tobacco 101 part 2 lesson 4 - emory university · tobacco 101 part two, lesson four 2016 a...

Tobacco101PartTwo,LessonFour

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: REDUCINGTHEPROBLEMOFTOBACCOUSELESSON4

StrategiesforSuccess Page4

CheckforUnderstanding Page33

Sources Page36


Tobacco101PartTwo,LessonFour

StrategiesforSuccess

Inpreviouslessons,wetalkedaboutthepoliciesthatareeffectiveatreducingtobaccouse,butwehavenotdiscussedthestrategiesthatmakethesepoliciesandprogramssuccessful.Thatwillbeourfocusforthisnextlesson.Wewilldiscussthehowofplanning,implementing,evaluating,andsustainingeffectiveprogramstoachievethefourgoalsdescribedinBestPractices.Attheendofthislessonyouwillbeableto:

1. Identifythefivestepsthatgointoimplementingatobaccocontrolprograminyourstateandcommunity.Therearefivemajorstepstogetaprogramupandrunningandtomakesureitissustainedlongterm.

2. Describewaystosustainadequatefundingfortobaccocontrolprograms.Tobaccocontrol

programsmustlastlong-terminordertohaveasignificantimpact,soplanninghowtosustainaprogramshouldoccurthroughoutthelifeoftheprogram.

3. DescribeeffectivestrategiestoachieveNationalTobaccoControlProgramgoals.Wewilllookat

eachofthefourgoalsoutlinedinBestPracticesandtalkaboutstrategiesthatworkinbothstatesandcommunities.


ImplementingPrograms

Implementingtobaccocontrolprogramsisaprocessthatrequirespatienceandperseverance.Muchtimeandeffortisputforthbyprogramstaffandcommittedcommunityorganizationstoplanfor,carryout,andevaluatetobaccopreventionandcontrolprograms.Thesearethefivemajorstepstogettingaprogramupandrunningandtomakingsureitcanbesustainedlongterm:

1. Engagestakeholders2. Developastrategicplan3. Implementtheprogram4. Evaluatetheprogram5. Sustaintheprogram

We’lltalkabouteachstepinturn.


Step1:EngageStakeholdersThefirststepintheprocessoftobaccocontrolprogramimplementationisfindingstakeholderstoworkwithyou.Stakeholdersarepeopleinthecommunitywhoareinterestedinorareaffectedbytobaccouse.Engagingstakeholdersandpartnersforyourprogramisoftenthehardestpartofgettingaprogramupandrunning.Thekeytoyoursuccessinacquiringpartnersliesin:

• Knowingwheretolookforthem• Buildingrelationshipsandnetworking• Providingthemwithinformationabouttobaccouse,suchasratesofuseandtheassociatedhealth

andeconomiceffects• Helpingcommunitygroupsunderstandhowtobaccouseaffectsthemandtheirobjectives• Communicatingthevalueatobaccocontrolprogramhastothem• Determiningtheroletheywouldplayinsupportingtobaccocontrolpolicies

Eachcommunitygrouphasitsuniquestakeinreducingtobaccouseandthereforerequiresadifferentwayofpersuadingdecisionmakerstochangepolicies,topromotetobaccocontrolprograms,andultimatelytoreducetobaccouse.Engagingstakeholderswillhelptomobilizethecommunityintowantingtochangeandthenworkingtowardschange.Awell-informed,diverse,andbroad-basedcommunitycollaborationisnecessarytochangepoliciesandsocialnorms.


Step1:EngageStakeholders–WhotoIncludeAssemblinginfluentialkeystakeholdersisessentialforasuccessfulprogram.Sometimestalkingtotherightpeoplehasadominoeffect-oneinterestedpartywillintroduceyoutoanother.Whoyouwantaspartnersvariesdependingonwhetheryouareestablishingagovernment(state,county,orcity)programoranongovernmentprogram.Belowisjustapartiallistofsomeofthetobaccocontrolstakeholderswhocanhelpadvocateandsupportpolicies:

− ConcernedCitizens − Medicalproviderassociations− CommunityLeaders − BusinessCommunity− YouthGroups − TribalCouncils− LocalBoardsofHealth − Faith-BasedOrganizations− HealthCareProviders − NeighborhoodAssociations− Voluntaryhealthorganizations − ParentOrganizations− DepartmentsofHealthandChronicDisease

Programs− TeachersandOtherEducation

Professionals


Step1:EngageStakeholders–CommunityCollaborationTobuildadvocacysupportforpolicyinterventions,youmustworkcollaborativelywithothersinyourcommunity.Givingeverystakeholderandpartneravoiceandanopportunitytoparticipatemeaningfullyinyourprogramandpolicychangeeffortswillleadtothegreatestopportunitiesforsuccess.Theskillfulpartofthisprocessisrecognizingwhichgroupswouldbegoodpartners,howtopersuadethemtopartnerwiththeprogram,andhowtousetheirvoicestobestadvantage.

Thiscollaborationcantypicallybeachievedthroughcoalitions.Acoalitionbringstogetherindividualsandorganizationswithdiverseskillsandexpertisetoaddressaspecificissue.Coalitionsenhancestateandlocaltobaccocontroleffortsbymobilizingcommunities,advocatingforpolicies,andchangingsocialnorms.Tobaccocontrolcoalitionsformtoreducetheburdenoftobaccouseandshapetobacco-freenormssothattobaccobecomeslessdesirable,acceptable,andaccessible.Coalitionshavealsobeenproventobeeffectivecommunityinterventions,astheireffortsworktochangesocialnormsthroughpolicychangeandleadtodecreasedmorbidityandmortality.Becauseofthis,coalitionsareahighpriorityinvestmentfortobaccocontrol.

