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HomeMy WebLinkAboutMINUTES - 01171989 - 2.7 Td'. "'1` .,r BOARD OF SUPERVISORS s. FP-:* Mark Fi nucan* 6 , Health Services Director Contra CW la DATE: December 9 , 1988 Courty SUBJECT: Health and Economic Impact of Smoking in Contra Costa County SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDED ACTION : Accept report from the Health Services Department . FISCAL IMPACT : None . REASONS FOR RECOMMENDATION/BACKGROUND : In response to the request of the Internal Operations Committee on November 28 , we are reporting to the Board on data developed by the State Department of Health Services and the Bay Area Cancer Coalition (BACC ) on the health and economic impact of smoking for California and the San Francisco Bay Area . This data was presented by BACC at a press conference in support of Proposition 99 during the Health Officers Association of California annual meeting in early November . Reports on the data are attached for your review. Tne sta- tewide report provides detail on deaths , years of life lost , and costs related to smoking for each county in California ( Tables 6-8 ) . The Bay Area report provides similar data in graphic form for the seven counties active in BACC . Contra Costa ' s data indicates that we are about average on a relative basis with other counties throughout the state . In 1985 alone , the following events occurred in Contra Costa County : * 839 adults died from illnesses related to smoking ; * 8, 895 years of potential life were lost because of premature death due to smoking ; and * $87 ,486 ,405 were spent on health care for smoking related illnesses . This data graphically portrays the tremendous toll smoking extracts from society . While it has been apparent for decades that smoking is the primary preventable c se of death in the United States , this is the first ti we have CONTINUED ON ATTACHMENT: x YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): I n p n ACTION OF BOARD ON January 17 ., 19 89 APPROVED AS RECOMMENDED OTHER X DIRECTED the Health Services Director to transmit the report to health educators in all County school districts . VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES. AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THEDATE t DATE�pS�HOWN. cc: Delois Basnett, American Lung Association ATTESTED J1AN l 089 -- - Edith Davis, Richmond Quits Smoking PHIL BATCHELOR, CLERK OF THE BOARD OF Health Services Director SUPERVISORS AND COUNTY ADMINISTRATOR Public Health Director BY A ,DEPUTY M382/7-83 II l been able to calculate the extent of the health and economic costs of smoking in our own community . The data should be a powerful tool when analyzing future efforts to prevent smoking in Contra Costa County . Epidemiologists with the Department of Health Services have expressed great interest in continuing to work with the Bay Area Cancer Coalition in developing data that will have pre- vention and public policy impact at the local level . The BACC Tobacco Task Force is currently developing an inventory of public policies that are in effect both locally and nationally to prevent and control smoking . The Contra Costa-wide Smoking Ordinance is a model in this field . The Task Force will be issuing a report sometime in 1989 indi - cating the scope of possibilities open to policymakers to strengthen local smoking control ordinances . Delois Basnett of the American Lung Association , Edith Davis of the Richmond Quits Smoking Project , and Jean Nudelman and Marice Ashe of the Contra Costa Health Services Department are local personnel involved in this BACC Task Force . The Contra Costa Smoking Education Coalition and your Board will , therefore , be kept up to date on this project . There will probably be a series of activities or policies suggested that we could implement in Contra Costa County . Also attached is a copy of the Contra Costa Times and Oakland Tribune coverage of theBATT__press co�rence . All orthe major Bay Area newspapers and several television and radio stations also covered the story . -2- THE IMPACT OF A CIGARETTE TAX INCREASE ON SMOKING BEHAVIOR AMONG TEENAGERS IN CALIFORNIA AND THE BAY AREA Jim Perkins , Dr . P. H. Susan Kersch DeYoung Bay Area Cancer Coalition November , 1988 THE IMPACT OF A CIGARETTE TAX INCREASE ON SMOKING BEHAVIOR AMONG TEENAGERS IN CALIFORNIA AND THE BAY AREA Abstract: Previous research has demonstrated that teenagers and young adults are highly susceptible to changes in cigarette pricing. An increase in the state cigarette tax of 25 cents, as proposed by Proposition 99, would deter significant numbers of adolescents and young adults from