CDC Telebriefing – CDC is launching the fourth phase of the highly successful Tips From Former Smokers Campaign

KATHERINE LYON DANIEL: Good morning. I'm Associate Director for Communications here at CDC. Welcome to CDC’s media briefing on the fourth phase of the Tips From Former Smokers national ad campaign, featuring new health conditions caused by smoking. I would like to welcome our guests in the room and also those joining by webcast or satellite. Today’s briefing will preview some of the new ads and we’ll also describe adult tobacco use released earlier today in CDC’s MMWR, Morbidity and Mortality Weekly Report. We’ll hear from three speakers today, followed by questions and answers. First speaker will be Dr. Tim McAfee, who is an M.D., Director of CDC's Smoking and Health Office. Dr. McAfee is responsible for providing leadership and direction for all scientific, policy, and programmatic issues related to tobacco control and prevention. Next we will have Dr. Brian King, Ph.D, a senior scientist in CDC’s Office of Smoking and Health, an author on today's report on tobacco use among adults. Joining us also today is Amanda, a former smoker, a mom, and a participant in this year's campaign. We are so pleased that Amanda is able to join us today, to represent former smokers who have come forward to tell their stories. Dr. McAfee?

TIM MCAFEE: Thank you very much for being here and joining us today. Today I’m pleased to announce the launch of new hard-hitting ads for CDC’s Tips From Former Smokers. These ads encourage people to quit smoking by revealing the devastation that smoking-related illnesses inflict upon smokers and their loved ones. Beginning on July 7th, these ads will run nationwide for nine weeks and feature a new group of people who are living with serious health consequences associated with smoking, but which are not as well-known. For example, gum disease, tooth loss, preterm birth, and complications associated with HIV and smoking. We will also continue our emphasis on deepening the understanding of the suffering caused by conditions that are traditionally associated with smoking, like lung cancer and head and neck cancer. Each ad participant brings a new perspective. Overall the pain of tobacco related death and disease is all too common in our nation. Most smokers, like our Tips participants started as kids and half of long term users die, almost half a million deaths in our nation each year. For every smoking-related death, at least 30 Americans continue living with a serious smoking related illness. Besides the death and disease it causes, smoking also takes a devastating toll on our nation’s economy, amounting to more than $289 billion a year in excess health care costs and loss productivity. This suffering, death, and high cost is entirely preventable. In the words of our Surgeon General, “Enough is enough.” The 50th Anniversary Surgeon General’s Report on tobacco and health released earlier this year, laid out a roadmap for ending tobacco-related death and disease in the United States. The report found that if we don't do more, 5.6 million children who are alive today will die from prematurely from smoking. To prevent these deaths the Surgeon General recommended that we accelerate proven, but underutilized strategies to prevent and reduce tobacco use. First among these recommendations, was running high-impact national media campaigns, like Tips, for 12 months a year for a decade or more. The Surgeon General based this recommendation on sound evidence. Campaigns like Tips works. So far Tips has inspired millions of American to make a quit attempt and hundreds of thousands quit permanently. When Tips ads are on the air, calls to 1-800-QUITNOW immediately surge, and when the ads go off line the calls immediately fall, suggesting that a longer campaign would produce more quit attempts, and successful long term quits. At a cost of less than $200 per life year saved, Tips is also a highly cost-effective bargain. Most clinical and preventive interventions cost thousands of dollars per year of lives saved. Tips serves as an important counter for the more than $8 billion that is spent each year by the tobacco industry to make their product more attractive and more affordable. The tobacco marketing conjures images of glamor, of freedom, and vitality through event sponsorships, magazine ads, movies, the internet, and in-store displays. But Tips From Former Smokers pulls back the curtain and reveals the reality of smoking: Addiction, painful disease, and loss of loved ones. While Tips has done a powerful job encouraging smokers to quit, in 2014 they will be on the air for a total of only 18 weeks and its budget is equivalent to about three days of tobacco industry spending on advertising and promotion. Today CDC is also releasing new data that reminds us that the tobacco industry remains successful, disturbingly successful, in recruiting and maintaining consumers of their highly addictive and exceptionally dangerous products. So I’d now like to invite one of the lead authors of the report, Dr. Brian King, to share the report’s findings.