Formoreinformation…abouttobaccocontrolcoalitions:

DownloadtheBestPracticesUserGuide:CoalitionsfromtheCDC:http://www.cdc.gov/tobacco/stateandcommunity/bp_user_guide/pdfs/user_guide.pdf


Step2:DevelopaStrategicPlanThenextsteptogettingaprogramupandrunningisdevelopingastrategicplan.Strategicplansareessentialtothesuccessofatobaccocontrolprogram.Astrategicplanislikeamap,definingthedirectioninwhichtoheadandgivinginstructionsonhowtoreachyourdestination.Astrategicplanforatobaccocontrolprogramisaframeworkthatshows:

• Goals• Objectives• Plannedinterventionsandrelatedactivities• Methodsofevaluation

Inthestrategicplanningprocess,keystakeholdersandcommunitymembersdevelopasharedvisionandthestepsneededtomovetowardtheoutcomesneededtorealizethatvision.Thediagrambelowdepictsanoverviewofthestrategicplanningprocess,whichinvolvescontinuallyreviewingresultsandrevisingtheplan.Wewon’tgointomoredetailaboutstrategicplanninginthislesson,aswritingastrategicplanisoutsidethescopeofthistraining.

Results

PreparingthePlanningProcess

SituationAnalysis:-InternalIssues-ExternalIssues

Mission,CoreValues/Beliefs,Goals,Obhectives

ActionPlanBudgeting


Step3:ImplementtheProgramOnceyouhaveyourstrategicplan,itistimetobeginachievingobjectivesoutlinedinyourplanthroughplannedactivities.TheseactivitiesshouldreflecttheessentialelementsofacomprehensiveprogramdescribedbyBestPracticesandutilizeinterventionsproventobeeffective,suchasthosedescribedinTheCommunityGuide.WewilldiscussimplementationofstrategiesandactivitiesfurtherinthenextsectionofthisLesson.Successoftendependsonbeingabletobuildinfrastructureforyourprogramandincreaseitscapacitytotakeonprojects.Trainedstaffandadequatefundingareessentialforeffectiveprogramcapacity.Programcapacitypairedwithstableandadequatefundingarerequiredtoachievelong-termresults.


Step4:EvaluatetheProgramEvaluationisanessentialstepinestablishingwhetherornotyourprogramiseffective–whichiskeytosecuringfundingandsustainingyourprogram.Severalpublicationsonevaluationareavailabletohelpyouplanandimplementprogramevaluationanddeterminetheeffectivenessofyourprograms:

• EvaluationToolkitforSmoke-freePoliciesisdesignedspecificallytohelpevaluatelocalsmoke-freelaws.

• KeyOutcomeIndicatorsforEvaluatingComprehensiveTobaccoControlProgramshasinformation

on120keyoutcomeindicatorsusedinevaluatingstatecomprehensivetobaccopreventionandcontrolprograms.

• IntroductiontoProcessEvaluationinTobaccoUsePreventionandControlhelpswithdesigningand

implementingvalidandreliableprocessevaluations.Italsoshowsthelinksbetweenprogramactivitiesandresults.

• IntroductiontoProgramEvaluationforComprehensiveTobaccoControlPrograms:isa"howto"

guideforplanningandimplementingevaluations.Ithelpsinplanning,designing,implementing,andusingtheresultsofcomprehensiveevaluationsoftobaccocontrolprograms.


Step5:SustaintheProgramTohavesignificantimpact,tobaccocontrolprogramsmustlastforyears.Planninghowtosustainyourprogramshouldbeginassoonasyouhavetheideaforaprogram,continueduringstrategicplanning,andneverstopthroughoutthelifeoftheprogram.Everysuccessfulelementofacomprehensiveprogramhelpscreatethecaseforsustainingsupportfortobaccocontrol.Sustainingatobaccocontrolprogramcanbechallengingforseveralreasons:budgetcuts,lobbyingpressurebycompetingcommercialinterestgroups,otherhealthissuestakingpriority,andpoliticalconcerns.Inrecognitionofthesechallenges,theCDCequipsstateswithresearchandtoolstohelpthemsustainorbuildtheirtobaccocontrolprogramsby:

• Consultingwithstatesandterritoriesonhowtodevelopsustainabilityplanstailoredtotheirenvironmenttobuildsupportfortheirfuturetobaccocontrolendeavors.

• Researchingbestpracticesfortobaccocontrolprogramsandprovidingtheresultstostatetobaccocontrolprograms.

• Trainingstateprogramstaffinmethodsforsustainingprogramslongterm.

ForMoreinformationaboutsustainingtobaccocontrolprograms:

CheckouttheSustainingStateFundingforTobaccoControlpagefromtheCDC:http://www.cdc.gov/tobacco/tobacco_control_programs/program_development/sustainingstates/sustaining_funding/index.htm


Step5:SustaintheProgramSustainingacomprehensivetobaccocontrolprogramshouldbeanon-goingactivityforyouandyourpartners.Somewaystosustainadequatefundingare:

• Createastrategicplanthatclearlycommunicatestheprogram’svision,goalsandobjectives.Sharetheplanwithpotentialfunderstoshowthemhowtheprogramwillsavelivesandreducehealthcarecosts.

• Educatefundersandpolicymakersaboutthecontinualsocietalcostoftobaccouse.Focuson

howthetobaccoindustrychangesitsproductsandmarketpracticestoattractyouth.

• FollowthemanagementandadministrationproceduresinBestPractices.Funderslookfororganizationsthatareefficient,wellorganizedandwellmanaged.

• Engagediverse,skilled,andactivestakeholderleaderstorepresentyourimpactincommunities.

