tobacco 101 part 2 lesson 2 - emory university€¦ · 4 tobacco 101 part two, lesson two tobacco...

Tobacco101PartTwo,LessonTwo

2016

ASELF-GUIDEDE-BOOKINTWOPARTS

©2016EmoryCentersforTrainingandTechnicalAssistance2

IntroductiontoTobacco101WelcometoTTAC’sTobacco101!Tobacco101isaself-guidedtutorialthatprovidestheinformationandresourcesnecessarytounderstandwhytobaccouseisconsideredthe#1preventablecauseofdeathintheUS,aswellastheevidence-basedandpromisingstrategiesthatcanreducetobacco’stoll.Youcanbenefitfromthiscoursewhetheryouarenewtotobaccocontrolandneedanintroductiontokeytopics,orareanexperiencedprofessionallookingtorefreshandupdateyourknowledge.

Tobacco101wasrevisedinthespringof2013tocontainthelatestinformation,resources,andtoolsavailable.Theuser-friendlyself-guidedformatallowsyoutocompletethetutorialatyourownpaceandexplorethevariousexternalresourcesandtoolsasneeded.Tobacco101isorganizedintotwopartscomprisedoffourlessonseach.Optionalreviewquestionsareofferedattheendofeachlessontoallowyoutocheckyourunderstandingofthecontent,trysomeoftheresources,andreflectonhowtheinformationappliestoyourroleintobaccocontrol.

Youcanstartatthebeginningandreadthroughthecoursefrombeginningtoendorsimplyselectthosesectionsthatareofgreatestinterest.

Part1:IntroductiontoPreventionandControlofTobaccoUse• Lesson1:TheEvolutionofTobaccoControl• Lesson2:TobaccoUseintheUnitedStates• Lesson3:ImpactofTobaccoUse• Lesson4:FactorsthatDetermineTobaccoUse

Part2:ReducingtheProblemofTobaccoUse• Lesson1:CredibleTobaccoControlResourcesandKeyPartners• Lesson2:TobaccoControlModels• Lesson3:EffectiveTobaccoControlPolicies• Lesson4:StrategiesforSuccess

TTACalsoprovidestailored,on-siteTobacco101trainingsfororganizationswhowanttoincludeitinconferencesandworkshops.Tolearnmore,visitourwebsitewww.tacenters.emory.eduorcontactusattacenters@emory.edu.


TableofContentsPART2: REDUCINGTHEPROBLEMOFTOBACCOUSELESSON2

TobaccoControlModels Page4

CheckforUnderstanding Page26

Sources Page30


Tobacco101PartTwo,LessonTwoTobaccoControlModelsThislessonwillexplainthepublichealthapproachtotobaccocontrolanddescribetwosuccessfulmodelsforcomprehensive,population-basedapproachestoreducetobaccouse.Attheendofthislessonyouwillbeableto:

1. Explainthepublichealthapproachtotobaccocontrol.Wewilltalkaboutwhatthepublichealth

approachmeansandexplainwhythisapproachissuccessfulinimprovingpopulationhealth.

2. DescribethesixinterventionsincludedintheWorldHealthOrganization’sMPOWERmodel.WewilldiscusstheWHO’sMPOWERmodel,whichrecommendsmultipleinterventionstoreducetobaccouseandtobacco-relatedharmworldwide.

3. DescribethecomponentsoftheCentersforDiseaseControlandPrevention’sBestPracticesfor

ComprehensiveTobaccoControlPrograms.CDC’sBestPracticesforComprehensiveTobaccoControlProgramsoutlinesindetailthefourgoalsoftheNationalTobaccoControlProgramandtheelementsofascience-basedprogramtoachievethosegoals.

4. Discusshowsuccessfulprogramsachievelongtermgoals.Effectivetobaccocontrolinterventions

havemultiplecomponents,areadequatelyfundedandaresustainedformanyyears.Wewilllookathowsuccessfulprogramsachievelong-termgoals.


ThePublicHealthApproachThemissionofpublichealthistoprotectandimprovethehealthofpopulations,withafocusonpreventingproblemsbeforetheyoccur.Whenthinkingaboutpublichealth,educationalcampaignsandclinicaltreatmentoftencometomind.However,evidenceshowsthatthoseeffortsbythemselvesdonotreachthepopulation-level,andthatmorebroad-basedeffortsarenecessarytogetthere.

Becauseofthis,thePublicHealthApproachfocusesonchangingtheenvironmenttomakeitmoreconducivetogoodhealthforanentirepopulation,ratherthanonchangingthebehaviorofindividualsoneatatime.Dataandscientificevidenceareusedtodescribepublichealthproblemsanddrivedecision-makingaboutthesepopulation-basedsolutions.Inusingthisapproach,publichealthprofessionalscanprotectandimprovethehealthofentirepopulations.


