CERC 5 th Annual Health Disparities Institute Rod Lew, M.P.H. Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL) October 19, 2012

Overview Tobacco as a Social Justice Issue Introduce 4-Prong Policy Change Model Examples of Legislative Policy (state, federal and local) Tobacco tax in Guam FDA regulation of tobacco (and menthol issue) Local CBPR project resulting in tobacco retail licensing Elements of Change

The APPEAL Network

APPEAL Principles National Network for diverse Asian American, Native Hawaiian and Pacific Islander (AAPI) Includes focus on U.S. –associated Pacific Islands (USAPIs) Addressing tobacco and other health issues as social justice issues Communities have different readiness levels requiring capacity building Move communities toward social norm change

Tobacco as a health disparities and social justice issue Sacred Use of Tobacco History of Tobacco’s Commercialization Heavy Targeting by the Tobacco Industry Disparities in Resources and Capacity Tobacco as a Social Justice Issue

Tobacco Use among Native Hawaiians/Pacific Islanders

Distribution of U.S. Population by Race/Ethnicity, 2010 and 2050 NOTES: All racial groups non-Hispanic. Data do not include residents of Puerto Rico, Guam, the U.S. Virgin Islands, or the Northern Marina Islands. Totals may not add to 100%. SOURCE: Kaiser Family Foundation, based on U.S. Census Bureau, 2008, Projected Population by Single Year of Age, Sex, Race, and Hispanic Origin for the United States: July 1, 2000 to July 1, Total = millionTotal = million

Per Capita Cigarette Consumption United States 1900 to 1999 Source: Tobacco Use - United States, MMWR November 5, 1999;

Impact of Tobacco Control Policies and Tobacco Tax Youth are most sensitive to tobacco price change- every 10% price increase decreases youth smoking by 6.5% and adult smoking by 2% (CTFK) Tobacco tax has impact on tobacco prevention and treatment (Chaloupka 1999) but needs to be paired with tobacco control spending (Rice 1999) Scenario : tax increase by $1, tc spending increase by 20 cents= smoking prevalence decrease from 12.2% to 11.2% in 5 years. (Max 2011). This results in $2.3 billion less in health care expenditures, 2367 lives saved and 46,000 years of life gained.

4- Prong Policy Change Model 1. Need to work within our racial/ethnic communities where tobacco may not be a high priority 2. …within the mainstream tobacco control movement where racial/ethnic communities are not a high priority 3. …with legislators where neither tobacco nor racial/ethnic communities are a priority 4. …against the tobacco industry where racial/ethnic communities are one of the highest priorities

Legislative Policy Change State or Territorial Level Federal Level Local Level

Tobacco use in Guam Indigenous Chamorro represent 37% of the 159,358 population Second highest prevalence of tobacco use of any U.S. state or territory Many tobacco distributors and tobacco influence Other factors including high suicide rate among youth

Guam’s Legislative Policy Bill 150 to raise tobacco tax by $2.00 per pack of cigarettes Collaborative process of key public health, policymakers and broad-based coalition Legislative policy focused on relationships and building on years of previous successes Key components of capacity building and leadership development

Posted: Tuesday, January 26th, :49 AM HST Guam lawmakers OK bill to triple tobacco tax By Associated Press HAGATNA, Guam (AP) — Smokers on Guam are waiting to see if they will be paying the second highest tobacco tax in the United States. The Legislature of the U.S. territory on Friday approved a bill to increase the $1 tax on a pack of cigarettes to $3. If signed into law by Gov. Felix Camacho, Guam would tie Connecticut for second place behind Rhode Island's tax of $3.46 a pack. Lawmakers say the intent of the increase is to stem the tide of smoking-related illnesses on the island. American Medical Center family physician Dr. Vincent Taijeron Akimoto says tobacco abuse has led to hospitals being filled with people suffering from heart and lung disease. If Akimoto had his way, Guam's tobacco tax would increase by $10 a pack. Guam passes tobacco tax

Federal Legislative Policy Tobacco industry has been targeting racial/ethnic communities and have successfully adapted their strategies to changing markets and policies June 22, 2009 President Obama signed the Family Smoking Prevention and Tobacco Control Act Unintended consequences of Master Settlement Agreement and FDA Legislation CAPAC advocacy to encourage FDA to ban mentholated cigarettes Increase of little cigars and cigarillos

Local Legislative Policy: Study on Environmental Influences of Tobacco CBPR study among Pacific Islander and Asian American communities in 3 cities (Long Beach, Richmond and Seattle) Aim was to study the relationship between environmental characteristics (both pro- and anti- tobacco influences) and tobacco use among youth using GIS mapping and Photovoice

Describe Your Community Exercise

“Here you can see part of Richmond stores trying to make money by selling smokes and having ads to influence people to smoke. By selling smokes that slowly kill us while they make money we should reduce smoke shops and ads.”

 Advocates  Communities  Coalitions  Leaders  Partnerships  Resources  Time  Community Participation  Community Competence  Community Empowerment Prioritization and Goal- Setting Leadership Development Infrastructure Development Community Mobilization and Organizing Inputs Guiding Principles Strategic Planning Community Capacity Building Short Term and Intermediate Outcomes Long Term Outcomes Programs  Cessation  Prevention 4-Prong Policy Change Model  Community Policy  Mainstream Institution Policy  Legislative Policy  Corporate Policy Reduced Tobacco Use Health Parity and Health Justice Strategic Framework for Tobacco Control among Asian Americans, Native Hawaiians and Pacific Islanders Community Readiness Environment Assessment and Data

Elements of Effective Policy Change 4-Prong policy change approach Different pathways to policy change Build capacity through advocacy trainings and leadership development Policy change builds upon years of work Building alliances between all racial/ethnic communities TRDRP funded cross-cultural project Aims to increase vulnerable populations understanding of impact of tobacco use and mobilize them to advocate for tobacco control and policy changeBuild capacity through CA Cross-Cultural Tobacco Control Leadership TrainingTRDRP funded cross-cultural project Aims to increase vulnerable populations understanding of impact of tobacco use and mobilize them to advocate for tobacco control and policy changeBuild capacity through CA Cross-Cultural Tobacco Control Leadership Training

Implications for Other issues in the Pacific 23

Thank you !!