Theirvoiceswillbeheardasauthenticconcernedcitizenswhoseethelong-termbenefitsofcomprehensivetobaccocontrolprograms.

• Buildrelationshipsthroughnetworking.Muchsuccessinfundingisattributedtohavinggood

personalandprofessionalrelationships.

• Evaluateyourprogramsoyouhaveevidenceofsuccess.Turndataintounderstandableinformationbyprovidingclearandconciseprogressreportsthatquantifytheprogram’sresults.

• Keeptobaccoissuesinthenewsmediawithstoriesaboutboththedangersthattobacco

presentsandtheaccomplishmentsoftheprogram.Keepingtobaccointhemediashouldbepartofthestrategicplan.Toberelevanttoseveraldifferentaudiences,thesestoriesshouldbepresentedinavarietyofmedia.

Let’stakealookathowonestateusedsomeofthesestrategiestoovercomefundingcutstoitstobaccocontrolprogram.


Step5:SustaintheProgram-AStateExampleIn2003and2004,ColoradolegislatorscuttobaccocontrolfundingtolessthanonesixthoftheminimumrecommendedbyCDC.CitizensforaHealthierColoradoandtheStateTobaccoEducationandPreventionPartnershipworkedtogethertoreturnfundingtoadequatelevelsbyraisingvoterawarenessofthelegislature’scutinfundingthroughawell-fundedmediacampaign.ThecampaigneducatedvotersandlegislatorsaboutahealthcarecrisisoccurringinColoradothatcouldbeaddressedbytobaccoexcisetaxrevenues.Itfocusedonhowthefundingwouldbeprotectedtoaddressnotjusttobaccoprevention,butalsothedetectionandtreatmentofcancerandheartandlungdiseases.ItalsoexplainedhowincreasingtobaccotaxeswoulddecreaseyouthtobaccoinitiationandnotedthatColorado’scigaretteexcisetaxeswereamongthelowestinthecountryatthetime.Asaresultoftheseefforts,astatewidereferendumwaspassedthatincludeda$0.64perpackincreaseincigaretteexcisetaxesaswellasanewexcisetaxof40%ofthemanufacturer'slistpriceonnon-cigarettetobaccoproducts.Fundswereearmarkedrevenuesforhealthprogramsandatleast$25million(16%ofexpectedrevenue)wasallocatedeachyearspecificallyfortobaccopreventionandtreatment.ThisbroughtColoradototheCDC-recommendedminimumfundinglevelforitscomprehensivetobaccocontrolprogramin2005.

Formoreinformationabouthowstateshaveworkedtosustaintheirtobaccocontrolprograms:

Lookunder“StateSnapshots”ontheSustainingStateFundingforTobaccoControlpagefromtheCDC:http://www.cdc.gov/tobacco/tobacco_control_programs/program_development/sustainingstates/index.htm


StrategiesforSuccess:BestPracticesNowthatwe’vediscussedthefivestepsoftobaccocontrolprogramimplementation,wewillexpandonthefourgoalsthataredescribedinCDC’sBestPractices:

1. Preventinitiationamongyouthandyoungadults.2. Promotequittingamongadultsandyouth.3. Eliminateexposuretosecondhandsmoke.4. Identifyandeliminatetobacco-relateddisparitiesamong

populations.Inthenextsectionofthislesson,wewillfocusonstateandcommunitypolicyandsystem-basedapproachesproventoreducingtobaccousethatworktowardsachievingthesegoals.TheGuidetoCommunityPreventiveServices(oftenreferredtoastheCommunityGuide)analyzesresearchfindingstolearnwhichinterventionsworktoachievethesegoals.TheCommunityGuideisanessentialresourcetohelpprogramstoselectstrategiesandinterventionsthatareevidence-basedandaddresspopulationneeds.


StrategiestoPreventInitiationamongYoungSmokersThefirsttobaccocontrolgoaldescribedinCDC’sBestPracticesistopreventyoungpeoplefromstartingtousetobacco.Itiswidelybelievedthatpreventingadolescentsandyoungadultsfrombecomingsmokerswill,inthelongrun,dothemosttoreducesmokingprevalenceandtheresultingdeathanddiseasecausedbytobacco.The2012SurgeonGeneral’sReportPreventingTobaccoUseAmongYouthandYoungAdultsstatesthecasequiteclearly:

“Preventioneffortsmustfocusonbothadolescentsandyoungadultsbecauseamongadultswhobecomedailysmokers,nearlyallfirstuseofcigarettesoccursbyage18(88%),with99%offirstusebyage26.”

Sowhatworkstopreventinitiationamongyouth?1. Raisethepriceoftobacco.Aswehavestatedalready,oneofthe

mosteffectivepoliciestodiscourageyouthfromstartingistoraisethepriceoftobaccoproducts.Forevery10%increaseinthepriceofcigarettes,youngadultsmokingdropsbyabout3.5%,andyouthsmokingdropsabout6-7%.Raisingthepricecanbeaccomplishedthroughincreasingexcisetaxesontobaccoproductsatthefederal,state,andlocallevel.

2. Changehowtobaccoismarketed.The2012SurgeonGeneral’sReportfoundthatadvertisingand

promotionalactivitiesbytobaccocompaniescausetheonsetandcontinuationofsmokingamongadolescentsandyoungadults.The2009FamilySmokingPreventionActprohibitstobaccocompaniesfromtargetingyoungpeoplebyputtinginplaceseveralproductregulationsandrestrictionsthatprotectyouth.Italsoremovedafederalprohibitionforstatesandcommunitiessettingtheirownmorestrictstandardsfortobaccomarket.