TheHealthImpactPyramidThe5-tierHealthImpactPyramidpicturedbelowprovidesausefulwaytothinkaboutthepublichealthapproach.ThePyramidwasoriginallypresentedbytheDirectoroftheCentersforDiseaseControlandPrevention,Dr.ThomasFrieden,inanarticlepublishedintheAmericanJournalofPublicHealthin2010.Interventionsthatdealwithchangingsystemsandenvironmentsareatthebaseofthepyramid,whichindicatesthegreatestimpact.Interventionsthateducateandcounselindividualpatients,whichhavelessofanimpactatthepopulationlevel,areatthetopofthepyramid.Interventionsfocusingonlowerlevelsofthepyramidtendtobemoreeffectivebecausetheyreachbroadersegmentsofthepopulation.Thatisn’ttosaythatindividualcounselingandeducationeffortsarenotimportant–interventionsworkingtogetheratalllevelsofthepyramidarenecessary.However,interventionsthatfocusonthefactorsatthebottomofthepyramidaffectalargerproportionofthepopulation,whichismoredesirablefromthePublicHealthstandpoint.


ThePublicHealthApproachtoTobaccoControl

Governmentagenciesandtobaccocontroladvocacyorganizationsalikeusethepublichealthapproachintheirtobaccopreventionandcontrolefforts.IntermsoftheHealthImpactPyramid,tobaccocontrolworksatalllevels.Atthetopofthepyramidareclinicalinterventions,counseling,andeducationforpersonswhousetobacco.However,themainemphasisisoninterventionsatthebottomofthepyramid-policy,environment,systemschange,andcommunicationscampaignstochangesocialnorms.Toachievetheseinterventionsoftenrequiresawell-organizedcollaborativeorcoalitioncommitment.

Forexample,considerthesetwotobaccointerventions:individualcounselingbyaclinicianinaworkplaceandasmoke-freelawappliedtoallworkplaces.Thestatewidesmoke-freepolicyhasabroadreachacrossthepopulationandcreatesanenvironmentwheresmokingisprohibited.Suchanenvironmentalchangemakessmokingmoreinconvenientandwillpromptmanymorequitattemptsthanworksitecounselingalone.Policychangesalsohavetheadvantageofbeingmoresustainablethanindividualeducationorinterventionprograms.However,thecombinationofsmoke-freepolicyandaccessiblecessationassistancewillcreatemanymoresuccessfulquitattempts.


ModelsforaPublicHealthApproachtoTobaccoControlTherearetwomainpublichealthmodelsthatprogramscanusetoreducetobaccouse:

1. MPOWER,theWorldHealthOrganization(WHO)model2. BestPractices,theUnitedStates’CentersforDiseaseControl

andPrevention(CDC)model

Whiledistinct,bothmodelsusethepublichealthapproach,andincludesomesimilarcomponents,suchasemphasizingtheimportanceofenactingspecificpoliciesorlaws(e.g.,smoke-freelaws).Wewillfirsttalkabouttobaccocontrolfromaglobalperspective.TheWHOFrameworkConventiononTobaccoControl(FCTC)istheWorldHealthOrganization’sfirstinternationalpublichealthtreaty.Thetreaty,adoptedin2003,recognizestobaccouseasaglobalepidemic.IthassincebecomeoneofthemostwidelyembracedtreatiesinUnitedNationshistory,establishinginternationalcooperationandstandardstoreducetobaccouse.AsofJanuary2013,176nationshavesignedtheFCTC.TheUShasnotsignedthetreatyasofyet.


GlobalTobaccoControl:MPOWERTheFCTCanditsguidelinesprovidethefoundationforcountriestoimplementandmanagetobaccocontrol.Tohelpmakethisareality,WHOintroducedtheMPOWERmodelin2008.Themodelcontainssixpoliciesandinterventionsthatareintendedtoassistinthecountry-levelimplementationofeffectiveinterventionstoreducethedemandfortobacco.

M – Monitortobaccouseandpreventionpolicies.

P – Protectpeoplefromtobaccosmoke.

O – Offerhelptoquittobaccouse.

W – Warnaboutthedangersoftobacco.

E – Enforcebansontobaccoadvertising,promotion,andsponsorship.

R – Raisetaxesontobacco.

Wewilltalkabouteachstrategyseparatelynext.


MPOWER:Monitortobaccouseandpreventionpolicies

Monitoringtobaccouseandtobaccocontrolprogramsisessentialtothesuccessoftheotherfivepolicyinterventions.Monitoringsystemsmusttrack:

1. Theprevalenceoftobaccouse,secondhandsmokeexposure,andtobacco-relateddisease.2. Whetherpolicyinterventionsareinplace;and,ifso,whethertheywork.3. Marketing,lobbying,andpromotionactivitiesofthetobaccoindustry.

