The California Tobacco Control Program: A Model for Change TOBACCO CONTROL SECTION California Department of Health Services March 2001 c

Comprehensive Funding Evaluation State Administration Statewide Advertising and Publications Community Grants 61 Local Health Departments

Goal = change social norm Outcome = prevention & cessation

Denormalization Strategy Lasting change in youth behavior regarding tobacco can only be secured by first changing the adult world in which youth grow up.

Strategy to Reduce Tobacco Use in California Reduce Exposure to ETS and Tolerance to Exposure Reduce Access to Tobacco from Retail & Social Sources Provide Cessation Services Decreased Tobacco Consumption Decreased Tobacco Use Prevalence Decrease Youth Uptake of Tobacco Decreased Exposure to ETS Counter Pro-Tobacco Influences

Training/ TA Clearing- house Quitline 11 Regions 4 Ethnic Networks 83 Competitive Grantees 61 Health Department Coalitions Statewide Evaluation CDCLegacy DHS Tobacco Control Program STAKE Statewide Media Campaign

Local Programs

Statewide Projects Direct Service Providers Quitline Clearinghouse Tobacco Industry Sleuthing Project Training/TA Providers Technical Assistance Legal Center Media/PR Technical Assistance BREATH (Smoke-free Bar Project) Impact Leaders and Institutions Youth Advocacy Network Entertainment Industry Campaign Key Opinion Leader Project Divestment Project Labor Project Ethnic Networks

Provides intensive telephone cessation counseling to adults and teens Provides self-help kits and referral services Serves approximately 3500 new clients per month and 1200 new clients counseled monthly 26.7% success rate at one year f/u

Educational materials distribution Educational materials development Library services Maintain web sites Technical assistance Serve 170 Contractors &1000 School Districts

Technical Assistance Legal Center Provides California communities with free technical assistance on legal issues related to drafting and passing tobacco control policies Provides high quality legal analyses to city attorneys, county counsels, elected officials and project directors

TCS Workgroups Gardening experts…. Secondhand Smoke Point-of-Sale Practices Project SMART Money Chew/Dip, Cigars & Alternative Tobacco

Statewide Campaigns Operation Storefront Project SMART Money Communities of Excellence

The Media Campaign

Mature Campaign Apathy Awareness Concern Attitudinal Shift Social Expectation Action/ Legislation Social Norm Expectation Contentment The Cycle Of A Social Issue

Strategies That Work Secondhand Smoke –Educate people about the hazards, and they will take action to protect themselves –Turns public apathy into action –Gives non-smokers a voice –Cessation is an outcome--people quit to protect their families

Strategies That Work Countering Pro-Tobacco Influences –Causes people to question industry motives and rallies smokers & non- smokers alike –Youth & adults rebel against industry manipulation –Supports local policy activities

Youth Strategic Learning Strategies that DID Motivate “Tobacco Industry Manipulation” Nicotine Addiction “Secondhand smoke is more dangerous than you think” Impactful personal stories

Youth Strategic Learning Strategies that DIDN’T Motivate Long-term health effects Short-term health effects Short-term cosmetics effects Romantic rejection Smoking isn’t cool

“If health education and prevention can’t show it’s effective, it doesn’t deserve the money.” Evaluation and Surveillance The Law We Live or Die By

Source: California State Board of Equalization (packs sold) and California Department of Finance (population). U.S. Department of Agriculture. Note that CA data is by fiscal year (July 1-June 30) and U.S. data is by calendar year. Prepared by: California Department of Health Services, Tobacco Control Section, June Packs/Person California and US cigarette consumption, packs per fiscal year, 80/ /99 US CA

California vs. U.S. Adult Smoking Prevalence Sources:United States--NHIS, US Centers for Disease Control and Prevention California--CTS, 1990, , 1996, weighted to 1990 CA population; CATS/BRFS, , weighted to 1990 CA population. Prepared by:California Department of Health Services, Tobacco Control Section, May 24, Tax Increase and Start of the CA Tobacco Control Program * Definition change in 1996 resulted in more “occasional smokers” being counted. *

30-day smoking prevalence among California youth using a telephone survey, Source: CYTS Prepared by: Tobacco Control Section, California Department of Health Services, June Percent

1999 Youth Smoking Prevalence Substance Abuse and Mental Health Services Administration (SAMHSA)

Cumulative Number of Cities with Smoke-Free Provisions in Ordinance California

Protection From Environmental Tobacco Smoke In The Workplace Protection From Environmental Tobacco Smoke In The Workplace Percentage of workers protected CTS, 1998

Smokers with Children Under 18 Who Prohibit Smoking in Their Household

Relation Between Policy and Cigarette Consumption Source: CTS 1999 Daily Cigarette Consumption and Smoking Bans Cigarettes/Day

Percent of Retailers Selling Tobacco to Youth Percent Attempted buy protocol ; Actual buy protocol Due to different methodologies 1994 survey results may not be comparable to the results. Source: California Youth Purchase Survey, Prepared by: California Department of Health Services, Tobacco Control Section, September 2000.

Lung and Bronchus Age-Adjusted Cancer Rates, EAPC = -2.3* EAPC = United States (Surveillance, Epidemiology, End Results [SEER]) includes the following registries Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, and Atlanta. San Francisco-Oakland has been excluded. 2 California Cancer Registry, California Department of Health Services (11/99) * Estimated annual percent change (EAPC) is significantly different from zero (p<0.01) Rate per 100,

Savings in Smoking Attributable Direct & Indirect Costs Billions $836 Million $8.4 Billion

Conclusions A comprehensive program is most effective. Media and local programs must be coordinated and well funded. If you want kids to not smoke, you have to get the adults to change their behavior. Anti-industry and secondhand smoke strategies are effective. Empower the communities to advocate. Be culturally sensitive Accountability is the key to success. Provide strong leadership and allow program flexibility.