smoking. The proportion of smokers among 12 to 17 year olds would be reduced by 20%; among IS to 19 year olds by 16%. Almost 90,000 teenagers in California, including over 16,000 Bay Area teens, would quit smoking or never start because of a 25 cent tax increase. Since 9O% of all smokers start smoking by age 19, this would lead to a meaningful reduction in total smoking and associated health consequences. The devastating health consequences of smoking make it imperative from a public health perspective that all reasonable efforts be made to reduce smoking among the general public. Teen-agers are a particularly important group for targeting non-smoking efforts. Ninety percent of all smokers start by the age of 19; sixty percent start by the age of 141 . If individuals can be discouraged from starting to smoke in their teen years, it is highly likely that they will never start. Increasing the cost of cigarettes has come to be seen as a potent tool of health policy because of the demonstrated effects of changes in the price of cigarettes on the incidence and quantity of smoking. Teenagers are particularly susceptible to changes in cigarette pricing. A 25-cent per pack increase in the state excise tax on cigarettes is called for by Proposition 99 on the California ballot in the 19BB election. Since teenage smoking is such an important determinant of adult smoking behavior and resultant health consequences, it would be useful to assess the effects that such a tax increase could have on teenage smoking patterns. Such -estimates are possible using previous research by health economists such as Eugene Lewit and his colleagues from the National Bureau bf Economic Research`;'•�5, and Kenneth Warner from the School of Public Health at the University of Michigan". These researchers have measured the elasticity of demand for cigarettes. Elasticity of demand refers to the degree to which demand is responsive to changes in price. A high degree of elasticity would be indicated by a significant decline in the purchase of cigarettes following an increase in price, or by an increase in cigarette consumption following a meaningful decrease in price. Teenagers and younger adults have been shown to exhibit a significantly higher degree of elasiticity in cigarette consumption than older adults. There are three likely reasons for this: (1) teenagers and young adults have smoking habits that are less well-defined and of shorter duration, implying less habituation or addiction and, hence, the potential for more price responsiveness; (2) younger people may be more inclined to start smoking as a the result of a price decrease than would older adults; and (3) on average, younger people will have less disposable income, so that price response may include more of an income effect. In sum, teenagers' cigarette demand has been shown to be quite elastic, while that of adults is relative inelastic63. The major component of this elasticity is smoking "participation" - that is, whether an individual smokes or does not smoke at all , as contrasted to changes in the amount of cigarettes that smokers consume. In other words, changes in the price of cigarettes can have a significant impact on whether teens and young adults start or do not start to smoke. Methods Quantitative estimates of the effects of a proposed increase of 25 cents in the cost of a pack of cigarettes can be made for Bay Area Counties, as well as for the state as a whole. These estimates utilize the elasticity estimates developed by Lewit and his colleagues, and procedures developed by Warner for projecting the influence of changes in the federal excise tax on cigarettes. They are applied to California and Bay Area population measures. The first step was to assess the percentage of change in smoking participation in different age groups that would occur following a 25 cent excise tax increase. The average price of a pack of cigarettes in the Bay Area is approximately $1.406. A 25 cent increase constitutes an increase in total cost of 16.4%x. Multiplying the elasticity coefficients for each age group by . 