BRIAN KING: Thank you Dr. McAfee. Today CDC released the article “Tobacco Product Use Among Adults, United States 2012-2013” in the Morbidity and Mortality Weekly Report. In it we provide the most recent national estimates of tobacco use among U.S. adults 18 years of age and older using data from the National Adult Tobacco Survey. We assessed use of a wide range of tobacco products, including cigarettes, cigars, pipes, e-cigarettes, hookahs, and various other smokeless tobacco products. We also assessed the use of these tobacco products overall and by several demographic factors, including sex, age, race/ethnicity, U.S. region, education, household income, and sexual identity. These findings indicate that during 2012-2013, 21.3 percent of U.S. adults, or 50 million people, used a tobacco product every day or some days. And while prevalence of cigarette smoking was 18 percent, when factoring use of all combustible products, like cigars, pipes, and hookahs, prevalence increased to 19.2 percent. This is a concern because 50th Anniversary Surgeon General’s report concluded that combustible tobacco products are responsible for the overwhelming burden of death and disease from tobacco use in the United States. When we accounted for adults who reported rarely using each product, prevalence increased further among all population groups. About 25.2 percent of adults, or 60 million people, reported using a tobacco product every day, some days, or rarely, and 22.9 percent used a combustible product every day, some days, or rarely. Differences in tobacco use were also observed by demographic factors. Tobacco use was higher among younger adults, and adults living in the Midwest and south. It’s nearly seven times higher among adults with a GED compared to those with a graduate degree. Nearly 30 percent of adults with household incomes of $20,000 use tobacco compared to about 13 percent earning $100,000 or more. Nearly one in three lesbian, gay, or bisexual adults use tobacco compared to about one in five heterosexual straight adults. The findings in this report underscore the importance of implementing proven interventions that focus on the diversity of products used in the United States. These tried and true interventions include increasing tobacco product prices, implementing and enforcing comprehensive smoke-free laws, and increasing help quitting. All in junction with regulation of tobacco products by Food and Drug Administration as well as fully-funded and sustained state tobacco control programs. These data also call to attention the need for high-impact media campaigns such as Tips From Smokers that warn the public about the dangers of tobacco use. I will now turn it over to Dr. McAfee to introduce the 2014 Tips Campaign participants and to show their ads, thank you.

TIM MCAFEE: Thank you very much, Dr. King. When the Tips Campaign began in 2012, we knew that our strategy to tell the real stories of real people suffering from debilitating diseases caused by smoking was rooted in sound evidence. And we knew that our ad participants were worthy of attention and respect. But we did not foresee that Tips would be so powerful that 1.6 million people would make quit-attempts leading to almost 100,000 permanent quits just in the first year. And we did not foresee that the ad participants in the Tips Campaign would enter the nation's consciousness so deeply becoming true heroes of public health. One of those heroes was Terry Hall. Terry tried her first cigarette at the age of 13 was addicted by the age of 17. At 40 she was diagnosed with oral and throat cancers and had her larynx removed – her voice box. For the next 13 years of her life, Terry fought cancer courageously before dying this past September at the age of 53. More than anything Terry wanted to help motivate smokers to quit and kids not to start by her story so they would avoid the pain and suffering she went through. Terry’s first ad broke all the records for views and comments of any video on CDC’s YouTube channel with over 3.4 million views. Terry asked us to visit her in the hospital to film this last ad. No, to be more accurate, Terry demanded that we come and film her for this last ad, just days before she passed away. I’d now like to show you this last ad from terry.

