Description
Cigarette smoking and exposure to secondhand smoke (SHS) is the leading preventable cause of death in the United States, resulting in approximately 480,000 premature deaths and 16 million smoking-related illnesses. Cigarette smoking can lead to increased cardiovascular disease, multiple types of cancer, pulmonary disease, adverse reproductive outcomes, and the exacerbation of chronic health conditions. Annual costs associated with tobacco-related illnesses amount to nearly $280 billion in medical expenses and lost productivity. Electronic cigarette (e-cigarette) use among U.S. youth and young adults has increased considerably, growing 900% among high school students from 2011 to 2015. Cancer is the second leading cause of death in the United States, with approximately 1.5 million new diagnoses and over 550,000 deaths each year. Commercial Tobacco use is the leading preventable cause of cancer and cancer deaths. It can cause not only lung cancer but also cancers of the mouth and throat, voice box, esophagus, stomach, kidney, pancreas, liver, bladder, cervix, colon and rectum, and a type of leukemia. Each year, 660,000 people in the US are diagnosed with and 343,000 people die from a cancer related to commercial tobacco use. The direct cost of cancer care in the United States was $125 billion in 2010, and is expected to increase to $158 billion in 2020. Tobacco-Related Disparities Tobacco disparities exist among racial and ethnic groups, including persons with low socioeconomic status (SES), persons with histories of mental illnesses and substance abuse disorders, the lesbian, gay, bisexual, and transgender (LGBT) community, persons with disabilities, persons living in certain geographic regions, and among youth high school drop-outs. Nearly 1 in 4 LGBT adults smoke cigarettes compared with about 1 in 6 heterosexual/straight adults. Approximately 25% of U.S. adults have some form of mental illness or substance use disorder, and these adults consume almost 40% of all cigarettes smoked by adults. 2016 BRFSS estimates of current smoking rates for persons with disabilities in the US are 28.2% compared to 13.4% for persons without disabilities. The proportion of current cigarette smokers who report smoking daily is highest among smokers living in the Midwest (68.3%), and lowest among those in the West (56.9%). Differences in flavored tobacco use, including menthol, exist across states and subpopulations. Subpopulations with the greatest overall prevalence of flavored tobacco use include persons who are male, younger in age, non-Hispanic, or non-white. Nearly 9 of every 10 African American smokers (88.5%) aged 12 years and older prefer menthol cigarettes. Disparities in the number of smokers who quit also persist among specific subpopulations including non-Hispanic blacks, persons with lower education, persons with disabilities, and persons on Medicaid or without health insurance. While information about the dangers of cigarette smoking have been provided to the public for more than 40 years, this basic information may not have reached persons who have limited English proficiency, such as those who have recently arrived in the United States, e.g. Asian Americans, Pacific Islanders and Hispanics. Forty percent of the U.S. population live in state or local communities with no comprehensive smoke-free air laws. Secondhand tobacco smoke exposure causes heart disease and lung cancer in nonsmoking adults and sudden infant death syndrome, acute respiratory infections, middle ear disease, exacerbated asthma, respiratory symptoms, and decreased lung function in children. Cancer-Related Disparities Twelve cancers are caused by commercial tobacco use (lung, esophageal, laryngeal, oral cavity and pharyngeal, stomach, pancreatic, kidney, bladder, cervical and some leukemia’s); and evidence exists for a causal relationship with several others. Furthermore, tobacco use also impacts health outcomes in patients and survivors with these tobacco-related cancers as well as other cancers. Tobacco use could adversely affect treatment outcomes, increase all-cause and cancer specific mortality, and also increase risk for second primary cancers. While lung cancer is the leading cause of cancer death among most men and women in the United States, several populations experience a disproportionately high number of cancer diagnoses and high rates of cancer-related deaths. The liver cancer rate among African American (10.3) per 100,000), Asian Pacific Islander (12.4), American Indian/Alaska Native (11.1), and Hispanic (13.4) men is much higher compared to white men (7.4). Additionally, liver cancer is the fourth and fifth leading cause of cancer death among Asian American and Pacific Island men respectively. Among Hispanic females, cervical cancer is the seventh most common cancer, with a rate of 7.5 per 100,000, a rate substantially higher than the U.S. aggregate of 9.4. Death rates from cervical cancer are higher among African American and Hispanic women compared to others. Uterine (endometrial) cancer is the fourth most common cancer among women in the United States; however, death rates from this cancer are almost twice as high among African American women (7.1) compared to white women (3.9). Finally, while white women have higher incidence rates of breast cancer, breast cancer death rates are lower among white women than among African American women (20.5, 28.1, respectively). Evidence-based, public health approaches for reducing the risk of cancer occurrence, and increasing the quality and duration of life following a cancer diagnosis includes prevention and cessation of commercial tobacco use, reduced exposure to secondhand smoke, regular physical activity, and maintenance of a healthy weight. Routine consultation with health-care providers about recommended screening and vaccination schedules are critical as well. Survivorship plans that that lay out the follow up prevention work as well. The Office on Smoking and Health and Division of Cancer Prevention and Control seek to build on the successes of the previously funded National Networks (CDC-RFA-DP13-1314) and expand work to address tobacco-and cancer- related health disparities among these populations. This NOFO will focus prevention and control efforts on populations most vulnerable and harder to reach. Many factors also contribute to cancer-related disparities such as socioeconomic status, cultural characteristics, diet, and access to healthcare services. Efforts will address the unique need for population-specific capacity and infrastructure to support tobacco and cancer control strategies and promote access to tobacco cessation services, cancer prevention, and treatment and survivor resources for populations experiencing disparities. Tailored strategies are designed to achieve the benefits of an overall population-based policy approach to commercial tobacco and cancer control. The NOFO seeks to eliminate tobacco- and cancer- related health disparities. National Networks selected (up to 8) may focus on one of the following specific populations experiencing tobacco and cancer-related health disparities: 1) African Americans; 2) American Indians/Alaskan Natives; 3) Asian Americans/Pacific Islanders/Hawaiian Natives; 4) Latinos/Hispanics; 5) Lesbian, Gay, Bisexual and Transgender persons; 6) Persons with Low Socioeconomic Status; 7) Persons with Mental Health and Substance Abuse Disorders; and 8) Geographically Defined Populations with High Commercial Tobacco Use and Related Health Disparities. A culturally tailored approach for these specific populations will help prevent the high prevalence of commercial tobacco use and tobacco-related cancers and accelerate the elimination of existing disparities, thus achieving the benefits of an overall population-based approach to commercial tobacco use prevention and cancer prevention and control. Program strategies will focus on national and state interventions, training, technical assistance, mass reach health communication, and network administration and management. Activities will be purposefullyare aligned with CDC’s key domains (https://www.cdc.gov/chronicdisease/resources/publications/four-domains.htm), CDC’s Winnable Battles (https://www.cdc.gov/winnablebattles/report/tobacco.html), and both the Office on Smoking and Health goals (https://www.cdc.gov/tobacco/about/osh/index.htm) and DCPC priorities (https://www.cdc.gov/cancer/dcpc/about/programs.htm). Some previous successes of Funding Announcement, CDC-RFA-DP13-1314, that will build on this current NOFO include: Increased reach of the work conducted by the previously-funded National Networks. The National Networks contributed to the development and/or expansion of their Networks through increasing representation and participation of membership and enhancement of infrastructure; as well as increased diversity in partnership that contributed additional information and expanded reach, communication, coordination, and potential collaboration among the partners. Lessons learned from existing assessments were utilized to identify specific needs and/or gaps to inform the planning of activities to help in addressing the disparities and tailor technical assistance and training for the CDC funded National Tobacco Control Program (NTCP) and National Comprehensive Cancer Control Program (NCCCP) and stakeholders. Supporting documents were identified and disseminated that inform and assist with implementing evidence-based or promising interventions. Various tools and resources developed to help fill gaps.