State and Community Collaborations: An Approach to Restricting Youth Access Steve McElravy, M.S.W.Alejandro Arias, Ed.D. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention

The Challenge to Reduce Youth Access to Tobacco Accountability The 1992 Synar Amendment requires States to enact and enforce laws prohibiting sales of tobacco to minors. The 1996 Synar Regulation sets a target for all States to achieve a retailer violation rate (RVR) of 20% or less. States not in compliance with the requirements risk losing 40% of Substance Abuse Prevention and Treatment (SAPT) Block Grant funds. Action States are given flexibility to implement the requirements. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends a comprehensive approach as most effective. Resources States may use SAPT Block Grant funds to support administrative aspects of Synar. Most states have limited resources to enforce the law.

The Challenge Was Met States Achieving Retailer Violation Rates of 20 Percent or Lower for FY97-FY03* † *All years include data from the 50 States and the District of Columbia. † In FY03, 49 States and D.C. were found in compliance with the Synar goal of 20%, +/- 3 percentage points

National Weighted* Average Retailer Violation Rate: FY97-FY03 † *Weighted by state population (RTC 2001) † All figures include data from the 50 States and the District of Columbia.

Single State Agency implementing SAPT Block Grant usually lacks the resources to achieve Synar targets alone. Collaboration across agencies is one of key elements of success. Increasing Synar Compliance Rates…

Common components of collaboration –Share a common need or goal –Share ideas –Pool resources –Ensure commitment over time –Involve all members in decision making –Define roles and time commitments –Create formal links with written agreement –Develop new resources and joint budgets –Share leadership –Maintain and value communication

Delaware After Delaware missed its target RVR in FY 1999, the Governor’s office convened all State agencies with Synar responsibilities. Strategic planning and regular monthly meetings focused on the key issues in Synar compliance. Memorandum of Understanding resulted among four Cabinet secretaries and the Governor. Departments of Health and Social Services, Children Youth and Families, Public Safety and Finance each play a key role. Governor’s staff ongoing involvement helps maintain the momentum, which has brought Delaware’s RVR to one of the lowest in the nation.

New Mexico Strong four-way collaboration at the State level: Departments of Regulation and Licensure, Public Safety, and Health (Behavioral and Public Health Divisions). Supported by Executive Order from Governor, and Joint Power Agreement between Health and Public Safety for enforcement activity. Local collaboration: tobacco coalitions support Synar through additional inspections, merchant education, and policy development; invite retailers to join local coalitions. Public Health and Behavioral Health Divisions collaborate on strategic planning and proposal review, including use of CDC and Master Settlement funds.

North Dakota Departments of Health, Human Services and Attorney General collaborate on CDC’s comprehensive tobacco approach through informal meetings. Issue joint news releases and support policies that reduce youth tobacco use. Department of Health supports local tobacco coalitions, which have worked for enactment and enforcement of local youth tobacco access laws stronger than state law. Department of Human Services works through some local coalitions to recruit Synar inspection teams.

Maine Strong 3-way collaboration among Bureau of Health, Office of Substance Abuse, and Attorney General. Memorandum of Agreement supports random unannounced inspections of retailers and enforcement of youth access law through local law enforcement agencies. Developed a comprehensive public health oriented, incentive-based merchant education and compliance program based on requests from retailers.

Synar Retailer Violation Rates FY97-FY03

Challenges in Collaboration Letting go of competition Changing organizational behavior/culture Defining clear roles and responsibilities Committing human and financial resources Time to coordinate Nurturing ongoing relationships

Lessons Learned Reducing youth access to tobacco involves multi-agency efforts in virtually every State. States vary in the formality of their collaborations. States overcame the challenges and succeeded. –Committing to a common goal –Sharing ideas and resources –Creating formal and informal agreements defining roles and responsibilities –Engaging in joint programming and strategic planning –Leadership from the top and from those doing the work Collaboration maximizes resource use, avoids duplication of effort, and supports comprehensive programming.