164 gives the percent reductions in smoking participation (that is, reduction in the percent of individuals in each age group who smoke at all ) resulting from a 25 cent tax increase. These are presented in Table 1. These percentages are then translated into the actual numbers of fewer smokers for the seven Bay Area Counties, the Bay Area as a whole, and the State as a whole. These numbers are based on population estimates for July 1 , 198563. Table 2 presents estimates of the number of current smokers by age group. These estimates are derived by multiplying the percentage of smokers in each age group by the total population of each group. The smoking participation percentages are taken from Warner9 and are based on data provided by the Office on Smoking and Health, USDHHS. The figures for the 12-17 year old group were derived from a 1982 National Institute on Drug Abuse (NIDA) household survey in which smoking is defined as daily use of cigarettes during the preceding 30 days. . Data for 18-19 year olds were taken from a 1984 NIDA survey of high school seniors. Figures for adults come from a 1983 Health Interview Survey. While these estimates are a few years old, they are assumed to be rather stable, as evidenced by the fact that later NIDA surveys of high school seniors show that the 18.7% smoking participation rate for this group has been stable over four years. The estimated decreases in the numbers of smokers by age group are presented in Table 3. These were calculated by multiplying the anticipated percentage reduction in smoking from Table 1 times the numbers of smokers from Table Results The anticipated decreases in percentage of smokers by age group resulting from a 25 cent increase in the state excise tax on cigarettes are shown below and in Figure 1: Percent Decrease in Age Group Smoking Participation 12-17 20% 18-19 16% 20-25 12% 26-35 7% 36-74 2% Adults 20-74 4% A 16% increase in the cost of a pack of cigarettes would result in a decrease in the percent of teenage smokers between the ages of 12 and 17 of one-fifth, and a slightly smaller decrease of 16% among older teens. As suggested above, the decrease is much smaller among adults, decreasing with age and averaging a mere 4% for all adults aged 20 and above. These percentages translate into the following absolute numbers of teenagers in the bay Area and across the state who would not participate in smoking because of a 25 cent increase in the cigarette tax: 3 Reduction in Number of Young Smokers Age Bay Area California 12-17 11 ,954 65,369 18-19 4,424 23,524 Total 16,378 88,893 Almost 90,000 teenagers in California, over 16,000 of whom are Bay Area youth, would not smoke due solely to an increase in the cost of cigarettes of twenty-five cents a pack. This represents a combination of youth who will never start and of youth who currently smoke but will quit when cigarettes become more expensive. This is not an annual rate, bL&t rather reflects expected changes in the smoking behavior of the current cohort of Lalifornia and Bay Area teenagers. As new cohorts of children enter the teenage years, an effect on smoking of the same magnitude can be expected so long as the percentage increase in cigarette cost resulting from the tax remains constant. If overall inflation pushes up all prices, and the tax remains constant, the tax will become a decreasing percentage of the total cost of cigarettes, and its deterrent effect on youth smoking would be expected to diminish proportionately. These figures demonstrate that an increase in the state excise tar, on cigarettes of the magnitude proposed by Proposition 99 could have a significant effect on teenage smoking, in terms of both the proportion of teens who would not participate in smoking and the actual numbers of teenagers in the Bay Area and across the state who would be led away from dependency on cigarettes. These numbers would be increased as future cohorts of youth respond to the increased cost. It should be emphasized also that these reductions are a product of the cost increase alone; the benefits of expanded health education directed toward children and youth would be additive to these effects. Over the long term, the health consequences of smoking are tied to the smoking practices of the youngest generation. Few adults ipitiate and adopt the behavior of smoking on a regular basis after age 20. Further, reports of the Surgeon General have noted consistently a strong dose-response effect between the age at which smoking is initiated and mortality from all the major smoking-related diseases. The earlier a person begins to smoke as a teenager, the less likely that person is to quit smoking as an adult, the more likely she or he is to be a heavy smoker, and the more likely he or she is to die from smoking-related 4 cancer, heart disease or lung disease. The ultimate conquest of smoking-induced illness and death can come only from preventing the initiation of smoking in the teenage years. Increasing the cost of cigarettes through raising the excise tax can be an effective deterrent to teenage smoking. Notes 'Drug Use Among American Nigh School Students and Other Young Adults. National Institute on Drug Abuse, U.S. Department of Health and Human Services, 1986. aLewit, EM, D Coate and M Grossman: The Effects of Government Regulation on Teenage Smoking. Journal of Law and Economics XXIV:545-569, December, 1981. 