TheTobaccoControlLegalConsortiuminits2012publicationCauseandEffect:TobaccoMarketingIncreasesYouthTobaccoUsepresentsseveralpolicyoptionsforstatesandlocalcommunitiesthatimpactpoint-of-saletobaccomarketingtoyouth.Theimpactandefficacyofthesepolicyoptionsarestillbeingevaluatedandsomehaveresultedinlegalchallenges.


StrategiestoPreventInitiationamongYoungSmokers3. Changesocialnormssurroundingtobacco.Another

importanttacticinprotectingadolescentsandyoungadultsfromtobaccoischangingsocialnorms.Thiscanbeaccomplishedthroughpoliciesthatreducetobaccouse,suchasincreasedexcisetaxesandsmoke-freelaws.Thesepolicesmakebeingtobacco-freethe“norm,”therebyreducinginitiation.

Anotherwaytochangesocialnormsisthroughcounter-marketingthetobaccoindustry’smarketing.Counter-marketingmeansthattobaccocontrolorganizationsproduceanddisseminateadvertisementsthatrespondtotheadvertisingclaimsofthetobaccoindustry.Justasyoungpeoplearesusceptibletomessagesthatencouragethemtobegintobaccouse,theyarealsosusceptibletomessagesthatencouragethemnottostartortoquit.AnexampleofthisistheAmericanLegacyFoundation’sTruth®Campaign,thelargestyouthfocusedsmokingpreventioncampaigninthecountry.Truth’sadvocacycampaignseducateyoungpeopleabouttobaccoindustrytacticsandappealtoyoungpeople’ssenseofjustice.

4. Empoweryoungpeoplebyinvolvingtheminyourprogram.Youngpeoplearepersuasiveadvocates

withpeers,families,andpolicymakers.TheBestPracticesUsersGuideforYouthEngagementfocusesontheroleyouthplayinadvancingpolicyaspartofacomprehensivetobaccocontrolprogramandencourageslocaltobaccocontrolprogramstoenlistyoungpeopletoadvocateforyourprograminyourcommunityandtohelpwithsmoke-freepoliciesintheirschools.


StrategiestoPromoteQuittingThenextgoalinCDC’sBestPracticesistoencourageadultandyoungpeoplewhousetobaccotoquit.AmongcurrentU.S.adultsmokers,about70%reportthattheywanttoquitcompletely,andmillionsofthemhaveattemptedtodoso.Itisimportanttorememberthatsuccessfulquittingisdifficult,andoftenrequiresmultipleattemptsoveraperiodofyears.Sowhichstrategiesworktohelptobaccousersquit?1. Enactsmoke-freeandtobacco-freepolicies.Smoke-freepoliciescanmotivatepeopletoquitasthese

policiesmakeitmoredifficulttofindasociallyacceptableplacetosmoke.Tobacco-freepoliciesmayalsohavethesameeffectforusersofsmokelesstobaccoproducts.

Weknowthatthenumberoftobaccousersattemptingtoquitaftersmoke-freelawspassishigherthanbeforeasmoke-freelawispassed,givingusauniqueopportunitytomaximizethepositiveeffectthatanewsmoke-freelawhasonbothexposuretosecondhandsmokeandonquitrates.

2. Increasethecostoftobaccoproducts.Lawsthatincreasethecostoftobaccoproductshavealsobeen

showntoincreasetobaccoquitratesashighcigarettepricesinducesmokerstoquit.Forexample,every10%increaseinthepriceofcigarettesreducesoverallcigaretteconsumptionbyapproximately3-5%.


StrategiestoPromoteQuitting3. Facilitateaccesstoeffectivecessationtreatments.Effectivecessationtreatmentsneedtobe

comprehensiveandsystems-based.Briefclinicalinterventions,counseling,quitlines,andcessationmedicationarealleffectiveindependently,butaremosteffectivewhenusedincombination.Hereisalittlemoreinformationabouteachtreatment:

• Briefclinicalinterventionsconsistofadoctortaking10minutes

orlesstodeliveradviceandassistanceaboutquitting.• Counselingcanbeinperson,overthephone,orthroughweb-

basedsupport.Counselingprovidesasmokerwiththesupportandresourcesneededtoquittobaccouseforthelongterm.Often,copingstrategiesarerecommended.

• Quitlineshavecounselorstoassistsmokersinbehavior

modification.Quitlinecounselorsareusuallyavailablebyphone,buttheymayalsoworkwithasmokerviatheinternetore-mail.Theyprovideinformationaswellascounseling.Somequitlinesalsoprovidetheirnicotinereplacementtherapiesatnocostorreducedcost.

• Cessationmedications,whetheravailableoverthecounter(suchasnicotinegum)orbyprescription

(suchasChantix)areallapprovedbytheFDAtohelpsmokersgraduallydecreasetheirdependenceonnicotine.


StrategiestoPromoteQuitting4. Utilizeacomprehensiveapproachtocessationinterventions.Forcessationinterventionstobeeffective

ingettingalargepopulationtoquittobacco,theapproachesmustbecomprehensiveandwellintegrated.Forexample:

• Peopleneedtoknowthatresourceslike1-800QUIT-

NOWexisttohelpwithquitting.Thatrequiresusingallthecommunicationmethodsavailablenowadays—notjustbrochures,butmassmediaadvertisingcampaignsthatincludesocialnetworkingmethodslikeFacebookandTwitter.

• Healthcareprovidersmustbetrainedtoeffectivelyintervenewiththeirpatientsaboutthehazardsoftobaccouseandreferthemtoquitlinesandothertreatmentoptions.Thehealthcaresystemneedstomakeaskingabouttobaccouseasroutineascheckingbloodpressure.

• Worksitewellnessandhealthcenterprogramsneedtoincludeeducationabouttheharmsof

tobaccoandreferraltocessationprogramsincludingquitlines.

