The 2016-2016 Tobacco Cessation Grantee cohort with staff from the Hawaii Department of Health and HCF.

Reversing the trend of tobacco use in Hawaii

A collaboration by the state, nonprofits, medical providers and individuals has made a huge difference.

During the 46 years Donita Garcia smoked cigarettes, both of her parents died early from tobacco-related illnesses, a younger brother had triple bypass surgery and her sister pulled an oxygen tank to manage COPD. Donita herself carried two different inhalers and couldn’t walk very far or manage even a slight hill.

“I couldn’t breathe. This would put me in a panic,” she says. “My biggest fear was wanting a cigarette. I hated smoking, the smell, the cost, being a slave to it — but the addiction would take over.”

Fast forward two years, three months and one day from May 17, 2016, when Donita Garcia went smoke free.

“I feel 100 percent better. I can breathe now, without the inhaler. I can smell again. I sleep better. I can walk further, and up hills. I have more energy, and I rarely think about smoking. The obsession is gone. I don’t have the fear anymore.”

What enabled Donita to quit after her past attempts failed? The simple answer is, this time she had access to more tools. Through trial and error, services from Adventist Health Castle and the Hawaii Tobacco Quitline, she found the right combination that worked for her.

“I started on the nicotine patch, then the gum, but I didn’t want another addiction so I stopped. I didn’t want to gain weight, so I joined the gym. I went to the Wellness Center. I tried every tool in the book.”

Donita discovered that getting past the first seven minutes of a craving made all the difference. When she couldn’t exercise, change her mind frame or distract herself, she reached out for help.

“The Hawaii Tobacco Quitline understood what I was going through. They talked me through the critical moments, day or night. I wouldn’t have been able to quit if I didn’t have all those tools to help me.”

Success stories like Donita are the culmination of an ambitious collaboration by the state, nonprofit groups, medical providers and individuals to make a difference in the community — and illustrates the power of working together to enable residents to lead healthier, more productive lives.

Over two decades ago, the Hawaii Department of Health created the Tobacco Prevention and Control Trust Fund from tobacco settlement money. DOH contracted the Hawaii Community Foundation to administer the Trust Fund. HCF has supported tobacco prevention and cessation community grant programs, the Hawaii Tobacco Quitline, advocacy efforts and a statewide communications campaign.

Trust Fund programs, along with many other tobacco control efforts across Hawaii, have made a huge difference. Today, Hawaii has the third-lowest smoking rate in the nation (13 percent) with 73,300 fewer smokers than in 2000. Over the same period, DOH reports a corresponding drop in heart disease (34 percent), stroke (41 percent) and lung cancer (11 percent). Among high school students, smoking has dropped 71 percent.

“The air we breathe is cleaner today. Fewer people are smoking and suffering from smoke-related diseases. More families can share the happy story of a loved one quitting the habit,” says Larissa Kick, senior program officer for Community Grants & Investments at HCF.

“The $151.4 million spent by Hawaii from 2000-2017 to curb smoking has saved an estimated $1 billion in health care costs,” she adds. “That’s a phenomenal return on investment.”

Moving forward
 

The Tobacco Prevention and Control Trust Fund has already begun a campaign against e-cigarettes and the retailers that target young people. E-cigarettes contain highly addictive nicotine that can harm brain development, and are a gateway to combustible cigarettes, according to the Centers for Disease Control and Prevention and a UH Cancer Center study. In 2017, more than 1 in 4 (25.5 percent) public high school students and 1 in 6 public middle school students in Hawaii reported using e-cigarettes.

To combat this new trend, the Hawaii Community Foundation, through the Trust Fund, is supporting efforts that educate youth and their families on the harms of tobacco and e-cigarettes. One current effort is a media campaign developed by youth, for youth, and distributed largely through social media. “Our work isn’t done, but we’re thinking big,” Kick says. “Our keiki deserve to live long, healthy lives free from the harms of tobacco. We must help Hawaii become tobacco free.”

“Our keiki deserve to live long, healthy lives free from the harms of tobacco.”

-Larissa Kick

The power of policy
 

Changes to state laws on smoking do more than encourage better health. They also signal a shift in culture and attitudes toward tobacco. If we continue this trend, and our keiki reinforce the education among peers and to their own keiki, smoking might someday be a relic of the past, found only in old movies.

  • 2001 / All counties pass a restaurant smoking ban
     
  • 2003 / Smoking is banned at all public schools
     
  • 2005 / Tobacco retailers must obtain a permit that includes inspection, investigation and penalties
     
  • 2006 / The clean indoor air law expands smoke-free restrictions to restaurants, worksites, shopping malls, multi-unit housing common areas, health care facilities, public areas and airports
     
  • 2008-2010 / Hawaii County bans smoking at all beaches, parks and recreational facilities, as well as in vehicles with children
     
  • 2012 / Honolulu bans smoking at city and county parks and beaches, and bus stops. Hawaii prohibits the sale and purchase of electronic smoking devices (ESDs) by minors
     
  • 2015 / Hawaii becomes the first state in the nation to raise the legal smoking age from 18 to 21, including vaping (ESDs)
     
  • 1999-2017 / Hawaii raises the excise tax on cigarettes to an all-time high of 16 cents per cigarette, or $3.20 per pack
     
  • 2017 / Honolulu prohibits smoking in vehicles with children and expands the definition of tobacco products to include ESDs, thus prohibiting ESD use in all sites where smoking is prohibited