Maryland’s Cigarette Restitution Program Georges C. Benjamin, MD FACP, Secretary Maryland Department of Health and Mental Hygiene November 2000 Protecting Our Children’s Future

Maryland Legislation Leaving a Legacy ATTACKING TWO FRONTS Tobacco Use Cancer Burden

CRF Appropriations Public Health Programs Medicaid 24% $24.6M Cancer/ Tobacco Related Diseases 30% $30.8M Substance Abuse 18% Tobacco Use Prevention & Cessation 18% Crop Conversion 9% $18.5M $18.1M $9M MD Health Care Foundation 1% $1.5M TOTAL: FY01 Health & Tobacco $102.5M Source: MLIS 90-Day Report

Tobacco Control Goals by 2010 Decrease –Adult smoking –School-age tobacco use –Smoking by pregnant women –Childhood exposure to secondhand smoke Increase –Smoking cessation during pregnancy –Number of insurance companies funding cessation –Compliance with youth access laws –Number of primary care providers advising against smoking –Number of jurisdictions with Community Coalitions

CRF Appropriations Tobacco Prevention & Cessation Countermarketing Media 28% $5M Local Public Health 39% $7M Surveillance & Evaluation 17% Statewide Public Health 13% $3M $.8M Five Program Components TOTAL: FY01 Tobacco $18.1M $2.3M Administration 3%

Program Components Countermarketing/Media Smoking Cessation Programs Community-Based Programs School-Age Populations Statewide Activities Enforcement Surveillance and Evaluation Administration CDC Guidelines Tobacco Control

Special Considerations Baseline and Annual Surveillance Studies - DHMH & MSDE –Youth –Minority –Adult –Pregnant Women Evaluation of All Components Initial Planning Grants - $10,000 CRF Tobacco Control

Formula based on Number of smokers under age 18 Number of individuals who smoke Local Community Funding Tobacco

Youth Tobacco Survey Underway Adult Tobacco Survey Underway Legacy Foundation Grant Received - $100,000 Tobacco Component Status

CRF Appropriations Cancer Reduction Programs Local Public Health 42% $12.8M Academic Health Centers 49% $15M Surveillance & Evaluation 7% Statewide Public Health 0% $2.3M $0M $.8M Administration 3% Five Program Components TOTAL: FY01 Cancer $30.8M

Cancer Control Goals by 2010 Decrease Cancer incidence and mortality Disparities in cancer deaths  Minorities and Geographic areas Prevalence of tobacco use Increase Survival and quality of life Access to care for underserved communities Treatment services Partnerships, collaboration and coordination Access to clinical trials

Surveillance & Evaluation Cancer Component Baseline and Annual Surveillance Studies: D H M H Cancer Registry Enhance Cancer Surveillance System Evaluation of All Program Components Initial Planning Grants - $10,000

Statewide Academic Health Centers –Research –Specialty Treatment –Academic Linkages Special Environmental Cancer Registry (JHMS) Cancer and Tobacco-related Diseases Network (UMMG) Academic Health Center Cancer

Formula Driven by Targeted Cancers Number of individuals with targeted Cancer Number of individuals who died from targeted Cancer How Much Does Local Health Get?

Attack the Problem Targeted Cancers Source: DHMH Vital Statistics Administration 1998 Total Cancer Deaths – MD: 10,187

Targeted Cancers Lung Colorectal Breast Cervical Prostate Oral Skin

Coalition Development by LHD Strategic Planning/Goal Setting Budget Preparation DHMH Approval Procurement of Services Annual Progress Reports  Minorities, Youth and Women Local Heath Process

Activities Cancer Education Cancer Prevention & Early Detection Cancer Treatment and Supportive Services Local Public Health Cancer Control

CRF Program Start-up Phase Executive Steering Committee DHMH Reorganization Program Briefings Cancer Council DHMH Public Health Roundtable

CRF Program Start-up Phase DHMH Operations Resource Team Memorandum of Understanding Ethics Commission Meeting Centers for Disease Control & Prevention

CRF Administration Managing for Results (MFR) - prepared and submitted plan to General Assembly Staff - hired Medical Director, Epidemiologist and Program Administrator Administrative Costs - defined, developed and distributed to LHDs

CRF Surveillance and Evaluation Baseline Cancer Report - distributed to Governor and General Assembly Funding for Cancer - local funding developed using formula in legislation Evaluation - data to be collected by LHDs & academic health centers for program evaluation.

CRF Local Public Health Component Cancer Implementation Teams - }Local Health Officers }Baltimore Group } University of MD Network }University of MD Medical Group }Johns Hopkins Institutions }DHMH staff

CRF Local Public Health Component Cancer Planning Grants: }LHDs to apply for grants Program Inventory: }Distributed standard form to record local publicly-funded cancer programs

CRF Local Public Health Component Medical Advisory Committee on Colorectal Cancer }Formed to advise DHMH on screening, diagnosis and treatment guidelines for Colorectal Cancers }Developed minimal clinical elements for Colorectal Cancer }Committee has met three times

CRF Statewide Academic Health Component Cancer Research Grants:  University of Maryland Medical Group MOU to handle CRF fiscal matters  State Ownership MOU for cancer research licenses  Grant Guidance developed for two academic centers  UMMS Grant Application received  Working with JHU on their application

CRF Maryland Statewide Network Grant Grant Applications/Instructions }Received grant applications from University of Maryland Medical Group }Infrastructure Budget Request included in grant application

CRF - Cancer Implementation Baltimore City Baltimore Leadership Meeting Meet with Sinai Hospital BCHD Completed Community Inventory Structure Finalized }Executive Committee Formed }Responsibilities Clarified }Accountabilities under construction (MFR)

Structure of Cancer Public Health Grant devised by: }UMMG }Johns Hopkins Institutions }Baltimore City Health Department CRF Public Health Grant Baltimore City

CRF - Cancer Next Steps Receive & Evaluate Academic Center Research Grants Name Major Community Hospitals Baltimore City Cancer Coalition Solicit & Award Outreach Grants Implement Local Health Proposals –One awarded & two under review

CRF - Tobacco Next Steps Finalize Tobacco Surveys Issue Baseline Tobacco Survey Receive & Evaluate Tobacco Proposals Implement Local Health Proposals Media Solicitations Evaluation Solicitation

CRF Implementation Special Issues Tobacco Enforcement Workgroup Ensuring Statewide Cancer Programs Cancer Treatment Payments FY 2002 Programs –Tobacco related diseases –Major community hospital