[Terry’s ad plays]

TIM MCAFEE: So Terry was an amazing human being. And she performed an incredible public service for our nation. I am sure that probably hundreds of thousands of people made good attempts because of Terry's stepping up to a very difficult plate. And tens of thousands at least have successfully quit and had their lives extended. Now this year we introduce a new group of heroes. These people are from all over the country and from all walks of life. But they share in common the experience of starting to smoke while they were young, becoming powerfully addicted, and suffering health consequences they never expected would happen to them. For example, we will meet Felicita from Florida who tells her story in Spanish. She started smoking at the age of 12 to look cool. By her mid-30s she had developed aid gum disease, a danger for all smokers. Felicita lost all her teeth by the age of 50. She has now quit smoking and can keep up with her children on walks, but is self-conscious about her appearance and doesn't smile much anymore. Brett from New Mexico also tells the story of how his smoking led to gum disease. Brett began smoking as a teen to impress a girl. By 42 he had to have most of his teeth removed. After several tries, Brett finally quit. He now knows that he can't smoke even one puff or he could relapse. As many as half of periodontal diseases cases may have been caused by smoking. We’ll also introduce Rose from Texas who started at age 13. After several years she developed a two-pack a day smoking addiction, and in her 50s nearly lost a leg because of clogged blood vessels. When she went to have surgery on her leg due to the blood clot, a chest X-Ray unfortunately revealed she had lung cancer. This later spread to her brain despite surgery, radiation, and chemotherapy treatments. Sean of Washington state started smoking at the age of 14 to fit in at a new school. In his mid-40s a chronic cough and laryngitis turned out to be throat cancer. He endured 38 radiation treatments and finally quit smoking, but the doctors were unable to save his larynx --his voice box. We will also meet Brian, who is featured in digital and print ads. Brian was in good health, working in California, and managing his HIV, the virus that can cause AIDS. But smoking combined with HIV led to clogged blood vessels. At age 43 he had a blood clot in his lungs, a stroke, and surgery on an artery in his neck. Formerly a skilled potter, today he has a hard time making a simple bowl. And Today it is my very special honor to introduce you to Amanda. I will let Amanda tell you tell you the story of her addiction to smoking and her child’s early birth. Amanda’s story is shared by many women. More than 400,000 women in our country each year find themselves pregnant and addicted to smoking. And like many women, Amanda did not think that smoking would lead to health complications during her pregnancy. Amanda  has now quit smoking and she shares her story to inspire all women to quit smoking or never to start. I now would like to show you all of the new Tips television ads and will invite Amanda to join me at the podium while we watch them.

[All Tips ads play]

AMANDA: Thank you. I’m sharing my story with people in hopes that it inspires others, especially expecting mothers, to quit smoking or never start. I had my first cigarette in fifth grade and by the time I was 12 I was smoking every day. In high school I started skipping class to smoke and by then I knew I was addicted to nicotine. I smoked when I was young because everyone I knew smoked and as I became older, smoking became my way of dealing with stress. Through college and other stressful times I would turn to cigarettes. I tried to quit many times. I remember throwing out multiple packs of cigarettes only to buy another pack later that day. When I found out I was pregnant I was still smoking. I knew it was bad, but I really didn't think anything bad would actually happen to me or my baby. But it did. My daughter was born two months early and she weighed only three pounds. I did not get to see or hold her right after she was born, and she and spent the first couple weeks of her life in an incubator getting fed through a tube. For most of my life, smoking was my escape from stress, but now it has caused me so much pain and a lot of stress for my entire family. I'm sharing my story to save other moms from the guilt I feel and so more families can feel the joy of a happy and healthy baby. Thank you again to everyone for your support, especially my family. One of my biggest supporters in this campaign has been my dad who was diagnosed with stage four lung cancer within weeks of shooting this ad. My family is a real example of how harmful smoking can be. I’m extremely grateful for the opportunity to share my story to motivate others quit smoking, or never start. Thank you.

TIM MCAFEE: So thank you so much Amanda. I think, as you all can see, it takes an incredible, incredible level of courage and dedication to the people of our country for ad participants like Amanda  to step forward and tell what is a very difficult and painful story. The reason they do this is because they care about the young people; they care about the people in our country who have continued to smoke and they want to do something about it. With 50 million adult tobacco users in the U.S. we are far from achieving our goal of ending tobacco-related death and disease. But we have much reason for hope. With campaigns like CDC's Tips, FDA’s youth-oriented Real Cost Campaign, and Legacy's Truth Campaign, which will begin airing again later this year, there is an unprecedented tobacco presence in the media this year. Yet these three campaigns still represent less than five percent of what the tobacco industry is spending on promotional activities this year. The Affordable Care Act makes evidence-based cessation treatment more easy to get than ever. Talk to your doctor, your dentist, your pharmacists, or nurse for support. Free help is available at CDC.gov/Tips or 1800-quit-now. More than half of the people who ever smoked have quit successfully now. Our Tips ad concludes with a powerful message, so will I. You can quit. Thank you for joining us. I will open the floor for questions on the telephone line or in the room. I’ll start with questions from the room first.