Monitoringdataisnecessarytodeterminetheextentandcausesofthetobaccoproblem,aswellastoplanandimplementeffectivesolutions.Datacollectedthroughmonitoringprovidepowerfulevidencethatapolicyisworkingandhasvalue,orisnotworkingandmayneedfurtherevaluation.Monitoringensuresthatresourcesareallocatedwheretheyaremostneededandwillbemosteffective.ReadmoreabouttheMonitorinterventiononWHO’swebsiteandintheWHOMPOWERbrochure.


MPOWER:Protectpeoplefromtobaccosmoke.Asdiscussedpreviously,thereisnosafelevelofexposuretotobaccosmoke.Thecreationof100%smoke-freeenvironmentsistheonlywaytoprotectthepopulationfromsecondhandsmoke.Smoke-freeairpoliciesalso:

• Reducethenumberofsmokersandreducetobaccouseamongsmokers.• Increasetheprevalenceofsmoke-freehomes,protectingfamilymembersandchildren.• Helpsmokersquit.• Discourageyouthfromstartingtosmoke.

TheWHOrecommendslegislativelymandatedsmoke-freepoliciesthatofferuniversalprotection.Asthegraphatrightdemonstrates,smoke-freeairpoliciesarepopularandsuccessful.Yet,thetobaccoindustryclaims(falsely)thatsmoke-freeairlawsarecostlytobusinesses,anddifficulttoenforce.Areviewofworldwideeconomicimpactstudiesofsmoke-freepoliciesshowstheydonothaveanegativeeffectonbusinesses.The2006SurgeonGeneral’sReportstatesthatsmoke-freeindoorenvironmentsareproven,simpleapproachesthatpreventexposureandharm.ReadmoreabouttheProtectinterventiononWHO’swebsiteandintheWHOMPOWERbrochure.


MPOWER:OfferhelptoquittobaccouseProgramstotreattobaccodependenceshouldincludeavarietyofmethods,fromsimplemedicaladvicetopharmacotherapyandtelephonehelplines(quitlines).PrimaryCareandOtherHealthCareSystems

• Visitstohealthcarefacilitiesgivehealthcareprofessionalsanopportunitytoremindpatientsthattobaccoharmstheirhealthandthehealthofothersaroundthem.

• Repeatedadvicefromhealthprofessionalsgreatlyincreasescessationrates.QuitLines

• Accesstoaquitlinecombinedwithnicotinereplacementtherapyisevenmoreeffectivethannicotinereplacementtherapyalone.

• Quitlinesreachpeopleinremoteplacesandcanbetailoredforspecificpopulations.

• Quitlinesareavailabledailyandyear-round,tobeavailablewhenthetobaccouserisreadytoquit.

PharmacologicalTreatment

• Treatmentdoublesortriplesquitrates.• Nicotinereplacementtherapycomesinpatches,lozenges,

gum,andnasalsprays.• Prescriptionmedicationssuchasbuproprionandvarenicline

arealsoavailable.GovernmentSupportforTreatment

• Supportconsistsofquitlines,subsidizednicotinereplacementtherapy,andcounselingservices.

• Fundingservicestohelppeoplequitusingtobaccoenablesthegovernmenttoreachthosemostdirectlyaffectedbytobacco-relatedillnessanddeath.

• TheAffordableCareActrequiresthatinsurancecompaniescoverthecostofpharmacologicaltreatment

ReadmoreabouttheOfferinterventiononWHO’swebsiteandintheWHOMPOWERbrochure.


MPOWER:WarnaboutthedangersoftobaccouseHerearesomeofthemosteffectivewaystowarnpeopleabouttobaccouse:EducationOnewaytowarnpeopleistoeducatethemabouttherisksoftobaccousethroughmassmediacampaigns.Theextremeaddictivenessofnicotineandresultinghealthconsequenceshavenotbeenadequatelyexplainedtothepublicingraphic,realisticterms.Consequently,peoplebelievetheycanreduceorstoptobaccousebeforehealthproblemsoccur.Inrealitymosttobaccousersfinditdifficulttoquit,andhalfofthemwilldieoftobacco-relatedillnesses.Agoodexampleofahard-hittingmassmediacampaignisthe2012-1013TipsfromFormerSmokersCampaignfromtheCDC.ChangetheimageoftobaccoThetobaccoindustrywantspeopletoassociateitsproductswithpleasure,butthroughcommunityactionthatassociationcanbedisproved.Wemustworktohavepeopleassociatetobaccowithitsextremeaddictionanddangeroushealthconsequences.

Placewarningswithgraphicpicturesoncigarettepacks.Mostpeoplesupportputtinggraphicwarningsoncigarettepacks,andtheideaencounterslittleresistanceoutsidethetobaccoindustry.Imageshavemoreimpactonmostsmokersthanwordsalone,causingemotionalreactionstothehealthandsocialconsequencesoftobaccouse.TheFDACenterforTobaccoProductsproposedgraphicwarninglabelsonallcigarettessoldintheUS;however,thetobaccoindustrychallengedtheconstitutionalityofthismeasure,tying

uptheimplementationintheUSCourts.ReadmoreabouttheWarninterventiononWHO’swebsiteandintheWHOMPOWERbrochure.


