The Nebraska Unicameral approved, and Governor Mike Johanns signed, legislation that allows the funding of $1.5 million per year from the Tobacco Master Settlement Agreement for tobacco prevention and control.

The legislation will be in effect for approximately twenty years.

Senators Jim Jensen of Omaha and Dennis Byars of Beatrice led the fight to re-fund the Tobacco Free Nebraska program. Under the program, tobacco use within the past 30 days by Nebraska teens declined from 39.2 percent in 1997 to 24.1 percent in 2003.

The floor debate was also led by several other senators. Senators Patrick Bourne, Ernie Chambers, Pat Engel, Joel Johnson, and Lowen Kruse all spoke in favor of taking the annual $1.5 million from the Master Settlement Agreement money that comes into the state each year.

While the annual allotment is still far short of the $13.8 million annual minimum recommendation for Nebraska from the Centers for Disease Control, prevention leaders hailed the passage of the $1.5 million. “Tobacco Free Nebraska has been an efficient and effective prevention program, and we thank the Nebraska Legislature for approving the continuation of this program.” states Susie Dugan, PRIDE-Omaha, Inc. Executive Director.

To contact state senators, you may write to them at:

On March 18, 2004, Idaho Governor Kirk Kempthorne signed into law a bill that eliminates smoking in all workplaces, except stand-alone bars and bowling alleys. The law will take effect on July 1, 2004.

New York City’s smoke-free workplace law took effect in March, 2003. According to Commissioner of Finance Martha Stark, “New York’s bars and restaurants paid the city 12% more in business taxes in the months since the law began than they did in the corresponding period in 2002.”

In addition to higher revenues, almost 10,000 new jobs were added to New York City’s hospitality industry, according to data from the New York State Department of Labor.

This report continues the trend found across the nation—when actual sales tax revenues are tabulated and compared to previous years, cities that have passed ordinances to ban smoking in workplaces are experiencing no drop in bar/restaurant revenue. Most have experienced increases in business.

~ Omaha World Herald, January 18, 2004

On December 16, 2003, the City of Ralston became the third city in Nebraska to pass an ordinance to put all retail tobacco and nicotine products out of the reach of children.

The ordinance, introduced December 2nd by Council member Maureen Konwinski, was the result of community involvement by youth, parents, and other concerned citizens.

Pam Jorgensen, a member of the Ralston Community Drug Awareness Council, worked to help make the ordinance a reality. Jorgensen states that the push to get the ordinance passed started earlier this year. A group of students from the Clown Troupe at the Ralston Middle School had sent the City Council an interest survey on the subject.

The Drug Awareness Council then studied the information from PRIDE-Omaha, Inc. and our “Operation Storefront” findings regarding retail placement of tobacco products. Other community members soon joined the effort and approached Council member Konwinski.

The new ordinance places tobacco products behind the counter requiring the assistance of a store clerk. The ordinance also makes it unlawful to give away free samples of cigarettes or to sell single cigarettes.

The cities of Plattsmouth and Omaha passed similar ordinances in 2002.

Health advocates who proposed a 100% smoke-free workplace ordinance in Lincoln, NE are criticizing the final law that passed on December 22, 2003.

The Lincoln City Council overrode a veto by Mayor Coleen Seng and passed a complicated workplace smoking ban. Mayor Seng had vetoed the ordinance saying it was not fair to all workers, not fair to all business owners, and unenforceable.

The Lincoln Police Department, Law Department, and Lincoln-Lancaster County Health Department warned that the law does not protect all workers, that it will be difficult to enforce, and that it could leave the city vulnerable to legal challenges.

According to the Omaha World Herald, Lincoln-Lancaster County Health Director Bruce Dart, who supported the original 100% smoke-free workplace ordinance, criticized the final law because it is unfair to say that some employees and patrons must breathe secondhand smoke while others don’t.

The final ordinance takes effect in July, 2004, and bans smoking in public areas and workplaces, including restaurants. Smoking will be allowed in hotels, smoke shops, and bars where food comprises less than 60% of total sales. Other businesses are allowed to have special smoke rooms set aside for employees and the public. Bars that allow smoking cannot admit anyone under 18 into the bar.

“Progress in Reducing Tobacco Use Across Nebraska: A Snapshot Progress Report on Tobacco Free Nebraska (TFN)” is an evaluation report of Nebraska’s comprehensive tobacco program. The report has been recently released by White Mountain Research Associates, L.L.C.

Since 1997, there has been a continual decline in the percentage of Nebraska youth who have ever used or are currently using tobacco. The percentage of youth who smoked cigarettes in the past 30 days dropped from 39.2% in 1997 to 24.1% in 2003.

The percentage of Nebraskans:

	who reported that their households do not allow smoking anywhere in the home increased from 71% in 2000 to 76% in 2003.
	who reported that they were no longer exposed to secondhand smoke at work also increased, with 77% reporting that their workplace did not allow smoking in any area in 2003, compared to 65% in 2000.
	who reported that smoking should not be allowed at all in workplaces increased from 65% in 2000 to 81% in 2003.

Percentage of Nebraska Youth Who Used Tobacco Products

Just The Facts ...

Across The Globe

Countries Go Smoke Free

Faith-Based Coalitions Urge Governors To Fund Tobacco Prevention

1. Use your head.  Tobacco is responsible for close to 420,000 deaths each year.

2. Stay active. Exercising and participating in sports is nearly impossible if you smoke cigarettes.

3. Stay informed. Young smokers are 100 times more likely to smoke pot and become addicted to other illicit substances such as heroin and cocaine.

4. Be aware of the risks. Smoking can lead to many physical problems, including emphysema, heart disease, stroke, and cancer.

5. Keep your edge. Smoking makes you smell bad, gives you bad breath, and gives you premature wrinkles.

6. Play it safe. Experimenting with smoking could lead to full-fledged addiction and a lifetime of trying to quit.

7. Do the smart thing. Smoking puts your health and the health of those around you at risk.

8. Get with the program. Smoking isn't "in" anymore.

9. Find ways to reduce anxiety. Smoking may actually contribute to your state of agitation.

10. Be a real friend. If you know someone who smokes, be part of the solution. Urge your friend to get help and quit.

FACTS ABOUT TOBACCO IN NEBRASKA

Tobacco is an addictive drug.

Cigarettes, cigars, chew, snuff, dip and pipe tobacco contain the addictive drug nicotine. Former U.S. Surgeon General C. Everett Koop has stated that nicotine is more addictive than heroin or cocaine. Tobacco is a drug. It is a controlled substance for a great number of Nebraska citizens (namely all of those citizens under the age of 18.) Nicotine addiction begins as early as the third cigarette.

Tobacco causes illness and death.

Tobacco use causes over 400,000 deaths in the United States each year. Approximately 2,600 people in Nebraska die each year as a result of smoking-related diseases.

Tobacco use is a factor in more deaths than all other drugs combined. Smokers have ten times the risk of lung cancer and two times the risk of heart disease of nonsmokers. Eighty percent of deaths from lung diseases such as emphysema and chronic bronchitis can be attributed to smoking.

Tobacco is a gateway drug.

Young people who use tobacco are much more likely to try other drugs than those who do not use tobacco. Research has found that over half of all cocaine users began with tobacco as their introductory drug, and they first used tobacco as a child. Illegal drug use is rare among those who have never smoked. Tobacco use teaches children how to sneak, how to lie, how to steal, how to inhale a drug and how to take risks and pleasure from using a drug. Tobacco use is often the first crime a child commits.

90 % of all tobacco users begin their use by age 19. Adults rarely start using tobacco for the first time. 37% of all Nebraska high school seniors are regular smokers.

Each year, more than 1 million children begin using tobacco. 

3,000 young people begin to smoke each day in America.

The tobacco industry realizes an estimated $221 million profit from illegal sales to minors each year.

Tobacco advertising is especially appealing to children, and does effect children’s behavior.

According to the Center for Disease Control, a 1993 study found that 86% of underage tobacco users ages 12-18 buy Marlboro, Camel or Newport, the three most-heavily advertised cigarette brands. Brand awareness in childhood carries throughout a lifetime. After the Joe Camel campaign started in 1988, Camel’s share of the children’s market rose from 0.5% in 1988 to 32.8% in 1992. A 1997 study found that industry promotional "giveaways" of non-tobacco products do entice kids to smoke.

The tobacco industry spends at least $6 billion each year to advertise and market its product.

The cost to Nebraska, in terms of lost productivity, morbidity and health care is estimated to be $330 - $360 million each year. Yet, tobacco tax revenue in Nebraska is less than $42 million. ($39,656,428 for cigarettes, and $1,975,836 for all other tobacco products.)

TOBACCO INDUSTRY DOCUMENTS SHOW TARGETING OF YOUTH

The State of Minnesota and Blue Cross and Blue Shield of Minnesota have sued 7 tobacco companies, The Tobacco Institute, and the Council for Tobacco Research to recover $1.8 billion spent treating smoking-related illnesses.

Among the internal tobacco industry documents revealed through this trial about marketing to youth:

• "They represent tomorrow’s cigarette business…As this 14-24 age group matures, they will account for a key share of the total cigarette volume-for at least the next 25 years. –RJR marketing plan presented to the company’s board of directors, 1974.

• "Growth is from 16-25-year-olds. At the present rate, a smoker in the 16-25-year age group will soon be three times as important to KOOL as a prospect in any other broad age category."—1973 B&W memo

• "Young blacks have found their thing. It’s menthol in general and KOOL in particular."—1974 Philip Morris marketing plan.

• "Evidence is now available to indicate that the 14-18-year old group is an increasing segment of the smoking population. RJR-T must soon establish a successful new brand in this market if our position in the industry is to be maintained over the long term." –1996 RJR memo

• "A careful study of the current youth jargon, together with a review of currently used high school American History books and like sources for valued things might be a good start at finding a good brand name and image theme." –1997 study by Canadian cigarette maker attempting to find out why children begin smoking.

• "…[A] new brand aimed at the young smoker must somehow become the "in" brand and its promotion should emphasize togetherness, belonging and group acceptance, while at the same time emphasizing individuality and ‘doing one’s own thing’…"

  ~ Philip Morris study of "hyperkinetic" grade school children.

  ---

THE TRUTH ABOUT SECONDHAND TOBACCO SMOKE

Secondhand Smoke: 

	is the third leading cause of preventable death in the United States. 1
	is a mixture of the smoke given off by the burning end of a cigarette, pipe, or cigar, and the smoke exhaled from the lungs of smokers. 2
	contains more than 4,000 chemical compounds.  Of these, 43 are known to cause cancer. 4
	is classified as a Class A Carcinogen by the Environmental Protection Agency. 2
	is a cause of disease and death in healthy nonsmokers.  Each year, Secondhand smoke kills and estimated 3,800 adult non-smokers from lung cancer, 12,000 from other cancers and 60,000 from heart disease and 200 from bronchitis or pneumonia. 7
	can cause significant amounts of nicotine and carbon monoxide in nonsmokers. 4
	is the only source of nicotine in the air. 4

Children and Young People Exposed to Secondhand Smoke:

	experience 150,000 to 300,000 lower respiratory tract infections each year. 4
	are hospitalized for pneumonia and bronchitis 7,500 to 15,000 times each year. 4
	have at least 10% more colds and acute respiratory infections than unexposed kids.  5
	miss 39% more school days than those not exposed. 8
	experience increased numbers and severity of asthma attacks. 5
	develop between 8,000 and 26,000 new cases of asthma each year. 4
	as infants, are 3 times more likely to die from SIDS if their mothers smoke during or after birth. 4
	are more likely to have middle-ear infections, reduced lung function, chronic cough, wheezing and phlegm than those not exposed. 4

Exposure to Secondhand Smoke in Restaurants and Workplaces:

	can cause workers to be 34% more likely to get lung cancer.  Compared to other female workers, waitresses in one California study were found to be 4 times more likely to die from lung cancer and 2.5 times more likely to die from heart disease. 6
	cannot be eliminated by air filtering systems.  Entire buildings need to be smoke free or smoking areas need to be separately ventilated to the outside to protect workers and customers. 9
	leaves business vulnerable to lawsuits from workers and customers. 9
	hurts businesses.  Some people, concerned about health, avoid smoky businesses.  Research proves that most businesses see improved business and improved bottom lines after going smoke free.  9

The right to breathe safely is more important than the right to smoke!

1.  “Smoking and Health Review”, Action on Smoking and Health,  July-August, 1991, Vol. 21, No. 4 

2.  “Secondhand Smoke”, Environmental Protection Agency, Washington, DC 20460, July, 1993, # 402-F-93-004. 

3.  “Secondhand Smoke: Smoke Alarm”, by  Betty  Gibb, The Listen Drug Facts Series, Listen Magazine, 1990. 

4.   “Facts About Secondhand Smoke”, U.S. Dept. Of Health and Human Services, CDC. 

5.   Tobacco Control Magazine report, Centers for Disease Control and Prevention Research by David Mannino, May 14, 1996. 

6.   Brooks, D., “Employment as a Waitress or Waiter and Risk of Lung Cancer. Boston, MA, Bureau of Health Statistics, Research and  Evaluation, Mass. Dept.  of Public Health, Nov., 1995. 

7.   Kawachi, I, et al.  A  prospective study of passive smoking an coronary heart disease, Circulation  95: 2374-2379, April 15, 1997 and Circulation, 86:699- 702, 1992, from: Secondhand Smoke, Clearing the Air in Enclosed Workplaces and Public Places. 

8.   Silvis, Gregory L. MD and Perry, Cheryl, PhD, “Understanding and Deterring Tobacco Use Among Adolescents.”, Pediatric Clinics of  North America.  Vol. 34. No. 2, April 1987, pp  363-379.   

9.   Secondhand Smoke in the Workplace, US Dept. Of Health and Human Services, CDC 

 SECONDHAND SMOKE HURTS BABIES

EFFECTS ON THE FETUS:  

    Increased risk of:

	Fetal and infant mortality
	Stillbirth
	Sudden Infant Death Syndrome (SIDS)
	Childhood cancers, including ALL, Non-Hodgkin’s lymphoma, and Wilms tumors
	Symmetrical IUGR
	Long-term neuro-cognitive and development deficits
	Thyroid disorders later in life
	Sperm defects in males
	Decreased birth weight
	Smaller height and weight in childhood
	Reduced fertility in females
	FEV in infants and children

PREGNANCY COMPLICATIONS:

    Increased risk of:

	Abruptio placentae
	Placenta previa
	Bleeding during pregnancy
	Premature rupture of the membranes
	Preterm delivery
	Spontaneous abortion
	Polyhydramnios
	Ectopic pregnancy

THE CHILDREN OF WOMEN SMOKING LESS THAN 20 CIGARETTES PER DAY ARE AT INCREASED RISK FOR:

	Anencephaly
	Cleft lip and palate
	Hydrocephaly
	Ventriculoseptal defects
	Urethral stenosis

PHYSIOLOGIC EFFECTS:

    Increased:

	Placental vascular resistance
	Carboxyhemoglobin levels in the mother and fetus
	Syncytiotrophoblastic necrosis
	Maternal heart rate
	Fetal heart rate
	Umbilical S:D ratio

    Decreased:

	FHR baseline variability
	Flow in fetal aorta
	Maternal blood pressure
	Pulsatility of fetal aortic and umbilical vein blood velocity

SEQUELAE IN SGA INFANTS:

	Increased risk of cerebral palsy
	Increased neonatal and perinatal mortality
	Small head circumference in childhood
	Short stature
	Neuro-cognitive deficits

Naeye RL, Effects of Maternal Cigarette Smoking on the Fetus and the Placenta, Br J Obstet Gynaecol, 85:732-737, 1978.

Moner, Smoking and Pregnancy.  In: The Canadian Task Force on the Periodic Health Examination.  Clin. Prev. Health Care, Ottawa: 1994: 26-36.

Wynn M & A, The Prevention of Handicap of Early Pregnancy Origin, pp 28- 33.  Found for Education/Research in Childbearing. 1981.

Hemsworth BN, Deformation of the Mouse Foetus After Ingestion of Nicotine by the Male.  IRCS Medical Science, 9:728-729, 1981

Ottawa-Carleton Health Dep’t, Why Choose Smoke-Free Child Care? 1995 and Environmental Tobacco Smoke Affects Children, 1995

Oncology News,  Fetus May be Harmed by Second-Hand Smoke, Vol 8, No 7,  July, 1999

AHA Medical/Scientific Statement, Active and Passive Tobacco Exposure: A Serious Pediatric Health Problem, 1994,  www.americanheart.org

AJC, Health Watch, April 23, 1996, A. Husted, Secondhand Smoke Can Hurt Unborn Babies, April 23, 1996.

Tobacco's Toll On Nebraska

A Report By The SmokeLess Nebraska Coalition

Cutting Tobacco Use

In 1964, the U.S. Surgeon General issued a report that smoking was dangerous based on body of research. Since that time, a body of research has grown regarding how to prevent the nation’s number one killer.

Experts agree that comprehensive efforts succeed at reducing tobacco use. Research shows that comprehensive tobacco control efforts succeed in preventing and reducing addiction. Comprehensive tobacco control programs work best when paired with policies and strategies such as:

• Increasing the price of tobacco products
• Preventing the sales of tobacco products to minors
• Providing environments with smoke free air, and
• Reducing the appeal of tobacco products

The Mission

Tobacco use is the number one health problem facing our state. Labeled as a pediatric disease, there are many biological, social and psychological reasons why people - mostly children – begin to smoke.

Because the problem is so complex, there is no magic bullet that can single-handedly prevent tobacco use and its many consequences. A real solution demands a comprehensive approach that deals with the forces causing tobacco use as well as methods to resolve it.

The SmokeLess Nebraska coalition represents a number of organizations that support funding a statewide, comprehensive program that will reduce the death, disease and destruction caused by tobacco use in Nebraska.

SmokeLess Nebraska wants to see:

• Significant dedication of money for statewide tobacco use prevention and cessation efforts;
• Funding of tobacco use prevention efforts at a level that reflects the economic and societal costs that tobacco use renders upon Nebraska; and
• Long-term funding of those efforts

Unless we act now, Nebraskans will continue to bear unnecessary and preventable future economic and health-related damages of tobacco.

Tobacco use is a major health and economic problem in Nebraska. It drains hundred of millions of dollars annually from our economy, reduces productivity in our businesses and industries, and robs families of their loved ones and resources.

Smoking is the number one preventable cause of death and illness in the United States, claiming more lives than alcohol, car crashes, homicides, suicides, fires, AIDS, and other drug use combined. Each year tobacco kills more than 2,700 Nebraskans and drains $432 million from our economy. Though these statistics are alarming, what is even more disturbing is the fact that 35,000 Nebraska children currently younger that 18 will die prematurely from tobacco use.

Tobacco-related diseases have a stranglehold on Nebraska’s economy. Medicaid costs related to smoking cost taxpayers almost $40 million every year. Another $203 million goes up in smoke as a result of lost income and productivity because of smoking related death and disease.

What would an effective tobacco control program for Nebraska cost?

The Burden Of Tobacco On Nebraska’s Health Care System

Smoking is a major cause of heart disease, bronchitis, emphysema and stroke and contributes to the severity of colds and pneumonia. In addition, cigarette smoking is a major cause of cancers of the lung, larynx, oral cavity, pharynx and esophagus. Likewise, it is a contributing cause of the development of the cancers of the bladder, pancreas, uterus, cervix and kidney. Not only are these diseases deadly, they are extremely expensive to treat. The life expectancy of people who smoke is decreased by 14 years. The cost of treatments exceeds $179 million yearly in Nebraska alone.

Smoking is responsible for:

• 87% of lung cancer cases;

• 82 % of deaths from chronic obstructive pulmonary disease (emphysema and chronic bronchitis);

• 21% of deaths from heart disease; and

• 18% of deaths from stroke

Does Nebraska really need to spend that much money on tobacco prevention?

The impact of smoking on maternal and child health is tremendous. For the pregnant woman, smoking dramatically increases heartbeat and blood pressure, which in turn can have a negative impact on both her own health and that of her baby. Even more dangerous is a crossover of the poisons from inhaled cigarette smoke to the placenta. Carbon monoxide, arsenic and tar are just some of the deadly poisons that reach the developing fetus. The results are tragic, costly and can be deadly.

1. Smoking during pregnancy is estimated to account for 20% to 30% of low birth weight babies.
2. As much as 14% of pre-term deliveries are a result of a mother’s smoking.
3. Sadly, smoking accounts for 10% of all infant deaths.

These numbers have a staggering effect on families because of the tremendous strain this places on new parents as well as the economy because of the costliness of providing health care for these babies. In addition, maternal smoking during and after pregnancy has been linked to asthma among infants and young children. This in turn may mean a lifetime of expensive health care and medications.

The Burden Of Tobacco On Our Children

Youth smoking is on the rise. Experimental tobacco use can eventually lead to addiction and death. Cigarette smoking during childhood and adolescence produces significant immediate health problems among young people. These include increases in the number and severity of respiratory illness, decreased physical fitness, coughing, an unfavorable lipid profile and potential retardation in the rate of lung growth and the level of maximum lung function.

The early addiction will lead to years of smoking and the potential development of deadly diseases such as lung cancer. The earlier a person starts to smoke, the harder it is to quit. People who begin smoking at an early age are more likely to develop severe levels of nicotine addiction than those who start at a later age, making it more difficult to quit smoking.

	The 1997 Youth Risk Behavior Survey conducted by the Nebraska Health and Human Services System and The Buffalo Beach Company revealed that an alarming 39% of high school students have smoked a cigarette in the last 30 days.
	The 1997 national Youth Risk Behavior Survey reported that current cigar use among high school students is 22 percent.
	A 1997 survey identified that 9.3% of high school students used smokeless tobacco. Although smokeless tobacco use was previously uncommon among adolescents, more older teens began using it between 1970 and 1985 (at the same time that the smokeless tobacco industry strengthened its marketing efforts.)
	Nebraska’s retailers illegally sold an estimated 471,564 packs of cigarettes to children in 1995.
	A recent national survey indicated that among students younger than 18 who were current smokers, almost 67% reported never being asked for proof of age when buying cigarettes in a store.
	Of adolescents who have smoked at least 100 cigarettes in their lifetime, most report that they would like to quit, but are unable to do so.

The devastating health consequences of tobacco use are alarming in and of themselves. Unfortunately, tobacco use can lead to other dangerous behaviors. It is associated with alcohol and illicit drug use, acting as a "gateway drug." Nicotine from tobacco is generally the first drug used, and can lead to use of tobacco, alcohol, marijuana and other drugs. A 1994 Surgeon General’s report found that 12 – 17 year-olds who reported having smoked in the past 30 days were three time more likely to smoke marijuana and 22 times more likely to use cocaine than children of the same age who had not smoked.

The initiation and development of tobacco use among children and adolescents progresses in four stages: forming attitudes and beliefs about tobacco; experimenting with it; regularly using tobacco; and lastly, becoming addicted. Youth become addicted quickly. Tobacco use in adolescence is associated with a range of health-compromising behaviors including being involved in fights, carrying weapons, engaging in high-risk sexual behavior and using alcohol and other drugs.

California, Massachusetts and Oregon have already implemented tobacco prevention campaigns that have reduced overall smoking within their borders at a faster rate than elsewhere in the country.

Similarly, while youth smoking rates were rising steadily nationwide, in California, Massachusetts and Oregon they either went down or increased much more slowly.

What types of prevention programs will be funded?

There are numerous tobacco prevention programs being coordinated in communities throughout the state.

Thanks to extensive research and evaluation of existing tobacco prevention programs in other states. Nebraska can establish a blueprint for an effective program. In fact, ongoing evaluation of Nebraska’s program will allow the state to continue to refine its efforts and create the most effective program possible.

The Burden Of Smoking On Our Senior Citizens

The negative health impact is just as great in the growing senior population as it is for children. Older adults began smoking before its harmful effects were well understood. This generation of Americans is now experiencing the health consequences of an average of 40 years of smoking.

	More than 13 million Americans older than 50 smoke. Older smokers are significantly less likely than younger smokers to believe that smoking harms their health.
	Smoking is a major risk factor for six of 14 major cause of death for person s60 years of age or older.
	Cigarette brands that contain high amounts of nicotine are popular with older smokers, with 58% smoking brands that have the highest nicotine content. Older smokers are highly dependent on nicotine, as measured by the need to smoke within 30 minutes of waking.
	Older smokers ages 50 to 74 are less likely to have tried to quit than smokers age 21 to 49.
	Men 65 or older who smoke are twice as likely to die from a stroke. Women smokers are about one and a half times more likely to die from a stroke than their nonsmoking counterparts. The risk of dying for ischemic heart disease is 60% higher for smokers than for nonsmokers in that same age group.

Quitting smoking has proven health benefits, even at a later age. When an older person quits smoking, circulation improves immediately and the lungs begin to repair damage. In one year, the added risk of heart disease is cut almost in half and risk of stroke, lung disease and cancer diminish. Self help and formal smoking cessation treatments for older adults must emphasize strategies to overcome high levels of nicotine dependence and lifelong psychological dependence on smoking.

Keys To Success

Considerable evidence suggests that measures such as counter-marketing, community and school-based programs, cessation assistance and strictly enforced youth access provisions can significantly reduce tobacco use – especially among youth.

