1. TM Best Practices—2007 Centers for Disease Control and Prevention Deborah Houston McCall, MSPH, Program Consultant Program Services Branch Office on Smoking and Health National Associations of County and City Health Officials (NACCHO) and the National Associations of Local Boards of Health (NALBOH) Webcast: Attacking the #1 Cause of Preventable Death and Disease: Using the CDC Best Practices for Comprehensive Tobacco Control Programs December 8, 2008

2. TM Best Practices 1999  Evidence-based providing: —A blueprint for program components  Community Programs  Chronic Disease Programs  School Programs  Enforcement  Statewide Programs  Counter-Marketing  Cessation Programs  Surveillance and Evaluation  Administration and Management

3. TM. Evidence Base

4. TM Comprehensive Programs Work  Integrated programs influence social norms, systems, and networks.  The more states invest, the greater the reductions in smoking prevalence and consumption.  The longer states invest, the greater and faster the impact.

5. TM Updating Best Practices  States requested updated guidance  Cost of living has increased 30%  Evidence-based reviews of specific strategies  Broader range of state experience

6. TM Best Practices 2007  State and Community Interventions —Statewide Programs —Community Programs —Tobacco-Related Disparities —Youth (Schools and Enforcement) —Chronic Disease Programs  Health Communication Interventions  Cessation Interventions  Surveillance/Evaluation  Administration/Management

7. TM Best Practices 2007  Provides recommended level of annual investment within the funding range  Factors in state-specific characteristics

8. TM State and Community Interventions  Community resources must be the foundation of sustained solutions to pervasive problems like tobacco use  Making tobacco less desirable, less accepted, and less accessible  Importance of grassroots support for social norm change “All Prevention is local”

9. TM

10. State and Community Interventions  Consolidates Statewide, Community, School, Enforcement, and Chronic Disease into one category  Cost parameters include: —Duplication of 1999 cost parameters —Adjusting for cost of living increases, population shifts, smoking prevalence, and school enrollment  More explicit integration of policy interventions  Emphasis on eliminating disparities

11. TM State and Community Interventions: COMMUNITY PROGRAMS  Funding community organizations  Facilitating local coalitions  Collaborating with partners to build capacity  Supporting local strategies to educate  Promote public discussion  Establish local strategic plan  Ensure support for local PH infrastructure  Ensure grantees measure social norm change outcomes

12. TM State and Community Interventions: YOUTH PROGRAMS  Increase unit price of tobacco  Conduct mass media with community interventions  Mobilize community to restrict minors’ access  Implement school-based interventions with media and community efforts

13. TM The Community Guide’s Tobacco Control Strategies in Communities Goal Recommended Interventions When Implemented ALONE Increase CessationIncrease the price (excise tax) Reduce InitiationIncrease the price (excise tax) Reduce SHS ExpSmoking bans

14. TM The Community Guide’s Tobacco Control Strategies in Communities GoalInterventions with Insufficient Evidence Increase Cessation Smoking cessation contests Broadcast smoking cessation series Reduce Initiation Retailer education Youth point of purchase laws Active enforcement Community education / access Student delivered community education Reduce SHS Exp Community-wide efforts to reduce SHS exposure in the home

15. TM State and Community Interventions: CHRONIC DISEASE PROGRAMS  Collaborating with related PH programs  Implement interventions that link to other programs  Develop communications that link SHS to health outcomes  Use tax revenue to fund tobacco and other chronic disease programs  Link other programs to tobacco interventions (e.g., promoting quitline)  Promote insurance coverage of preventive services

16. TM State and Community Interventions: TOBACCO-RELATED DISPARITIES  Conduct population assessment  Seek consultation from specific populations  Ensure disparities addressed in strategic plan  Fund organizations that can reach and involve specific populations  Provide culturally competent TA  Provide communication to reach disparate populations  Ensure quitlines can meet the required needs of population subgroups

17. TM Health Communication Interventions  Health communication interventions are powerful tools to prevent initiation, promote cessation, and shape social norms.  Effective messages can stimulate public support and create a supportive climate for policy change.

18. TM Cessation Interventions

19. TM Cessation Interventions  Sustain, expand, and promote services such as quitlines  Coverage of treatment under public and private insurance  Eliminating cost barriers for underserved populations  Making the PHS-recommended health care system changes

20. TM  Current cost parameters include: —Updating 1999 cost parameters for health system changes and quitlines  State-specific characteristics —State population —Smoking prevalence  Recommended level of intensity: —6% of tobacco users enrolled into counseling Cessation Interventions

21. TM Surveillance and Evaluation  Current cost parameters include: —Maintain 10% of total program budget  Additional funds may be needed for: —Process evaluation —Local-level evaluation —Specific populations

22. TM Core Surveillance Systems  Behavioral Risk Factor Surveillance System  Youth Risk Behavior Surveillance System  Youth Tobacco Survey  Adult Tobacco Survey

23. TM Administration and Management  Current cost parameters include: —Maintain 5% of total program budget  Should fund: —Coordinated guidance and TA across program elements —Collaboration and coordination with other state agencies in public health programs

24. TM Disparities  Costs captured in multiple budget categories  State and Community Interventions —Fund local organizations to reach diverse populations —Support participation in coalitions —Fund multi-cultural organizations and networks  Health Communication Interventions —Use culturally appropriate messages and targeted media channels  Cessation Interventions —Develop culturally appropriate and translated materials —Provide access to multi-lingual quitline counselors  Administration and Management —Support participation in strategic planning

25. TM State Examples  Recommended Annual Investment Louisiana: $12.46 per capita $53.5 million Alaska:$16.11 per capita$10.7 million Utah: $9.23 per capita $23.6 million Oklahoma:$12.54 per capita $45.0 million New York: $13.15 per capita$254.3 million

26. TM “Knowing is not enough; we must apply. Willing is not enough; we must do.” - Johann Wolfgang von Goethe “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” - Margaret Mead

27. TM Best Practices—2007 Centers for Disease Control and Prevention Office on Smoking and Health Deborah Houston McCall, MSPH Program Consultant 770-488-1182 dmccall@cdc.gov