MPOWER:Enforcebansontobaccoadvertising,promotion,andsponsorshipThetobaccoindustryemployssomeofthebestmarketersintheworld,astheyhavetosellaproductthatkillshalfthepeoplewhouseit.TobaccoMarketingThetobaccoindustrysaysthatitsadvertisingandpromotionactivitiesarenottoexpandsalesorattractnewusersbuttoreallocatemarketshareamongexistingusers.Buttheirmarketinginfacturgesnonsmokers—especiallyyoungpeople—totrytobaccoandbecomelong- termcustomers.EffectiveRestrictionsForabantowork,ithastobecomprehensive,fullyenforced,andwithout loopholesorthepossibilityofpreemption,whichpreventslocaljurisdictionsform enactinglawsthatarestricterordifferentfromastateornationallaw.Restrictionsonadvertising,promotion,andsponsorshiprequirepreparationtimetoallowthoseaffectedtofindreplacementadvertisersandsponsors.Bansmayneedtobeamendedperiodicallytoovercomenewindustrytactics.Forexample,preemptionisoftenusedtolimitstrongerlawsatthestateorlocallevel.ReadmoreabouttheEnforceinterventiononWHO’swebsiteandintheWHOMPOWERbrochure.

“Today’steenageristomorrow’spotentialregularcustomer,andtheoverwhelmingmajorityofsmokersfirstbegintosmokewhilestillintheirteens.”- PhillipMorrisinternaldocument-1981


MPOWER:RaisetaxesontobaccoIncreasingthepriceofcigarettesandothertobaccoproductsthroughtaxesisthesinglemosteffectivewaytopreventtobaccouseandencourageuserstoquit.

• Tobaccoexcisetaxesarewellacceptedbyboththepublicandpoliticalleadershipbecausetobaccoisnotanessentialgoodandisstraightforwardtotax.

• Anincreaseintobaccopricesby10percentdecreasestobacco

consumptionby4percentinhigh-incomecountriesandbyabout8percentinlow-andmiddle-incomecountries.

• Apriceincreaseof10percentwouldreducethenumberof

smokersby42millionworldwideandsave10millionlives.• Hightaxesdeterthepeoplewhoaremostsensitivetoprice(the

youngandthepoor)fromusingtobacco.ReadmoreabouttheRaiseinterventiononWHO’swebsiteandintheWHOMPOWERbrochure.


MPOWERSummaryTheworldwidetobaccoepidemicisdevastating,butpreventable.MPOWERisamodelthatusessixpolicyinterventionstomovetowardatobacco-freeworld.TheWHOReportontheGlobalTobaccoEpidemic,2011:WarningabouttheDangersofTobaccohasfoundthatabout55%oftheworld’spopulationiscoveredbyatleastoneoftheseinterventions.Thisincludes:

• Massmediacampaignsreaching1.9billionpeoplein23countries• Atotalof458millionpeoplewarnedofthedangersoftobaccothroughpacklabelinglaws• Comprehensivecessationservicesmadeavailableto76millionpeople• Atotalof80millionpeopleshieldedfromtobaccoadvertising,promotion,andsponsorshipthrough

completebansDespitethisprogress,thereismuchroomforimprovementandprogresstoprotectpeopleworldwidefromtheharmsoftobacco.Tocounteractthetobaccoepidemic,countriesmusthavethepoliticalwilltosetupcomprehensivetobaccocontrolprogramsandadoptthesixMPOWERpolicies.

Forfurtherinformation…aboutMPOWERCheckouttheWHOReportMPOWER-APolicyPackagetoReversetheTobaccoEpidemichttp://www.who.int/tobacco/mpower/mpower_english.pdf


CDCBestPractices:RecommendationsforComprehensiveProgramsMPOWERisaglobaltobaccocontrolmodel,yettherearealsotobaccocontrolprogramsspecificallywithintheUnitedStates.TheUnitedStates’CentersforDiseaseControlandPreventionfocusesitseffortsonmakingtobaccocontrolprogramscomprehensivetobethemosteffective.Let’sstartbydefiningacomprehensiveprogram:“Acomprehensiveapproachisonethatoptimizessynergyfromapplyingamixofeducational,clinical,regulatory,economic,andsocialstrategies.”ThisisanexcerptfromCDC'sBestPracticesforComprehensiveTobaccoControlPrograms.BestPracticesisanevidence-basedguidetohelpstatesplanandestablishtobaccocontrolprogramstopreventandreducetobaccouse.The2007editiondescribesanintegratedprogramstructureforimplementingproveninterventionsandrecommendsthelevelofinvestmentneededtoreducetobaccouseineachstate.The2007editionofBestPracticesisafoundationaltobaccocontrolresourcethathasservesasastapleintobaccocontrolprogramdevelopment.


