, marketing the brand of truth, what is the truth about tobacco, and it builds a resistance against the pro-tobacco influences like those that you mentioned in the movies, as well as the continuing $8.2 billion-marketing campaign of the tobacco industry.

So these types of strategies do reach youth and, in fact, have significantly reduced youth initiation rate in a number of states, including California, Arizona, Massachusetts, Oregon, Florida, and more. So it is a matter of getting these effective campaigns to youth in all states.

AT&T MODERATOR: Just a quick reminder, ladies and gentlemen, if you do have a question, please press the one.

We do have a follow-up with Paul Munoz with CBS TV. Please go ahead.

QUESTION: Yes, I'm trying to understand what the nationwide median is, the way this is broken down is with men and women, and I'm wondering if there is a number to help our audience understand how our metropolitan area fits into this and how our tri-state region fits in, as a group of men and women. Does that number exist in your file?

DR. PECHACEK: The median level overall for the country in the BRFS was 23.3 for all adults, with the median for men as 24.4, and for females 21.2.

Now the median gives you kind of a reference number to compare against for any state or metropolitan area. Now, similarly, you'll find within the 99 metropolitan areas, there is another median across those that are slightly different. That is combining across the 99, and the median there is 22.7 overall, 24.0 for men, and 21.4 for women. Either of those numbers are, as you noticed, they're very similar, and neither one can be used a general kind of comparison point, in terms of who is higher or lower.

There obviously are places that are higher and lower, and when you look at this, you need to recognize that there are a number of factors that differ between metropolitan areas, in terms of age, and demographics. We do encourage that all sites try to reduce their level of smoking below the 12-percent goal for 2010.

AT&T MODERATOR: We do have a follow-up from the line of Neil Sherman with Health Scout. Please go ahead.

QUESTION: Do we know what's going on in Toledo, Ohio, at all?

DR. PECHACEK: Well, first of all, we place some caution in picking any one place or any one value. If you will notice, this is the first time we're putting out the local data, and due to the smaller sample sizes, the confidence intervals are somewhat larger.

So, in our analysis, it's inappropriate to focus probably on one place. However, we know that several metropolitan areas are significantly higher than other parts of the country, and I think that's probably generally relevant that there are some places that are higher. They tend to be in the middle of the country--Ohio, Tennessee, Indiana. So that's consistent with what we see in the statewide data, that our higher smoking prevalences tend to be in the middle part of the country. There might be a variety of factors which we don't fully understand that account for this, but we're also very encouraged that a number of these states are now moving toward funding of new comprehensive programs, particularly, Indiana and Ohio. So these states are already taking action to address this issue.

AT&T MODERATOR: We do have a follow-up from Paul Munoz. Please go ahead.

QUESTION: Yes, Doctor, I'm trying to understand if there's any reason why the Passaic-Bergen County region of New Jersey would have such a markedly lower percentage of people smoking, compared to the statewide average, by about 3 percent.

DR. PECHACEK: Well, again, the caution that these are fairly wide confidence intervals. So we're not finding a significant difference between sites within New Jersey. The point estimate is lower, but we need to track these over time, and we have not done the types of analyses that might explain these differences.

One of the things we want to do by putting these data out is encourage more research that will look at things such as the 2000 census data, other types of information on smoking programs and policies, and linking these together with this variation that we see across the area, so we can explain more about why some places are higher and why some places are lower. That level of research is what we're trying to encourage by the release of these data.

AT&T MODERATOR: We have no further questions in queue.

CDC MODERATOR: Dr. Pechacek, do you have anything else that you'd like to add?

DR. PECHACEK: I would like to focus a bit more on the secondhand smoke issue. We have 20 states that were participating this year, in the 2000, on the optional questionnaires that are tracking our policies and programs for protecting nonsmokers. We're encouraging more states to do this, and this is an important additional indicator besides smoking.

First of all, we're overall encouraged by the relatively high levels of support for most of these policies, and particularly for the almost uniform support for no smoking in schools, day care centers and those types of environments.

We also think it's very striking the high rates of not smoking in homes, which is an important place for protecting particularly smaller children. Our other research has shown that homes are a primary exposure point for young children to secondhand smoke, which includes over 250 toxic and carcinogenic compounds.

We're encouraging more states to participate in this, this optional tracking, and we're hoping to see continued improvement in the level of protection afforded to nonsmokers. You will notice that we have, in general, a very strong support across the nation for not smoking in indoor work areas, and the support for that tends to be higher than the level of protections that is being currently offered in states. In other words, people want more protection in their workplace than is currently being offered.

CDC MODERATOR: Any questions?

AT&T MODERATOR: No further questions.

CDC MODERATOR: Okay. Well, then that concludes our MMWR update telebriefing. Thank you all for being here. And, again, a full transcript of the teleconference will be available today, typically, around 3 o'clock, and the teleconference will also be webcast today at 4 o'clock on the CDC website.

AT&T MODERATOR: And, ladies and gentlemen, that does conclude your conference for today. We do thank you for your participation, and you may now disconnect.

[Whereupon, the telebriefing concluded.]

Listen to the telebriefing

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