b'GREATER MONADNOCK COMMUNITY HEALTH IMPROVEMENT PLAN 2015-2018 highriskforheartdisease.Smokingcanalsoincreaseriskfor\x01IntheUnitedStates,tobaccousecosts$300billionperyearin stroke,heartattack,vasculardisease,diabetes,aneurysm,directmedicalcare($170billion)andlostproductivity($156 tuberculosis,certain eyediseases,andproblemsoftheimmunebillion). system.Smokeless tobacco increases the risk of cancer, especially oral cancers.What Can Be Done?\x01Second- and third-hand smoke expose many others to the dangersReducing tobacco use and exposure to secondhand smoke where we associatedwithsmokeinhalationandexposure.TheCDChaslive,workandplaywillhelpreducehealthcomplicationsand reportedthatsecond-handsmokecancontainmorethan7,000environmentalhazards.Tobeeffectiveatachievingthisgoal,the toxic chemicals, 70 of which can cause cancer.These chemicals areRegion has identified three goal areas and related strategies.These especiallydangeroustoyoungchildren,andexposurestothesegoalsincludepreventingtheinitiationoftobaccouseamongyoung chemicalsplaceachildatahigherriskfordevelopingearpeople, eliminating nonsmokers exposure to secondhand smoke, and infections, asthma, bronchitis, pneumonia, and allergies.promoting quitting among adults and young people. \x01Smoking during pregnancy is associated with higher risk for poorStrategiestoaddressthesegoalsvaryfrominstitutingpoliciesand birthoutcomesoftenrequiringhospitalizationfortheinfant,programstoeducationandoutreachtoadvocacy.Examplesof mother, or both.Babies of mothers who smoke during pregnancystrategies include creating smoke-free environments including housing have a higher risk of Sudden Infant Death Syndrome (SIDS), lowdevelopment,worksites,commercialproperty,playgroundsand birthweight,orotherissues.AccordingtotheNHBirthData,recreationareas;developingtargetedoutreachandcommunications 17.3%ofthemothersintheRegionin2013reportedsmokingcampaigns that utilize technology such as texting and social media to during pregnancy.This is significantly higher than the statewidehelpreachyoungeraudiences;pursuingorsupportingactionsto rate of 14.2%. discourageexposureofsmokingtoyoungpeoplesuchasvendorcompliance checks, raising taxes on tobacco products, etc.Economic ImpactsWhat Are We Doing?\x01Each year, the state of NH spends $729 million in private and public healthcare costs directly caused by smoking, including $115 million covered by Medicaid.In 1995, CMC, through its Community Needs Assessment, determined that youth smoking was an issue of primary concern for the Region.As \x01Lost work productivity attributable to death from tobacco use ina result of this finding the Cheshire Coalition for Tobacco Free Youth the state accounts for more than $419 million per year.Economicwas formed in 1996, which later evolved into the Cheshire Coalition for costsduetoprematuredeathsattributabletosmokingareTobaccoFreeCommunities.Thiscoalition,whichiscomposedof estimated to be $483 million each year.physicians,educators,youth,communitymembers,police departments,andelectedofficials,hasundertakenanumberof activities and developed a variety of programs to provide treatment 27'