BestPractices:ComprehensiveProgramGoalsThegoalofacomprehensivetobaccocontrolprogramistoreducedisease,disability,anddeathrelatedtotobaccouse.TheCDC’sBestPracticesguidehasfourgoalsforcomprehensivetobaccocontrolprograms:

1. Preventinitiationamongyouth.2. Promotequittingamongadultsandyouth.3. Eliminateexposurefromsecondhandsmoke.4. Identifyandeliminatetobacco-relateddisparitiesamongpopulationgroups.Eliminationofhealth

disparitiesisacross-cuttinggoal;inotherwords,interventionstoachievehealthequityshouldbeincludedinallthreeothergoalareas.

TheBestPracticesGuidefurtheroutlineswhatatobaccocontrolprogramshouldconsistoftobeconsidered“comprehensive”andabletoachievethesegoals.


BestPractices:ComprehensiveProgramComponentsResearchshowsthatthemosteffectivepopulation-basedapproachestotobaccocontrolhavesomecommoncomponents,particularlythefivelistedbelow.Thesefivecomponentsinterrelatetoproducebetteroveralloutcomes.Acomprehensiveapproachisthemosteffectivewayofpreventingpeoplefromstartingtobaccouseandgettingpeoplewhoalreadyusetobaccotostop.

1. StateandCommunityInterventionsTheseconsistofarangeofintegratedactivitiesthatworktoenactlocalandstatepoliciesandsystemschangesthatsupportandinfluencetobacco-freenorms.

2. HealthCommunicationInterventions

Theseincludetheuseofmassmediaandnewmediatypes(e.g.socialmedia)totransmithard-hittingmessagesabouttheharmsoftobacco,aswellaseffortstokeeptobaccoissuesconsistentlyinthenewsmedia.

3. CessationInterventions

Thesearesystem-basedprogramssuchas1)worksiteprogramsthatrefertobaccouserstoquitlineservicesinworkplaces;2)ensuringthatallpatientsseeninhealthcarefacilitiesarescreenedfortobaccouse,receivebriefinterventionstohelpthemquit(ifneeded),andareofferedappropriatecounselingservicesandFDA-approvedcessationmedications;and3)eliminatingfinancialbarrierstoquittingbyrequiringcoverageforcessationservicesinprivateandpublichealthinsuranceplans.

4. SurveillanceandEvaluation

Theseincludepopulationsurveysandotherresearchactivitiesto1)determinetheprevalenceoftobaccouse;2)examinetobacco-relatedattitudes,behaviors,andbeliefs;3)monitorprogramactivities;and4)assesstheresultinghealthoutcomes.

5. AdministrationandManagementThiscomponentisthestaff,facilities,andequipmentavailabletoplan,run,manage,andevaluateatobaccocontrolprogram.


BestPractices:ComprehensiveProgramFundingLevelsInadditiontodescribingthecomponentsofcomprehensivetobaccocontrolprograms,BestPracticesrecommendsfundinglevelsforeachstateintheUnitedStates.Theleveloffundinghasagreateffectonthesuccessoftobaccocontrolprograms:thehighertheleveloffunding,thegreatertheimpact.TherecommendedCDCannualinvestmentisbasedoneachstate’scharacteristics,suchastobaccouseprevalenceandsocio-demographicandeconomicfactors.Theannualinvestmentincludesallrevenuefromgovernmentalandnon-governmentalsourcesthatiscontributingtotobaccocontrolinterventions.BestPracticesbreaksdowntherecommendedbudgetintotheamountsthatshouldbeallocatedtoeachprogramcomponentineachstate:

• SectionB:RecommendedFundingLevelforAll50StatesandtheDistrictofColumbia,PerCapitaandTotal

• SectionC:RecommendedProgramInterventionBudgets,byStateTobetterunderstandhowfundingimpactsoutcomes,let’stakealookattwostates:onethatinvestedanadequateleveloffundingforasustainedperiodandimplementedacomprehensiveprogram,andonethathasnotmadethesamecomprehensiveinvestment.


ComprehensiveProgramExample:WashingtonWashington:PercentofAdultsWhoAreCurrentSmokers,1995to2010

ThisgraphshowstheBRFSSadultsmokingprevalencefrom1995to2010inWashingtonStatecomparedtothenationaltrend.Noticeinthegraph:

• In2002,smokinginWashingtonstartedtodeclineasasharperratethanthenationaltrend.BasedonBRFSSdata,by2010,Washington’sadultsmokingratelowerthantheUSrate(15.2%compared19.3%).

• ThemorepronounceddecreaseinsmokinginWashingtoncoincidedwiththeirinvestmentstartingin

2000ofupto$27millionannuallyintoanintegrated,comprehensivetobaccopreventionandcontrolprogram.ThatstateprogramcloselyfollowedBestPracticerecommendationsandstrategicallyadjustedasstatetobaccotaxesincreasedandastatewidesmoke-freepublicplacelawwasenacted.Anevaluationoftheprogramdeterminedthatthecomprehensiveprogramwastheprimaryfactordrivingthedeclineinsmokingprevalence.

• Startingin2009,statefundingdecreasedsignificantlyduetoeconomicproblems.Thedecreasein

fundingcoincideswiththeprevalencetrendflatteningout,andthegapbetweenthestateandnationalratesdecreasing.

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ComprehensiveProgramExample:MissouriMissouri:PercentofAdultsWhoAreCurrentSmokers,1995to2010

ThegraphabovedisplaysMissouri’sBRFSSdataforthesameperiod(1995to2010).InMissouri,nostatefunds(fromtheMasterSettlementAgreementorothersources)wereallocatedforatobaccopreventionandcessationprogram.Noticefromthegraph:

• Thepercentageofadultsmokersconsistentlyexceededthenationalaverageeveryyear.• Thesmokingprevalencefrom1995through2010inMissouriwasjustover25%,andin2004itwas

justbelow25%.Withapoorlyfundedstatetobaccocontrolprogram,Missourihasoneofthehigherratesoftobaccouseinthecountry,andhasnotkeptpacewiththenationaltrend.

• By2010,thenationalprevalenceofadultsmokerswascontinuingtodeclineandwaspartially

attributabletoanumberofwell-fundedtobaccocontrolstateprogramsbeingimplementedinthepastdecade.

Let’snowtakealookathowwellstatesmeetCDC’srecommendedfundinglevels.

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ComprehensivePrograms:StateSpending

ThegraphaboveshowsstatespendingfortobaccopreventionandcontrolsinceTobaccoSettlementfundsbecameavailabletostatesin1999.Asyoucansee,between2008and2013,ithasdeclinedby36%($260million).

Unfortunately,becauseofbudgetconstraints,lobbyingpressures,andmisunderstandingsaboutcomprehensivetobaccocontrolprograms,fewstateprograms,ifany,arenowfundedatthelevelsrecommendedbyCDC.TheCampaignforTobaccoFreeKids’ReportBrokenPromisestoourChildrendocumentsthedeclineinstatefundingoftobaccopreventionandcontrolprogrambasedon2011spendinglevels.Conclusionsfromthereportinclude:

1. MoststatesarefallingshortoffundinglevelsfortobaccopreventionprogramsrecommendedbytheCDC.The$456.7millionthestateshavebudgetedamountstojust12.4%ofthe$3.7billiontheCDCrecommendsforallthestatescombined.

• In2012,onlytwostates—AlaskaandNorthDakota—fundedtobaccopreventionprogramsatCDC-recommendedlevels.Onlyfourotherstatesprovidedevenhalftherecommendedfunding,while33statesandDCprovidedlessthanaquarter.Fourstates—Connecticut,Nevada,NewHampshireandOhio—andDCprovidedzerostatefundsfortobaccoprevention.

TocomparehowyourstatespendingontobaccocontrolmeasuresuptotheCDCtherecommendations,gotothisinteractivemappublishedbytheCampaignforTobaccoFreeKids.

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BestPracticesSummaryTheCDC'sBestPracticesforComprehensiveTobaccoControlProgramsisausefulevidence-basedguidetohelpstatesplanandestablisheffectivetobaccocontrolprogramstopreventandreducetobaccouse.Itlaysoutthecomponentsofthemosteffectivepopulation-basedapproachestotobaccocontrol,andprovidesrecommendationsastohowmuchmoneyshouldbebudgetedtowardseachcomponentineachstate.DespitetheimpactimplementingcomprehensivetobaccocontrolprogramstructuresattheCDC-recommendedlevelsofinvestmentwouldhave,fewstatesarecurrentlyfundingtobaccocontrolprogramsattherecommendedlevels.However,weknowwhatworks,andifprovenstrategieswerefullyimplemented,staggeringtolloftobaccocanbeprevented.


PartTwo,LessonTwoConclusionInLessonTwo,wedefinedthepublichealthapproachtotobaccocontrolfrombothaglobalandnationalperspective,whichincludesaddressingthehealthoftheentirepopulationthroughwidespread,sweepingpolicyandenvironmentalchanges.Wealsodescribedtwousefultobaccocontrolmodels:MPOWERfromtheWorldHealthOrganizationandBestPracticesfromtheU.S.CentersforDiseaseControlandPrevention.MPOWERconsistsofsixtypesofpoliciesandinterventionstobeimplementedatthecountry-leveltoreducediseaseanddeathfromtobacco.BestPracticesdescribesfourtobaccocontrolgoalareasandthefivecomponentsofstatetobaccocontrolprogramsneededtoachievethosegoals.Finally,welookedatexamplesofhowstatetobaccocontrolfundingandprovisionofcomprehensiveprogramsasdefinedbytheCDCrelatestosmokingoutcomes.

Sofar,wehaveshownthatchangingtobaccopolicyandsystemsthatreachlargepopulationsarethebestwaytopositivelychangehealthoutcomes.Inthenextlesson,wewillfocusonwhatconstitutesaneffectivetobaccocontrolpolicy.


LessonTwoCheckforUnderstanding

1. TrueorFalse:Pleasedeterminewhetherthefollowingstatementsaretrueorfalse.

___ a.Thepublichealthapproachfocusesonthehealthofpopulations,ratherthanthehealthofindividuals.

___ b.IntheHealthImpactPyramid,interventionsatthetopofthepyramidhavealarger

population-levelimpactthaninterventionsatthebottomofthepyramid.___ c.InterventionsworkingtogetheratalllevelsoftheHealthImpactPyramidarenecessary

forimprovingpopulationhealth.

___ d.TheMPOWERacronymstandsfor:§ M:Monitortobaccouseandpreventionpolicies.§ P:Protectpeoplefromtobaccosmoke.§ O:Offerhelptoquittobaccouse.§ W:Warnaboutthedangersoftobacco.§ E:Enforcebansontobaccoadvertising,promotion,andsponsorship.§ R:Raisetaxesontobacco.

2. AccordingtoCDC’sBestPractices,whichofthefollowingarethecomponentsofacomprehensive

tobaccocontrolprogram?a. Surveillance;Smoke-freepolicies;Cessation;Mediaoutreach;Enforcement;Taxincreasesb. StateandCommunityInterventions,HealthCommunicationInterventions,Cessation

Interventions,SurveillanceandEvaluation,AdministrationandManagementc. Preventinitiationamongyouth;Promotequittingamongadultsandyouth;Eliminateexposure

fromsecondhandsmoke;Identifyandeliminatetobacco-relateddisparitiesamongpopulationgroups.

d. Population-basedcommunityinterventions;Counter-marketing;Programpolicy/regulation;Surveillanceandevaluation

e. Noneoftheabove3. AccordingtoCDC’sBestPractices,SectionC,therecommendedprograminterventionbudgetfor

Maineis:a. $9.0millionb. $18.5millionc. $45.0milliond. $67.3millione. $73.2million

4. AccordingtotheCampaignforTobacco-FreeKids,atwhatpercentageofCDCrecommendationis

Mainefundingitstobaccocontrolprogramin2013?a. 88.4%(ranks2ndamongstates)b. 58.8%(ranks5thamongstates)c. 40.7%(ranks9thamongstates)d. 6.6%(ranks34thamongstates)e. 0.1%(ranks46thamongstates)


5. WhatisCDC’srecommendedprograminterventionbudgetinyourstate?Atwhatpercentageof

thisrecommendationisyourstatefundingitstobaccocontrolprogram?6. Whataresomeofthereasonsyouthinkstatesareunabletofundtobaccoprogramsat

recommendedlevels?


LessonTwoCheckforUnderstandingAnswers

1. TrueorFalse:Pleasedeterminewhetherthefollowingstatementsaretrueorfalse.

___ a.Thepublichealthapproachfocusesonthehealthofpopulations,ratherthanthehealthofindividuals.

___ b.IntheHealthImpactPyramid,interventionsatthetopofthepyramidhavealarger

population-levelimpactthaninterventionsatthebottomofthepyramid.___ c.InterventionsworkingtogetheratalllevelsoftheHealthImpactPyramidarenecessary

forimprovingpopulationhealth.

___ d.TheMPOWERacronymstandsfor:§ M:Monitortobaccouseandpreventionpolicies.§ P:Protectpeoplefromtobaccosmoke.§ O:Offerhelptoquittobaccouse.§ W:Warnaboutthedangersoftobacco.§ E:Enforcebansontobaccoadvertising,promotion,andsponsorship.§ R:Raisetaxesontobacco.

CorrectAnswers:

a. True-Needtoreview?Gobacktothe“ThePublicHealthApproach”page.b. False-Needtoreview?Gobacktothe“TheHealthImpactPyramid”page.c. True-Needtoreview?Gobacktothe“TheHealthImpactPyramid”page.d. True-Needtoreview?Gobacktothe“GlobalTobaccoControl:MPOWER”page.

2. AccordingtoCDC’sBestPractices,whichofthefollowingarethecomponentsofacomprehensivetobaccocontrolprogram?f. Surveillance;Smoke-freepolicies;Cessation;Mediaoutreach;Enforcement;Taxincreasesg. StateandCommunityInterventions,HealthCommunicationInterventions,Cessation

Interventions,SurveillanceandEvaluation,AdministrationandManagementh. Preventinitiationamongyouth;Promotequittingamongadultsandyouth;Eliminateexposure

fromsecondhandsmoke;Identifyandeliminatetobacco-relateddisparitiesamongpopulationgroups.

i. Population-basedcommunityinterventions;Counter-marketing;Programpolicy/regulation;Surveillanceandevaluation

j. Noneoftheabove

CorrectAnswer:b.Needtoreview?Gobacktothe“BestPractices:ComprehensiveProgramComponents”page.3. AccordingtoCDC’sBestPractices,SectionC,therecommendedprograminterventionbudgetfor

Maineis:a. $9.0millionb. $18.5millionc. $45.0milliond. $67.3million


e. $73.2million

CorrectAnswer:b.Needtoreview?Gobacktothe“BestPractices:ComprehensiveProgramFundingLevels”page.

4. AccordingtotheCampaignforTobacco-FreeKids,atwhatpercentageofCDCrecommendationis

Mainefundingitstobaccocontrolprogramin2013?f. 88.4%(ranks2ndamongstates)g. 58.8%(ranks5thamongstates)h. 40.7%(ranks9thamongstates)i. 6.6%(ranks34thamongstates)j. 0.1%(ranks46thamongstates)

CorrectAnswer:c.Needtoreview?Gobacktothe“ComprehensivePrograms:StateSpending”page.5. WhatisCDC’srecommendedprograminterventionbudgetinyourstate?Atwhatpercentageof

thisrecommendationisyourstatefundingitstobaccocontrolprogram?CorrectAnswer:Answerswillvary.6. Whataresomeofthereasonsyouthinkstatesareunabletofundtobaccoprogramsat

recommendedlevels?

CorrectAnswer:Answerswillvary.


Sources

Slide3,4:Frieden,T.R.(2010).AFrameworkforPublicHealthAction:TheHealthImpactPyramid.AmericanJournalofPublicHealth,100(4),590-595.doi:10.2105/AJPH.2009.185652.

Slide5,6,7,8,9,10,11,12,13:WorldHealthOrganization.MPOWER:APolicyPackagetoReversetheTobaccoEpidemic.Availableat:http://www.who.int/tobacco/mpower/mpower_english.pdf

Slide12:CampaignforTobacco-FreeKids.InternationalIssues:TaxationandPrice.Available:http://global.tobaccofreekids.org/en/solutions/international_issues/taxation_price/Slide14,15,16,17:CentersforDiseaseControlandPrevention.BestPracticesforComprehensiveTobaccoControlPrograms—2007.Atlanta:U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention,NationalCenterforChronicDiseasePreventionandHealthPromotion,OfficeonSmokingandHealth;October2007.Reprintedwithcorrections.Available:http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htmSlide17,18,19,20:JuliaA.Dilley,JeffreyR.Harris,MichaelJ.Boysun,andTerryR.Reid.Program,Policy,andPriceInterventionsforTobaccoControl:QuantifyingtheReturnonInvestmentofaStateTobaccoControlProgram.AmericanJournalofPublicHealth:February2012,Vol.102,No.2,pp.e22-e28.Slide18,19:CentersforDiseaseControlandPrevention.BehavioralRiskFactorSurveillanceSystemDatabase.Available:http://www.cdc.gov/brfss/Slide20:CampaignforTobacco-FreeKids.Brokenpromisestoourchildren:The1998statetobaccosettlement14yearslater.Available:http://www.tobaccofreekids.org/what_we_do/state_local/tobacco_settlement/


ImagesSlide3,4:Frieden,T.R.(2010).AFrameworkforPublicHealthAction:TheHealthImpactPyramid.AmericanJournalofPublicHealth,100(4),590-595.doi:10.2105/AJPH.2009.185652.

Slide5:WorldHealthOrganizationonTwitter.Available:https://twitter.com/WHO

Slide5:CentersforDiseaseControlandPreventionWebsite.Available:http://www.cdc.gov/

Slide6:WorldHealthOrganizationwebsite.Tobaccofreeinitiative.Available:http://www.who.int/tobacco/mpower/en/Slide8:WorldHealthOrganization.MPOWER:APolicyPackagetoReversetheTobaccoEpidemic,p.14.Availableat:http://www.who.int/tobacco/mpower/mpower_english.pdf

Slide9:TrinketsandTrash.QuitlineAd.Available:http://www.trinketsandtrash.org/detail.php?artifactid=2088

Slide9:TrinketsandTrash,NicoretteGumAd.Available:http://www.trinketsandtrash.org/detail.php?artifactid=3166

Slide10:WorldHealthOrganization.MPOWER:APolicyPackagetoReversetheTobaccoEpidemic,p.21.Availableat:http://www.who.int/tobacco/mpower/mpower_english.pdf

Slide14:CentersforDiseaseControlandPrevention.Bestpracticesforcomprehensivetobaccocontrolprograms—2007.Available:http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htmSlide20:CampaignforTobacco-FreeKids.StateTobaccoPreventionSpending,FY1999-FY2013.Available:http://www.tobaccofreekids.org/content/what_we_do/state_local_issues/settlement/FY2013/4.%20State%20Tob%20Prev%20Spending%201999-2013.pdf

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