MIKE STOBBE: Hi Dr. McAfee. Mike Stobbe from the Associated Press. I have a few questions. For Amanda, I wanted to know how your daughter is doing today.

AMANDA: She's doing fine but it was a rocky first couple of years.

MIKE STOBBE: Okay. Dr. McAfee, the New York City Health Department recently initiated a campaign that focused on light smokers, or somewhat focused on it, this campaign talks about – I mean, traditional campaigns focus on death and lung cancer, and heart-disease, this is moving into gum disease and pre-term birth, and other topics, is there a shift by federal officials into different types of topics? I don't know how to term them. They are not as death-oriented as in the past. Do you mind discussing that.

TIM MCAFEE: Thanks. That’s a great question, Mike. I appreciate it. The campaign is focusing, as you can see by the ads, far less on deaths. This is basically because the way we developed these campaigns was by doing focus work with thousands of smokers. And what they essentially told us was, somewhat to our surprise, was that death was less of a motivator for the individual smoker. I frankly think it is more of a motivator because of its impact on families and those around us, but that they were more motivated by the fear of disability, discomfort, and being a burden to others around them. And so, we focus much more on that. We have done it both with traditional diseases that most people are aware of, like lung cancer, as you could see in the ad with Rose. But we have also been trying to make it clear, as the 2014 surgeon general may clear, smoking is an activity we engage in at our deep, deep peril. That it affects almost every organ system in the body. It affects us from the beginning of life as Amanda’s story so touchingly reveals, all the way to the end of life, as Terry Hall's ad, which originally was not about death but both her and Nathan of the Oglala Sioux, who also died from second-hand smoke exposure this past year, illustrate that death is part of this equation. In terms of your question about New York City's focus on light smokers: we do think it is very important to make sure ads are resonating with  lighter smokers, because one of the findings in the report was unfortunately, people who cut back their smoking to a smaller number, unfortunately gain very little benefit from this. So we're quite worried. People who are quote-on-quote light-smokers, casual smokers, people who smoke less than ten cigarettes a day have a different kind of problem than Amanda had who was smoking up to two packs of cigarettes a day, and that is they are hoping and thinking that the cigarette smoking the way they are doing it is not hurting them and unfortunately nothing could be farther from the truth. Especially heart disease has a very steep curve even a few cigarettes a day is a huge difference for danger. The good news for Tips, and the reason we originally thought of doing a separate set of ads around light smokers but what we found in the first year was that light smokers were resonating well with the Tips Campaign and making additional attempts at the same rate as heavy smokers.

TIM MCAFEE: Additional questions? We’ll give you another one, Mike. Go ahead.

MIKE STOBBE: I had two more, if I may. I was wondering if the funding for the Tips campaign is declining now that you are in your third year. And I had a question about the MMWR today. There was a statistic that one in three gay and lesbian respondents were smokers, versus one in five –was it for the general population or heterosexual? I was wondering why that might be?

TIM MCAFEE: Well, to answer the first question, the good news is that the Tips Campaign funding is not declining. We have maintained this funding. The predominant source of the funding is from the Affordable Care Act Prevention Fund and this is a tremendous application. We have actually found in our studies of this, that we are saving --a year of life-save costs less than $200 for the Tips campaign, which is far less than most things that we do, both in prevention and in clinical medicine, so we're quite excited about that. In terms of your second question, the most important thing is that this is an observation that is true and of great concern. That -- that people of the LGBT are of a much higher rate of smoking than the general population. Part of this we think is due to selective targeting by the tobacco industry in the -- the ad campaigns that they have done that have either blatantly or subtly targeted the LGBT community. So we think this is a very, very important group. One sub example of this is the astonishing statistics that we are uncovering related to the risks that smoking poses to people who are HIV positive. And it’s basically turning out that now that HIV is becoming much more of a chronic condition when managed well with medication, that the biggest threat for disability and death is in fact smoking. So smoking needs to be and is becoming an integral part of the treatment, smoking cessation is becoming an integral component of HIV treatment, because people with HIV will die 20 years younger if they smoke than if they don't, so this is an enormous opportunity actually to extend life. And Mike, you said you had--those were all your questions?