Research and experience also show that these individual elements are most effective when integrated into a comprehensive program. California and Massachusetts have used this approach with considerable success and other states such as Arizona, Florida, Oregon and Minnesota are following their lead.

The U.S. Centers for Disease Control and Prevention recommends that states establish long-term tobacco control programs that provide comprehensive measures, involve community partnerships and contain the following elements:

Community programs: Community groups can effectively engage in a number of tobacco control activities where people live and work. They can include direct counseling for prevention and cessation, youth tobacco programs, interventions for special populations, worksite programs, training for health professionals and enforcement of Nebraska’s law prohibiting tobacco sales to minors.

School-based Programs: To operate most effectively, school-based programs must include curricula that have been shown to be effective. They must also include tobacco-free policies, cessation services, training for teachers and programs for parents.

Partnership Grants: Statewide partners can help reach specific populations that are targeted by the tobacco industry such as women, racial/ethnic minority populations and blue collar workers.

Counter-marketing: Research has demonstrated that tobacco industry marketing increases the number of kids who try smoking and become regular smokers. Not surprisingly, one of the best ways to reduce the power of tobacco marketing is an intense campaign to counter these pro-smoking messages.

Cessation: Cessation products and services should be made more readily available and more affordable. Moreover, treatment programs are most effective when they use a number of interventions, including pharmacological treatments, clinician-provided social support and skills training.

Surveillance and Evaluation: The result of all evaluation work must be used to constantly review each and all elements of the tobacco prevention initiative and to make any necessary adjustments to ensure that tobacco use declines as quickly and as sharply as possible.

What’s in Nebraska’s Future?

The costs in both lives and dollars from tobacco use are staggering. Tobacco-related health care costs each man, woman and child in Nebraska about $216 per person every year. More than 2,700 Nebraska men and women die needlessly each year because of tobacco-related causes. No other public health issue causes more harm and is more preventable than tobacco-caused deaths. Nationally, the number of deaths from tobacco is equal to five 727 airplanes, each carrying 220 people, crashing to earth with no survivors every day of every week of every month of the year.

Prevention works. Study after study confirms that for every dollar invested in good prevention programming, between $14 and $22 is saved in treatment and societal costs. And the human toll is immeasurable. Almost every family in Nebraska can speak of a death of a close relative to smoking-caused heart disease, stroke or cancer. For every 10 percent reduction, 530 fewer families will lose loved ones prematurely. It is not acceptable for us to stand by and wait for such tragedies to happen: not when we have the facts and not when we know how to prevent it.

Research shows that tobacco use can be reduced by funding a comprehensive tobacco control program, especially when coupled with significant increases in the price of tobacco products. Whether thousands of Nebraskans continue to die every year of tobacco-related causes is in our hands today.

SmokeLess Nebraska is a statewide coalition of more than 30 organizations working together to prevent needless death and disease caused by tobacco products.

Members of SmokeLess Nebraska

American Cancer Society, Heartland Division

American Heart Association

American Lung Association of Nebraska

Beatrice Alcohol, Tobacco And Other Drug Council

Boone/Nance County ATTAC

Buffalo County Tobacco-Free Coalition

Cass County TAD/Tobacco-Free Coalition

Citizens Against Tobacco, Scottsbluff

Dodge County SmokeLess Coalition

Health Education Incorporated

Healthy Habits Task Force, Jefferson County

Hastings Community Action Group

Lincoln-Lancaster County Health Department

Metro Omaha Tobacco Awareness Coalition

Nebraska Council to Prevent Alcohol and Drug Abuse

Nebraska Doctors Ought To Care

Nebraska Dental Association

Nebraska Medical Association

Nebraska Nurses Association

Nebraska PTA

Neligh-Oakdale Drug Free Group

Nebraska School Nurses Association

Norfolk Tobacco Awareness Coalition

Northern Panhandle Tobacco-Free Coalition

Panhandle Substance Abuse Council

PRIDE-Omaha, Inc.

Rural Region V Prevention Center

School-Community Intervention Program

SmokeLess Platte County

Tobacco-Free Hall County

Tobacco-Free Lincoln

Tobacco-Free Task Force, Sidney

York County Community Health Coalition

© 1999 PRIDE-Omaha, Inc. All rights reserved.