3Lewit, EM and D Coate: The Potential for Using Excise Taxes To Reduce Smoking. Journal of Health Economics 1: 121- 145, 1982. '*Warner, KE: Smoking and Health Implications of a Change in the Federal Cigarette Excise Tax. Journal of the American Medical Association 255(8) : 1028-1032, Feb. 28, 196. 3Ibid. 6This datum supplied by the Solano County Cancer Prevention Program. Following Warner, the denominator is calculated at the mean of the pretax change and posttax change prices, i .e. , the mean of $1.40 and $1.65. This assumes that the full tax increase is passed on to the consumer and that all other things (production costs of cigarettes, other tares on cigarettes, etc. ) remain equal. aPopulation Research Unit, Department of Finance, State of California: Population Projections for California Counties, 1980 Through 2020 with Age/Sex Detail to 2020_ Report 86-P-3. Projected Total Population of California Counties. December, 1986. 5 N td N toN N N o G cp 0 4 ocla �- � a •-- CD o a _ n r� 0 o CU s, N w � N 4 TABLE 1. Expected Change in Percent of Smokers Resulting From a 25 Cent Increase in the State Tobacco Tax Price Expected Age Group Elasticity Change 12-17 -1.20 -0.20 18-19 -0.97 -0.16 20-25 -0.74 -0.12 26-35 -0.44 -0.07 36-74 -0.15 -0.02 All Adultsf -0.26 -0.04 *Ages 20 to 74 TABLE 2. Estimated Number of Smokers by Age Groups, 1985 Age X of San Santa San Contra Bay Group Smokers Francis Clara Mateo Solana Costa Alameda Marin Area State 12-17 14.7 5685 18201 6501 3737 8829 14606 2207 59772 326844 18-19 18.7 2562 B485 29B3 1676 3943 7000 1003 27651 147024 20-25 36.8 22462 62330 21743 12232 26599 48947 8033 202346 1042769 26-35 35.1 52258 97214 38511 17969 42894 74293 15531 333670 1652618 36-74 31.8 104951 164978 85338 30214 93688 146241 32790 658202 3144817 All Adults 29.3 158207 278612 12BOB8 52578 143307 235732 49573 1046097 5107382 TABLE 3. Estimated Decreases in Number of Smokers Attributable to a 25 Cent Increase in the State Cigarette Excise Tax Age Percent San Santa San Contra Bay Group Change Francis Clara Mateo Solana Costa Alameda Marin Area State 12-17 -0.20 1137 3640 1301 747 1766 2921 441 11954 65369 18-19 -0.16 410 135B 477 268 631 1120 161 4424 23524 20-25 -0.12 2695 7480 2609 1468 3192 5874 964 24281 125135 26-35 -0.07 3658 6455 2696 1258 3003 5200 1097 23357 115683 36-74 -0.02 2099 3300 1707 604 1874 2925 656 13164 62896 All Adults -0.04 6328 11144 5124 2103 5732 9429 1983 41844 204295 I t Marin ' Son Fronei San Bay Area Cancer Coalition HEALTH AND ECONOMIC IMPACT OF SMOKING San Francisco Bay Area - 1985 In 1985, about 16% of all deaths among adults in the San Francisco Bay Area, more than 6,000 were due to smoking. Of these smoking attributable deaths, 30% were from lung cancer; 21% were due to heart disease; 23% were due to respiratory diseases. In the same year, San Francisco Bay Area residents lost over 61,000 years of life prematurely due to smoking. 24,489 years of life were lost because of lung cancer; 17,144 years were lost to heart disease; 9,618 years were lost to respiratory diseases. - That year, over 12.5% of all non-pregnancy related hospitalizations among adults in the San Francisco Bay Area were due to smoking. Almost 4,000 hospitalizations for lung cancer were due to smoking; Over 8,000 hospitalizations for heart .disease were due to smoking; Almost 21,000 hospitalizations for respiratory disease were due to smoking. - These hospitalizations and other medical expenses due to smoking cost San Francisco Bay Area residents $642.6 million in 1985. $371.4 million of these costs were for hospital care; 44% of these hospital costs ($282.7 million) was paid from public funds (Medicare, MediCal , Medically Indigent) . - The total economic -burden of smoking in the Bay Area in 1985 was over $1.1 billion. $643 million was for direct medical costs ; $127 million was for lost productivity due to illness and disability; (morbidity) $356 million was for lost future earnings due to premature death. (mortality) 11/2/88 32sm j N • O � tr O O N O " CD O N til \ '� (ID C) 0CIA o � fl.zM CD P co OD (P 00CD IA o � *;3 @ _ CO N 3 C N 0 Q .� s cD .y . O CA O ' O O d� O • � O N © O D V It C) _� N C) 4Y /` ,... .� -•.1 1.:) 0100000 � O � , -• M � N ♦ N o n m O � � N c ro� 0 0 N Q N 0 N CO n c�D Q o CP �' • N roCD CD p C� Q ( tD o� a'0"1a CD -`rs, 3 N 3 C Q ,/„. U+ Q ' LD CD CPa 0 Q � V O N �+V'� CD �t ,•ar C)o W � o � o � CD n o o �, - N CD CP n 0 OR VV �i o CD 3 ,,,.• D 0 CP O N � � O O N N N `.'G CD CD © p C) ° % r• CD CD tt V ..� CA o t''r CD� ,.- CD Ct? N ' N e.� CD � O 0 o co CP .� c "1 o 113 CDCP o cS� 0 0 . . Q. N � La IOR 3 ?4 4 0 C {D (P o -0 � 0 0 G N CD NU) r r O t9 CO CP, p coo � CD tS� 4 N .� . a N CA , . r• O N a � 3 C) ewe 0 0 WTI do o c CD o o . cS� 0 0 t -t1 � C 0 CD ch CD N W _ p '� .•t CD o Q C) o *:5 N 0 mm `V CD .•y (SOCo 0 .� ONLn . ,. a 0 ..c p 0 0 - � o 0 Table 1 Deaths, smoking•attributablo fractionsa, and smoking-attri butablo mortality by disease category and sex San Francisco Say Area% 1985 Miles Fr,nIIIIPs To[al Total /,due to Deaths due Total^ %due to Deaths due Deaths duo Disease Categoryb Deathsc Smoking to Smoking Oeathsc Smoking to Smoking to Smoking Adults 2, 20 years old Neopfisms 140-149 Lip, oral cavity, pharynx 110 .688 76 85 .413 35 1 1 1 150 F.soph3;us 125 .589 74 51 .536 27 !01 151 Stomach 199 .172 34 140 .254 36 70 157 Pancreas 226 .300 68 258 .142 37 104 161 Larynx 47 .806 38 14 .413 6 44 162 Trachea, lung, bronchus 1,424 .796 1,134 916 .750 687 1,821 180 Cefv6x uteri - .0 - 73 .369 27 27 188 Urinary bladder 118 .371 44 69 .274 1 9 63 189 Kidney, other urinary 90 .243 22 58 .118 7 29 Circulatory Disease's 401-405 Hyrertension 346 .156 54 407 .148 60 114 410-414 Ischemic heart disease <651,340 .285 382 360 .181 65 447 65+, 3,560 .159 566 3,766 .075 2 8 2 848 427.5 Cardiac arrest 136 .399 54 140 .344 48 1 0 2 430-438 Cerebrovascular disease 1,251 .096 120 1.898 .139 264 384 440 Arteriosclerosis 140 .238 33 248 .315 78 1 1 1 441 Aortic aneurism 201 .624 125 117 .468 55 180 Faspiratory DicPgseg 480-487 Pneumonia, influenza 722 .20a 150 854 .093 79 230 491-492 Chronic bronchitis, emphysema 299 .850 254 204 .694 142 396 496 Chronic airways obstruction ' 550 .850 468 450 .694 312 780 Diriestive Diseases 531-534 Ulcers 85 .479 41 71 .445 32 72 Pediatric diseases, <1 year old 765 Short gestation, low birthweight 22 .182 4 12 .182 2 6 769,770 Respiratory conditions of newborn 57 A62 10 39 .182 7 17 798.0 Sudden infant death syndrome 86 .128 1 1 56 .128 7 1 8 TOTALd 3,751 2,314 - -Total Deaths Attributable to Smoking 6,075 % of All Deaths Amorig Adults 18.6 6.0 15.8 Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara, and Solano Counties. a From Morbidity and ►clonalityyleekly Report. October 30, 1987. b International Classification of Diseas�os. ninth revision. c' Underlying Causo of Death. I Sums may not equj totals because of rounding. Source: California Chronic and Sentinel Diseases Surveillance Program. California Ceoartment of Noa!th Services. Table 2 Smoking-attributable years of potential life lost before age 80 by disease category and sex San Francisco Bay Area% 1985 Years cf Life Lost Disease Categorya Males Females Totalb Adults, > 20 years old Neoolasms 140-149 Lip, oral !cavity, pharynx 1,230 407 1,637 150 Esophagus 1,062 238 1,300 151 Stomach 1 425 360 784 157 Pancreas` 8.69 328 1,196 161 Larynx i 507 52 559 162 Trachea, ,lung, bronchus 14,928 9,561 24,489 180 Cervix uteri - 504 504 188 Urinary bladder 353 107 461 189 Kidney, other urinary 313 77 390 Circulatory Cisease ..' 401-405 Hypertension 602 373 975 410-414 Ischemic heart disease <65 9,460 1,472 10,932 65+ 2,514 699 3,213 427.5 Cardiac arrest 649 350 999 430-438 Cerebrovascular disease 871 1,132 2,009 440 Arteriosclecosis 140 120 260 441 Aortic aneurism 1,230 323 1,552 Respiratory Diseases 480-487 Pneumonia, influenza 1,043 229 1,273 491-492 Chronic bronchitis, emphysema 2,159 1,008 3,167 496 Chronic airways obstruction 3,104 2,074 5,178 Digestive Diseases 531-534 Ulcers 320 179 499 41,778 19,592 Totalb Years of Life Lost Attributable to Smoking 61 , 370 Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara, and Solano Counties. ` a International Classification of Diseases, ninth revision; based on underlying cause of death. b Sums may not equal totals because of rounding. Source: California Chronic and Sentinel Diseases Surveillance Program California Department of Health Services I Table 3 Smoking-attributable hospital discharges by disease category and sox San Francisco Bay Arua', 1935 b Hosoital Discharges Disease Cate gorya. Males Females Totalc Adults, Z 20 years old Neoolasms 140-149 Lip, oral cavity, pharynx 407 175 582 150 Esophagus 148 54 202 151 Stomach 70 73 143 157 Pancreas 122 56 178 161 Larynx 170 34 204 162 Trachea, lung, bronchus 2,132 1,781 3,913 180 Cervix uteri 194 194 188 Urinary bladder 420 .130 550 189 Kidney, other urinary 68 21 89 Circulatory Diseases 401-405 Hypertension 1,807 3,241 5,048 410-414 Ischemic heart disease <65 3,679 939 4,618 65+ 1,823 588 2,411 427.5 Cardiac arrest 612 413 1,025 430-433 Cerebrovascular disease 449 998 1,447 440 Arteriosclerosis 446 719 1,165 441 Aortic aneurism 604 242 846 ��•i � pry QISa3^,ES 480-497 Pneumonia, influenza 11101 409 1,510 491-492 Chronic bronchitis, emphysema 2,632 1,970 4,502 496 Chronic airways obstruction 9,125 5,611 14,736 pigestive Diseases 531-534 Ulcers 1,588 1,271 2,859 Pediatric diseases, <1 year old 765 Short gestation, low birthweight 759 655 1,414 769 Rsspiratcry oistrsz. --y—d.—cmc, 61 40 101 770 Other respiratory conditions of newborn 521 383 904 798.0 Sudden infant death syndrome 1 1 2 28,743 19,898 Totals Discharges Attributable to Smoking 48,641 % of All Adult Discharges 15.4 9.8 12.5 Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara, and Solano Counties a' International Classification of Diseases, ninth revision. b Discharge was counted it there was any mention of the disease in up to ten diagnoses. 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F' 2) 5 O O Y trJ z o (n cr (D G - (A O (D W OK O W z (A N S1 a Cl) U1 4A. 4j), H (n r- 0) CA r A m n W CL 0 �l O r N r li cn 0 LQ J w J rn t K O O (D w ul to w J z (n fD L3' K rr y �-3 W W En (D ►ri rC (n r Y• O b I-+ w tri 'ri V N rt z a v w ww y cn n•(n m A w o >` O O O q*� b rn w I tnNw )n, >yr ztr7 �wc o w 0 of (n ?�C y w N A 01 0\ tri H Al Ul W •,Ll O O O r %O z v to 1-10 1-3 Y O in in %D yy ;v' r w N d\ OD O w w m r -4 (n cn to r •1 W A A W + Lri r o cv cn v n H O (n q cr c H. to <n H tri (D w N O (n N J co w rn 4-3 • ON O W N > • r Li • ftl trl Fl w r w (n ) C N + N %O C,% (ri • Ln (n O A W Y [n N N N ON Ul + N TABLE 6 DEATHS ATTRIBUTABLE TO SMOKING BY COUNTY CALIFORNIA, 1985 DEATHS COUNTY MALES FEMALES TOTAL k20 YRS OLD >20 YRS OLD Alameda 905 577 1,482 Alpine 0 1 1 Amador 31 14 44 Butte 188 97 285 Calaveras 38 15 53 Colusa 17 7 - 23 Contra Costa 517 322 839 Del Norte 17 10 27 E1 Dorado 86 50 136 Fresno 427 219 646 Glenn 25 13 38 Humboldt • 111 59 170 Imperial 89 27 117 Inyo 17 12 29 Kern 387 188 574 Kings 54 35 89 Lake 90 50 140 Lassen 22 8 30 Los Angeles 51384 3,479 8,863 Madera 63 28 91 Marin 163 126 289 Mariposa 11 8 19 sir Mendocino ,. 80 43 122 3 Merced 121 51 172 Modoc 13 3 16 Mono 4 1 5 '_ Monterey 229 119 348 Napa 110 56 166 Nevada 61 . 32 93 ;.. • Orange 11359 829 2, 188 Placer 129 68 197 Plumas 16 9 2.4 Riverside 828 451 1,279 Sacramento 725 407 1,132 San Benito 26 12 38 San Bernardino 846 438 1,283 San Diego 11551 988 2, 539 San Francisco 774 415 1, 189 San Joaquin 385 195 580 San Luis Obispo 158 102 260 San Mateo 451 291 743 Santa Barbara 210 146 357 Table 6 (continued) Santa Clara 723 465 1,188 Santa Cruz 161 108 269 Shasta 139 77 216 Sierra 3 1 4 Siskiyou 45 21 66 Solano 203 101 303 Sonoma 290 171 461 Stanislaus 311 138 449 Sutter 47 31 78 Tehama 60 33 93 Trinity 11 5 16 Tulare 234 116 350 Tuolumne 41 30 71 Ventura 353 201 554 Yolo 101 51 152 Yuba 57 24 82 TOTAL CALIFORNIA 19,500 11, 572 31,072 Source: California Chronic and Sentinel Disease Surveillance Program California Department of Health Services i • TABLE 7 SMOKING ATIRIBUTABLE YEARS OF POTF3y= LIFE LOST TO AGE 80 BY COUNTY CALIFORNIA, 1985 YF.ARS OF POTEN= I LOST MALES FEMALES TOM COUNTY >20 YRS DID >20 YRS OLD Alameda 10,488 5,321 15,810 Alpine 5 25 30 Amador 240 100 340 Butte 1,710 866 2,576 Calaveras 464 126 590 Colusa 178 51 229 Contra Costa 5,868 3,027 8,895 Del Norte 171 69 241 El Dorado 888 467 1,355 Fresno 4,614 1,850 6,463 Glenn 188 128 316 Humboldt 1,281 479 1,759 In Aerial 957 261 1,218 Inyo 108 130 239 Kern 4,348 1,745 6,093 Kings . 632 347 979 Lake 776 387 1,163 Lassen 197 105 302 -` Los Angeles 60,856 29,185 90,041 Madera - 680 273 953 Marin 1,824 1,006 2,830 Mariposa 82 72 154 Mendocino 899 412 . 1,312 , Merced 1,242 _ ,.r 475 ::�,...:..1,718 _ f�} Modoc 79 9 88 Mono 25 11 35 Monterey 2,450 961 3,411 Napa 911 439 1,350 Nevada 629 263 892 Orange 15,271 7,107 22,378 Placer 1,441 606 21047 Pltmtias 146 65 211 Riverside 8,119 31634 11,753 Sacramento 7,543 3,588 11,132 San Benito 198 109 307 San Bernardino 9,681 3,872 13,553 San Diego 16,206 8,427 24,634 San Francisco .8,478 2,585 11,062 San Joaquin 3,990 1,709 5,699 San Luis Obispo 1,533 735 2,268 San Mateo 51063 2,513 7,576 Santa Barbara 2,000 1,045 3,045 Santa Clara 7,997 4,358 12,354 Santa Cruz 1,136 783 1,919 Table 7 (continued) Shasta ; 1,469 695 2,164 Sierra- 33 1 34 Siskiyou 393 175 568 Solano 2,499 945 3,444 Sonoma 2,800 1,286 4,087 Stanislaus ' 3,189 1,187 4,376 Slitter 541 267 808 Tehama 599 341 940 Trinity 73 43 116 Tulare 2,321 949 3,270 Tuolumne 397 310 708 Ventura 3,910 1,745 5,655 Yolo 1,081 468 1,549 Yuba 678 303 981 TOTAL CAUTMOTIA 211,575 98,443 310,018 Source: California Chronic and Sentinel Diseases Surveillance Program California Department of Health Services - _r - TABLE 8 HEALTH CARE COSTS A71RIBUTABLE TO SMJK[NG FOR COUNTY RESIDENTS BY COUN7`Y alllFUOTIA, 1985 COUNTY COSTS I Alameda $177,924,772 Alpine 467,151 Amador 5,393,434 Butte 38,116,239 Calaveras 4,307,165 Colusa 3,860,528 Contra Costa 87,486,405 Del Norte 1,990,647 El Dorado 13,683,807 Fresno 60,436,944 - Glenn 3,473,749 h)znboldt 15,593,198 Trial 18,157,191 Inyo 4,701,895 Kern 85,427,266 Kings 7,094,821 Lake 13,945,796 Lassen 2,365,265 Los Angeles 1,485,056,464 Madera 16,337,844 Marin 20,512,471 Mariposa 4,874,840 _ Mendocino 11,902,471 Merced 12,904,075 Modoc 930,905 _ Mono 528,876 Monterey 31,248,523 Napa 29,845,756 Nevada 9,472,678 Orange 353,080,578 ` Placer 19,644,418 :.. Plumas - 2,346,549 Riverside 144,550,220 ,- Sacramento 131,732,267 San Benito : '-2,277,829 ... San Bernardino 152,722,723 San Diego 284,927,099 San Francisco 147,429,218 San Joaquin 63,749,502 San Luis Obispo 32,865,563 San Mateo 79,690,524 Santa Barbara 38,084,004 Santa Clara 128,866,500 Santa Cruz 24,482,078 Shasta 26,072,912 Sierra 340,804 Table 8 (continued) Siskiyou 3,375,394 Solano 13,562,586 Sonara 42,685,008 Stanislaus 62,048,584 Slitter 6,839,998 Tehama 9,735,211 Trinity 2,369,024 Tulare 36,152,859 Tuolumne 6,835,436 Ventura 72,423,496 Yolo 16,496,907 Yuba 8,992,335 Tc7I'AL CA=PNIA $4,082,420,801 Source: California chronic and Sentinel Diseases Surveillance Project California Department of Health Services ` •:":.Oakland, CA w (Alameda_Co) Tribune 7 (Clr. D_152,739) 47 "(Clr..S. 156,163) .'.J5r ?fi¢q.:�a:}Ar. S ='. lien i`.� Fssy 5 •>888 ��j, S_"__oking`� dexpensive. to By Marie Fe ell The state health chief said re- n'° lease of the study sig days before ligarette BERKELEY voters decide on Proposition 99 -srnokinjLLed to 16 perce�rafmflDr.Wendell did not mean he was endorsing ' a the Bay Area in . Brunner, the measure. 1985; costing the region moreA director of Members of the Bay Area Can- than $1.1 billion a year in medi- public health cer Coalition, however, are ac- cal expenses, Iost wages and re- for Contra tively promoting the proposition. duced productivity,according toCosta County. "Frankly,we as health profes- a study released here yesterday _. . . sionals are .not content.to sit by.public health officials. back and rack up the toll. We The study was by the state at have a xesponsibility to do some- the request of the Bay Area Can- thing. We are strong supporters cer Coalition, an organization of of adult deaths*-attributed to of 99,"said.Brunner. county health officials, medical smoking. .... . Of the direct medical costs due researchers and volunteer "` to tobacco-related diseases in the A De artriient of Health Serv- health groups.._ p Bay Area, $282 million was bora The findings, said coalition ices study released this week by public health departments, members, 'underscore the need found 16 percent of theAeaths in according to the study. . for passage of Proposition 99, California could be .tracked to "We look at the 25 cents not as which would tag cigarettes to tobacco-related diseases._ a tag, but as a user fee," said fund health programs.The prop- The ecoaomic. burden .from . Brunner. ' .'' =_ osition is on Tuesday's ballot those deaths was$71 billion,the The increased cost will also Of the 6,000 Bay Area-deaths -.study said'. i; -' lead to a significant reduction in in 1985 because of smoking, the In announcing the findings smoking by teenagers, the coali largest number came from Ala- Wednesday,.`Dr.'Kenneth Kizer, tion said_ ineda County, the county with state health department direr- :--"Teenagers are particularly :the largest population. tor;was sharply criticized by op- sensitive to price, said Dr. Jim -Health care costs for smoking- ponents of Proposition 99, the Perkins, chief of health educa- related diseases cost Alameda state ballot measure that would tion for San Mateo County. .County $178 million. add a 25-cent tag to a pack of Based on previous research, The medical cost in Contra cigarettes. Perkins estimates raising the Costa County was$87 million.It A spokesman for Californians cost of cigarettes by 25 cents will registered the fourth largest to- Against Unfair Tag Increases reduce the proportion of smokers bacco death toll in the seven- called the state study, "a rehash among youths 12 to 17 years old county region, according to the of old allegations politically . by 20 percent. study released at the annual Cal- timed to try to influence the out- Of the Bay Area deaths attrib- ifornia Conference of Local come of an election." uted to tobacco use, 30 percent Health Officers.. The Bay Area statistics,based. were from lung cancer, 23 per- "The preliminary results indi- on information developed by the cent from respiratory diseases cate that the toll and cost of to-• state, were gathered over the and 21 percent due to heart dis- bacco-related chronic disease is past few months, said Dr: Wen- ease• far greater than had previously del Brunner. Overall,. deaths attributed to been understood," said George "This is completely accurate tobacco use were three times Kaplana, chief of the human information. The numbers are higher for men than women. populations laboratory of the not exaggerated. Tobacco is the . The study also estimates that state Department of Health leading preventable cause of Bay Area residents lost a total of Services. death,"said Brunner, director of 61,000 years of life prematurely The Bay Area figures exactly public health for Contra Costa because deaths related to smok- match the percentage statewide County. mg. Pin , ' • ` (Con trolei,a�Costj, ).. . WaStCounirttes:: ,. " ' ., t, (Cir'-�D''li4 048 •�` l:. • � 4 s<r� es UP- reap t lB� 71_ C_ health costs; of. smoldng By,Aachele Kanigel ing closely with thepromoters of Staff water the initiative, concocted a plan to An estimated 839 Contra Costans hold press conferences to release Who died in 1985 might be alive to- the report during.the final days of day if they hadn't smoked, the campaign." Sixteen percent of deaths in the Health orfcials.hope the tax will Bav Area that year were caused by _ OLL ; smoking-relat. ed illnesses according to figures re- leased Thurs =3 Females =Mates day by the Bay Q *' Area Cancer �t��� P L � Coalition. " 'These are �tjQf} ,yam -n individuals N501X "! who would not `„ 0.rQQ have died,had A they not been smokers” said IM4145,!�. - Dr. ' Wendel fgg Brunner,whoi1�2@ ( � . signs all death _ certificates in the county. Times "I'm complete- ly aware that ; every one of those deaths was utter- `.�discnurage'people,particularly teen- ly preventable." . agers, from smoking. Brunner, the county's public Ninety percent of all smokers health director, and health officials start by the age of 19,said Jim Per- from six other Bay Area counties re- ' kins; chief of health education for leased statistics on the health costs the San Mateo County Health De- of smoking;five days before Califor- partment. . nia voters decide on Proposition 99. .If individuals do not start smok- If approved, the state measure ing in their teen years, it'is highly would increase the cigarette tax likely that they will.never start;' be from 10 cents to 35 cents a pack. said.- "Obviously, this is a rehash of Perkins estimates that if the av- oid allegations politically timed to erage price of cigarettes rose from try tti-influence the outcome of an er 40 to $1.65, 20 percent of 1fr m election." said Jeff Raimundo, "17-year-olds and 1p percent 12 i8- Unfairto man for Californians Against and 19-year-olds would stop smok- Unfair Tax Increases, He charged that state health Di- ing. ..4... rector Kenneth Kizer, "coilaborat- Please see CANCER, Page 2A CANCER: Tobacco lobby, sTam'-s report =� � ��- • From Page 1A million in Solana County. lost earnings because of premature • • • "I really think this tax would •In 1985,more than 12.5 percent death. Bay.Area crountlaa,1985 help,"said Jennifer Jourdan, an 18- of all non-pregnancy-related hospi, Researchers estimated the num- Y mid A..of douan year-old,Contra Costa College stu- talizations among adults in the Bay ber'of deaths and hospitalizations dent and member of the Richmond Area were due to smoking. caused by smoking by applying sta- Quits Smoking Project. "I don't •In the same year,44 percent of tistics compiled last year by the fed think a lot of people would pay that, smoking-related hospital costs — eral Centers for Disease Control sop much for cigarettes." $283 million in the Bay Area — said George Kaplan, an epidemiolo Statistics released Thursday on were paid from public funds like gist with the California Department zoo smoking's impact on society: Medicare and Medi-Cal. of Health Services. '—e to •Medical expenses from smok. •The total economic burden of By comparing smokers, oriner 2°Q ing-related illnesses cost San Fransmoking to Californians in 1985 was smokers and non-smokers,the CDC cisco Bay Area residents neariyl more than $7.1 billion: $4.1 billion estimated the percentage of deaths 4 Haepitat urstng.protaa• pruga_ $643 million in 1985. That includes: for medical costs, $800 million for related to smoking for 24 diseasescaro :nom. wrvtca• $87 million in Contra Costa, $177f lost productivity because of illness including heart disease, hyper-ten- °1f' II urce.Calif, L vt aitn rvke :. trillion in Alameda County and$13 and disability_and S2.2 billion for sion and various forms of cancer. SoHe $ea::Tirt,e• I