MIKE STOBBE: Actually I thought of another one.

TIM MCAFFE: Well, is there anyone else in the room? And then we will perhaps open it up to people on the telephone. Anyone on the telephone Do we have people on the telephone? Anyone else? Anyone else -- well, actually Mike, we're going to let you have another.

MIKE STOBBE: I don't want to hog the floor. E-cigarettes have been such a big topic. Maybe that is something you were alluding to by the increased spending by the tobacco companies and others who deal in nicotine products, these ads don't talk about e-cigarettes, did you consider doing ads on e-cigarettes, are they coming, what's your plans if any regarding ads related to e-cigarettes?

TIM MCAFEE: Gee, I thought we were going to make it through without an e-cigarette question. But thank you, that's actually a great question. In terms of the campaign, one of the findings of the Surgeon General’s Report that we emphasized is that combustible tobacco products are responsible for more than 95 percent of the death and disease that the American people are facing from tobacco. So we have tried to stay laser focused -- particularly on cigarettes, which make up a large bulk of combustible products in our country--so we tried to stay laser focused on that, and we think that that’s the most important contribution we can make. And certainly, in terms of any benefits that may accrue to people from using an e-cigarette if they were an adult and were to switch completely to e-cigarettes, we are not worried about the word getting out about these because the tobacco companies and the independent e-cigarette companies are more than making up for this. We are anticipating close to $100 million will be spent promoting e-cigarettes in 2014, which far exceeds our own budget. We are considering this possibility but our message would be -- neither one of promoting or castigating e-cigarettes. I think the message, regardless of whether it’s a media campaign or not, for adult smokers, the thing that we want to be very clear and are quite worried is not clear, is that patterns of dual use where a smoker may substitute an e-cigarette a few times a day in a social situation for instance that they are unable to smoke in, they may think well, I’m cutting down a little bit so this is helpful to my health. If that keeps them from stopping smoking, that is a disaster, because partial substitution is not an effective strategy for improving health as a long term issue. That is a message we do want to get out and that we’re trying to figure out how to get out. The other big message for CDC around e-cigarettes is that the words "good" or "yes" or "positive" should never be associated with youth using any form of nicotine because nicotine is addictive, nicotine is bad for the adolescent developing brain, and until proven otherwise, which I sorely doubt it will be, we need to assume that use of nicotine products leading to addiction, leading to experimentation, exposure to ads, et cetera put our children at significant risk for use of cigarettes. Is there anybody on the phone that would like to ask one last question and then we will be closing down.

OPERATOR: I do have a question from Kim painter from USA Today.

TIM MCAFEE: Go ahead Kim.

KIM PAINTER: Yes, hi. I just wanted to clarify the cost. What is the amount you're spending on the Tips Campaign this year and what's the amount that's been spent up to now?

TIM MCAFEE: It's a more complicated question than you might think because we use money from different years but essentially approximately $50 million a year is being spent each year. That includes the production cost, the evaluation cost, and the purchase of media. We are also augmenting our support for states around quit line support since we are almost doubling calls to the quit lines that the states have to support.

KIM PAINTER: Okay, alright. Thank you.

TIM MCAFEE: Thank you. Thank you all very much.

KATHERINE LYON DANIEL: Thank you this concludes today's media briefing on the Tips From Former Smokers ad campaign. Thank you doctors McAfee and King and thank you Amanda. For media that are attending this in person we are happy to be available for interviews following this briefing. For those of you not in the room, and we do understand that the volume was low for the webcast, we will be posting the recording of the press conference available tomorrow and also please call CDC's media line at 404-639-3286 to arrange a follow up interview if you like. You can e-mail us at media@cdc.gov. Thank you.

###
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES