1. Successful Physician Advocacy Jonathan P. Winickoff, MD, MPH Associate Professor in Pediatrics Harvard Medical School April 26, 2013

2. …dedicated to eliminating children’s exposure to secondhand smoke and tobacco AND …ensuring that all clinicians ask the right questions about tobacco and secondhand smoke exposure

3. Objectives Understand one general approach to use at any advocacy level Understand importance of local practice and community level for building state and national change Hear from you about harnessing your special role as a clinician

5. Comparative Causes of Annual Preventable Deaths in the United States Sources: (AIDS) HIV/AIDS Surveillance Report 1998; (Alcohol) McGinnis MJ, Foege WH. Review: Actual Causes of Death in the United States. JAMA 1993; 270:2207-12; (Motor vehicle) National Highway Transportation Safety Administration, 1998; (Homicide, Suicide) NCHS, vital statistics, 1997; (Drug Induced) NCHS, vital statistics, 1996; (Smoking) SAMMEC, 1995 Suicide Alcohol Motor Homicide Drug Obesity Smoking Vehicle Induced

6. Scientific Knowledge: Critical Known Data Stop sale of tobacco in pharmacies Make cars smokefree Make multi-unit housing smokefree Link parents to quitlines at the child visit Raise tobacco purchase age to 21

7. Scientific Knowledge: Critical Known Data The clinician can authoritatively deliver the critical known data to the appropriate audience to make change People trust pediatricians When so much in this world involves money— Pediatricians have nothing to gain except better health for children and families

8. Why Local Level First? You understand it best You have the greatest chance of having influence You can work out the kinks in your plan You can speak about your experiences and develop anecdotes to use at all other levels

9. Tobacco 21 80-90% of adult smokers started before the age of 18—high school is where smoking starts Lester Hartman

10. Bonus Material: Tips and Tricks Anecdotes Anecdotes can be a powerful way to make your point Work them in with the scientific knowledge During the smokefree public housing debate in Maine, this anecdote about a patient with CF was used. Maine is first state with universal smokefree public housing!

11. Bonus Material: Tips and Tricks Press and Media Press and media can be your friend Thirdhand smoke appeared on the Today Show and suddenly people are aware of a tobacco control issue in a new way

12. Bonus Material: Tips and Tricks Do Something Write effective letter or email Phone call Persuade others to contact representatives Get out the vote Contributions to candidates Meet your representative Testify at a public hearing Protest/march Run for office

13. Bonus Material: Tips and Tricks How you say it matters Get your story straight Never, ever make up an answer Work hard/be nice (don’t be righteous) Learn how to negotiate (don’t view people with polarized lenses) Always say thanks

14. Bonus Material: Final Thoughts Dream the Impossible, but work in the realm of the Possible Sometimes losing is better than winning Never negotiate with the tobacco industry Work with the pros for legislative goals Assume someone has tried what you are trying and can teach you something