• PaymentforcessationtreatmentsneedtobecoveredbyMedicaid,privateandpublichealthinsuranceandmanagedcare.


StrategiestoEliminateExposuretoSecondhandSmokeThethirdgoaldescribedinCDC’sBestPracticesistoeliminatenonsmokers’exposuretosecondhandsmoke.Thebestwaytodothisisthrough100%smoke-freelawsandpoliciesforpublicplacesandworksites.Smoke-freeairpoliciesprotectnonsmokersfromexposuretosecondhandsmokeandalsoreducethenumberofsmokersandnumberofcigarettessmoked.AsdescribedinPartTwo,LessonThree,therehasbeenmuchprogressinincreasingthenumberofsmoke-freepoliciesthroughoutthecountry.However,therearestillseveralbarrierstoeffectivelyimplementingsmoke-freepolicy.Wewilldiscussafewofthemostcommonbarriersandtrapstoavoidwhenenactingsmoke-freelawsnext.

Formoreinformationonhowtodevelopsmoke-freepolicies…CheckoutthisToolkitforImplementingSmoke-FreeLaws:http://goingsmokefree.org/index.html


StrategiestoEliminateExposuretoSecondhandSmoke:PitfallstoAvoid1. Avoidvoluntarysmoke-freepolicieswheneverpossible.Smoke-freepoliciescanbeeithervoluntaryor

regulatoryefforts.Voluntarypoliciesareoftenusedinprivatesettingswherethereislessprecedenceforgovernmentalregulation.Promotingvoluntarysmoke-freeenvironmentscanalsoactasafirststeptolaythegroundworkforacitywideordinanceorastatewidelaw,andcanbeusefulineducatingbusinessownersandthepublic.However,theconsensusamongtobaccocontrolorganizationsisthatcomprehensivesmoke-freepoliciesshouldbeputintoplacebyordinance,regulation,orlawratherthanvoluntarily.Thisisbecause:

• Voluntarysmoke-freepoliciesdonotnecessarilyleadtothepassageofsmoke-freeordinances,and

canevenbeseenbylawmakersasareasontonotpassregulations.• Itcanbemuchmoredifficultandtimeconsumingtoconvincebusinessownerstoenactvoluntary

policiesonebyonethantoworkdirectlywithamayororcitycouncil.• Therearefewconsequencesfornoncompliancewithvoluntarypolicies,comparedtoregulatory

efforts,wherelegalconsequences(e.g.fines)arepossible.• Voluntarypoliciesarenotpermanentandcanbeeliminatedeasilywithchangesinownershipor

management.


StrategiestoEliminateExposuretoSecondhandSmoke:PitfallstoAvoid2. Don’tforgettohaveimplementationandenforcementplansinplace.Inthepast,mostlocalsmoking

ordinanceswereconsideredself-enforcing,andthevastmajorityofbusinessesandsmokerscompliedwithalaw'sprovisions.Althoughmostbusinessownersandsmokersstillreadilycomplywithsmoke-freelaws,acomprehensiveimplementationplan,includingwell-draftedregulationsandpenalties,shouldbeinplacetoanticipateandaddresspotentialenforcementproblems.

3. Avoidaddingapreemptionclausetothepolicyatallcosts.Preemptionisaprovisionatonelevelof

government(usuallyfederalorstate)thatpreventsalowerlevelfromenactingstrongerlawsonanissuethatexistatthehighergovernmentlevel.Oneofthetobaccoindustry’sfavoritetacticshasbeentolobbystatelegislaturestopreemptlocalsmoke-freelaws.Thistacticshiftsthestruggleforsmoke-freeairfromlocaljurisdictions,wheregrassrootssmoke-freeadvocateshavetheupperhand,tothestatelegislature,wherethetobaccoindustrywieldssubstantialinfluence.

Formoreinformationonwhylocalcontrolissoimportant…VisittheProtectLocalControlwebsite:http://www.protectlocalcontrol.org/whylocal.php


StrategiestoEliminateExposuretoSecondhandSmoke:PitfallstoAvoid

4. Avoidprovisionsandexemptionsthatinhibittheeffectsofsmoke-freepolicies.TheFundamentalsofSmoke-freeWorkplaceLawsprovidesaverygoodfoundationofthestepstofollowleadingtothepassageofaneffectivesmoke-freepolicyandlistsseveralprovisionstoavoidintheprocessofdraftingandnegotiatingsmoke-freepolicies.Thelistbelowhighlightsafewofthem:• VentilationProvisions:Havingventilationsystemscannotcompletelyremovethecancer-causing

andtoxicchemicalsinsecondhandsmoke.Going100%smoke-freenotonlyprotectsemployeesandpatrons,butalsoprotectsbusinessowners’bottomlineforboththeshortandlongterms.

• “MinorsOnly”orAgeRestrictionProvisions:Theseprovisionsprohibitsmokingonlyinsettings

whereminorsarepresent.Smokingispermittedinrestaurants,bars,bowlingalleys,and/orotherbusinessesaslongasthesevenuesareoff-limitstominors.Theseprovisionsareinconsistentwiththepurposeofsmoke-freepolicy,whichistoprotectallpeople,includingworkers,fromsecondhandsmoke.

• Exemptionsformembershipassociations(privateclubs):Membershipassociations(alsoreferredto

as“privateclubs”)arerarelyprivateatall.Thepublicmaybemisledtobelievetheyare“private”spaces,butinpractice,theyareoftenopentothepublicatcertaintimesandmayhavepaidemployees.Ifanorganizationhasemployees,itshouldbetreatedlikeanyotherworkplaceandofferthesameprotectionsfortheiremployees.

• Exemptionsfortobaccoretailshops,cigarbars,andhookahbars:Theseexemptions,althoughonce

common,arenolongerthenorm.Thetobaccoindustryandotheroppositiongroupscontinuetoassertthattheseestablishmentswarrantexemption.Inreality,thesebusinessesarenodifferentthananyotherworkplaceorpublicplace.Allemployees,nomatterwheretheyareemployed,deservetherighttobreathecleanairatwork.

• Exemptionsfor(non-tribal)casinosandgamingestablishments:Casinoworkers,likeotherworkers,

deservecompleteprotectionfromsecondhandsmoke.Thegamingindustryhasextremelydeeppocketsandiswillingtospendcountlessdollarsjoiningthetobaccoindustryandfightingsmoke-freelaws.Althoughtribalcasinosareunderthejurisdictionofatribe,non-tribalcasinosshouldbeincludedincomprehensivesmoke-freepolicies.

• “Hardship”Exemptions:Hardshipexemptionsallowrestaurants,bars,orotherhospitality

businessestoobtainawaiverfromcomplyingwithasmoke-freelawbecausedoingsosupposedlycausesthemeconomicharm.Peer-reviewedstudiesthatexamineobjectivemeasuressuchassalestaxreceiptsandemploymentlevelshaveconsistentlyfoundthatthisisnotthecase.


StrategiestoEliminateExposuretoSecondhandSmoke:NewFrontiersTheprogressintheadoptionofcomprehensivesmoke-freepublicandworkplacespoliciesdoesn’tmeanthebattlesforsmoke-freeplacesareover.Itjustmeansthefocusshiftstootherfronts:Multi-unithousing:Manypropertiesaregoingcompletelysmoke-free,andseveralstatesnowhaveprogramsunderwaytosupporttheadoptionofsmoke-freehousingpolicies.Publichousingauthoritiesareexpandingtheirnumberofsmoke-freeunitsandinsomecasesmakingalloftheirpropertiessmoke-free.Policiesinprivatelyownedhousingarevoluntaryandcomeaboutbytenantstakingactionandeducatingownersandlandlordsabouteconomicadvantagesofbecomingsmoke-free.

Residentialtreatmentfacilities:Smokingbansandcessationsupportinresidentialtreatmentfacilities(e.g.formentalhealthandsubstance-abusetreatment)canreducetobacco-relateddisparitiesamongpeoplewithmentalillnessandaddictions.One2010studyfoundthatamongstate-ownedtreatmentfacilitiesinOregon,only15%hadvoluntarilyimplemented100%smoke-freecampuspolicies,and47%offeredcessationresourcesatpatientdischarge.However,lessthan10%offacilitiesexpressedoppositiontothesefuturerequirements.

Collegeandworksitecampuses:Smoke-freeandtobacco-freecampusinitiativesforworksitesandcollegecampusesareunderwayinmanycommunities.Tobacco-freecampusescreateenvironmentsinwhichtobaccousersfinditeasiertoreducetheirconsumptionorquitaltogether.Inacollegesetting,thiswillhelpdecreasethehighertobaccouseratesamongyoungadults.

Formoreinformation…onnewfrontiersinsmoke-freepolicy:

• VisittheAmericansforNon-SmokersRightswebsiteforanexcellentlistofsmoke-freemulti-unithousingresourcesandtools.

• CheckoutthisCDCfactsheetandlistofresourcesfortobacco-freeworksites.• VisittheTobacco-FreeCollegeCampusInitiativewebsiteforinformationontobacco-free

collegecampusefforts.


StrategiestoEliminateTobacco-RelatedDisparitiesNowwecometothefourthgoalofatobaccocontrolprogram,eliminatingtobacco-relateddisparities.Healthdisparitiesaretypesofunfairhealthdifferencescloselylinkedwithsocial,economicorenvironmentaldisadvantagesthatadverselyaffectgroupsofpeople.Relatedtohealthdisparitiesisthebroaderconceptofhealthequity.Healthequityisachievedwheneachpersonhastheopportunitytorealizehisorherfullhealthpotentialandnopersonisdisadvantagedfromachievingthispotentialbecauseofsocialpositionorothersociallydeterminedcircumstances.Eliminatinghealthdisparities,likethoseseensurroundingtobaccouse,isasteptowardsachievinghealthequity

Aswesaidpreviously,somepopulationshaveahigherthanaveragerateoftobaccouseandtobacco-relateddeathanddisease.Theseabove-averageratesarereferredtoas“tobacco-relateddisparities.”Examplesofpopulationswithknowntobacco-relateddisparitiesinclude:

• LGBTs• AfricanAmericans• NativeAmericans/AlaskanNatives• Hispanics• Youngadults• Peoplewithlowincomes

Next,wewilldiscussstrategiesthatmoveuse closertohealthequitybyworkingtoeliminatetobacco-relateddisparities.


StrategiestoEliminateTobacco-RelatedDisparities1. Identifywhichpopulationsexperiencedisparitiesinyour

community.Populationswithtobacco-relateddisparities,aswellasthecausesofthesedisparitiesinthepopulation,canvarysignificantlyfromplacetoplace.Checkyourstateandlocaldatatoidentifytobacco-relateddisparitiesinthepopulationsyoureach.Localandstatedepartmentsofhealthareoftengoodsourcesforthisdata.NationaldatafromnationalsurveyresultsarepostedontheCDCwebsite,andtheNationalNetworksforTobaccoControlandPreventionarealsoimportantresourcesforprogramsastheyplanandimplementactivitiestoreducetobaccorelateddisparities.

Itisimportanttonotethatnationalandevenstatedatamaynotcorrespondwiththedataforyourcommunity.Thepopulationgroupsmayberelativelysmall,necessitatingtheuseofsupplementalsurveystoobtainreliabledata.

2. Incorporateachievinghealthequitybyeliminatingdisparitiesintoprogramactivityplans.Theseactivitiesshouldberelatedtopreventinginitiationamongyoungpeople,promotingcessation,andeliminatingsecondhandsmokeexposure.Youwillneedtousestrategiesthathavebeenshowntoworkbestwiththeparticularpopulationathand,andengagethepopulationintheprocess.Plantoreachouttothesepopulationsutilizingacommunitymembertoactasaspokespersonfortheprogram.


StrategiestoEliminateTobacco-RelatedDisparities3. UtilizeBestPracticesasaguidetoaddressdisparities.TheCDC’sBestPracticesguidealsorecommends

programsincludetheseactivitieswhenaddressingtobacco-relateddisparities:

• Conductingapopulationassessmenttoguideefforts• Identifyingandassemblingadiverseandinclusivestakeholdergroup• Prioritizingreductionintobacco-relateddisparitiesandassessingcapacity• Developingastrategicplan• Fundingcommunityorganizationstoimplementprovenorpromisinginterventions• Providingculturallycompetenttechnicalassistanceandtrainingtogranteesandpartners• Evaluatinginterventionefficacyandrefiningefforts

Evaluatingtheprocessusedandtheresultswillleadtomoreeffectiveuseofresourcesinthefuture.Documentingtheimprovementsinreducingdisparitiesbroughtaboutbyyourprogramhelpsbuildthecaseforcontinuedfundingandalong-termprogram.


EliminatingTobacco-RelatedDisparities:PolicyandSystemChangesWhenyouusecomprehensive,evidence-basedpracticesthatfocusonpolicyandsystemschange,theresultscanbebothpopulationwideandcommunityspecific,andoftenleadtoreductionsintobacco-relateddisparities.Someexamples:

• Acountysmoke-freeworkplacelawbenefitstheentirepopulation,butbenefitsworkersintheaffectedestablishmentsthemost.Frequentlyworkersinthehospitalityindustryarelowerincomeandmayrepresentminoritypopulationsdisproportionately.Acomprehensivebanofsmokinginrestaurantbarscanleadtoeliminatingdisparitiesinexposuretosecondhandsmoke.

• Changinghealthcaresystemsoftencreatesopportunitiestotargetprovidersandsystemsthatserve

populationswithtobacco-relateddisparities.ThestateofMassachusettsexpandedMedicaidinsurancebenefitstoincludecessationtreatmentsandpairedthatchangewithaneducationcampaignforbothhealthcareprovidersandpeopleonMedicaid.Theresultwasmoresuccessfulquitattemptsanddecreasedsmokingprevalenceamongapopulationwithhistoricallyhighratesofsmoking.

• TheAmericanLegacyFoundationsupportsinnovativeapproachestoreachingpopulationswith

tobacco-relateddisparities.TheHeadStartTobaccoCessationInitiativeisanexampleofintegratingtobaccocontrolpracticesintoanestablishededucationalprogramservinglow-incomefamilies.TheInitiativeallowedHeadStartandtobaccocontrolprogramstoachievetheirsharedobjectivesrelatedtothedevelopmentofhealthyenvironmentsforchildrenandfamiliesandtosystematicallyaddresstheissueoftobaccocessationandsecondhandsmokeexposure.


MovingForward:StrategiesforSuccessOnecommonprincipleinachievingresultsacrossallfourofthegoalsdiscussedisthattobaccocontrolprogramscannotdoitalone.Successwillcomethroughworkinginpartnershipswithorganizationsandcommunitymembers.Manystateshaveadoptedahealthycommunityapproachwhereindividuals,agencies,andorganizationsworktogethertotakeonacomplexmixofsocial,cultural,economic,andpoliticalissuesinordertodiscouragetobaccouse.

Restrictionsontobaccoads

Identifiabletobaccocontrol

Hightaxesontobacco

Nosalesoftobaccotominors

Publiceducationcampaigns

Cessationservices

Tobacco-freepublicplacesand

Detailedplanofaction

Monitor&countertobaccoinfluence

Tobacco-freeschoolcampuses

FormoreinformationaboutCommunitiesofExcellence…

CheckoutCommunitiesofExcellencePlus,atrainingdevelopedbyTTACthroughgrantsfromtheRobertWoodJohnsonFoundation,theAmericanLegacyFoundation,andtheAmericanCancerSociety.Theprogrambuildsskillsamongcommunitymemberstoassess,planandimplementeffectivetobaccocontrolprogramsbasedonCDC-recommendedbestpractices.


Part2,LessonFourConclusion

Inthislesson,wediscussedthefivestepsthatgointoimplementingatobaccocontrolprogram:

1. Engagestakeholders2. Developastrategicplan3. Implementtheprogram4. Evaluatetheprogram5. Sustaintheprogram

Welookedatseveralwaysinwhichtobaccocontrolprogramscanworktobecomesustainableoverthelong-term.WealsorevisitedthefourgoalsoftheNationalTobaccoControlProgram,

1. Preventinitiationamongyouthandyoungadults.2. Promotequittingamongadultsandyouth.3. Eliminateexposuretosecondhandsmoke.4. Identifyandeliminatetobacco-relateddisparitiesamongpopulations

andexaminedseveralstrategiesthatworktoachievethosegoalsatthestateandcommunitylevel.


Tobacco101Conclusion:MovingForwardwithStrategiesforSuccess

Thefieldoftobaccocontrolmobilizescommunitiestoapplyevidence-basedstrategiesthatrepeatedlydemonstratethatthepublichealthapproachtotobaccocontroliseffectiveatreducingtobaccouse.Theroadtosuccesscanbealongone,butisworththeeffort.Therearemanywaysthattobaccousetakesatollonthepeople,businesses,andhealthcaresystemswhereyouliveandwork.Yourjobistoreducethattoll,andmanycommunitiesacrosstheUnitedStateshavebeguntomakeamazingprogressbyengaginginstrategiesthatworktoreducetobaccouseandeliminatedisparitiesbyincreasingthepriceoftobacco,enactingandenforcingsmoke-freeairlawsandpolicies,andprovidingsystems-basedcessationservices.

Canyouimagineaworldwithouttobacco?

Withoutthedeathanddiseasethattobaccocausespeople?

Weknowthesolutiontotheproblem.Nowlet’smakeatobacco-freeworldareality.


LessonFourCheckforUnderstanding

1. TrueorFalse:Pleasedeterminewhetherthefollowingstatementsaretrueorfalse.

___ a.Thefivestepsthatgointoimplementingatobaccocontrolprogramare:1)Engagestakeholders,2)Developastrategicplan,3)Implementtheprogram,4)Evaluatetheprogram,and5)Sustaintheprogram.

___ b.Thesamemessagescanbeusedtorecruitalltypesofcommunitypartners,sincetobacco

affectsthemallinessentiallythesameway.

___ c.Sustainingacomprehensivetobaccocontrolprogramshouldbeanon-goingactivityforyouandyourpartners.

___ d.Populationswithtobacco-relateddisparitiescanvarysignificantlyfromplacetoplace.___ e.Cessationtreatmentsandservicesaremosteffectivewhenusedaloneinsteadofin

combination.2. WhichofthefollowingstrategieswasNOTmentionedinthislessonasaneffectivewaytoprevent

youthtobaccoinitiation?a. Changingsocialnormssurroundingtobacco.b. Raisingthepriceoftobacco.c. Educatingretailersaboutsellingtobaccotominors.d. Changinghowtobaccoismarketed.e. Empoweringyoungpeoplebyinvolvingthemintobaccocontrol.

3. Whichofthefollowingstatementsbestdescribeaneffective100%smoke-freepolicy?Chooseall

thatapply.a. Thepolicyisvoluntarilyputinplacebybusinessowners.b. Thepolicyisbackedbyimplementationandenforcementplans.c. Thepolicyincludesapreemptionclause.d. Thepolicydoesnothaveexemptionsforprivateclubs,tobaccoshops,andcasinos.e. Thepolicyhasprovisionsthatonlyallowsmokinginspeciallyventilatedareas.

4. HowwelldoyouthinkyourstateisdoingintermsofmeetingthefourgoalsoutlinedinBest

Practices?Whataresomestrategiesfromthislessonthatyourstatecouldusetoimproveprogress?FeelfreetoreferencethisinfographicandchartfromtheTobaccoControlNetworktogetstarted.

5. Whatpopulationismostaffectedbytobaccorelateddisparitiesinyourownstate?Whydoyou

thinkthatis?FeelfreetoreferencetheCDC’swebsitetocheckthedataforyourstate.


LessonFourCheckforUnderstandingAnswers

1. TrueorFalse:Pleasedeterminewhetherthefollowingstatementsaretrueorfalse.

___ a.Thefivestepsthatgointoimplementingatobaccocontrolprogramare:1)Engagestakeholders,2)Developastrategicplan,3)Implementtheprogram,4)Evaluatetheprogram,and5)Sustaintheprogram.

___ b.Thesamemessagescanbeusedtorecruitalltypesofcommunitypartners,sincetobacco

affectsthemallinessentiallythesameway.

___ c.Sustainingacomprehensivetobaccocontrolprogramshouldbeanon-goingactivityforyouandyourpartners.

___ d.Populationswithtobacco-relateddisparitiescanvarysignificantlyfromplacetoplace.___ e.Cessationtreatmentsandservicesaremosteffectivewhenusedaloneinsteadofin

combination.

CorrectAnswers:a. True-Needtoreview?Gobacktothe“ImplementingPrograms”page.b. False–Needtoreview?Gobacktothe“Step1:EngageStakeholders”pages.c. True–Needtoreview?Gobacktothe“Step5:SustaintheProgram”pages.d. True–Needtoreview?Gobacktothe“StrategiestoEliminateTobacco-RelatedDisparities”pages.e. False–Needtoreview?Gobacktothe“StrategiestoPromoteQuitting”pages.2. WhichofthefollowingstrategieswasNOTmentionedinthislessonasaneffectivewaytoprevent

youthtobaccoinitiation?a. Changingsocialnormssurroundingtobacco.b. Raisingthepriceoftobacco.c. Educatingretailersaboutsellingtobaccotominors.d. Changinghowtobaccoismarketed.e. Empoweringyoungpeoplebyinvolvingthemintobaccocontrol.

CorrectAnswer:c-Needtoreview?Gobacktothe“StrategiestoPreventInitiationamongYoungSmokers”pages.


3. Whichofthefollowingstatementsbestdescribeaneffective100%smoke-freepolicy?Chooseallthatapply.

a. Thepolicyisvoluntarilyputinplacebybusinessowners.b. Thepolicyisbackedbyimplementationandenforcementplans.c. Thepolicyincludesapreemptionclause.d. Thepolicydoesnothaveexemptionsforprivateclubs,tobaccoshops,andcasinos.e. Thepolicyhasprovisionsthatonlyallowsmokinginspeciallyventilatedareas.

CorrectAnswer:bandd–Needtoreview?Gobacktothe“StrategiestoEliminateExposuretoSecondhandSmoke”pages.

4. HowwelldoyouthinkyourstateisdoingintermsofmeetingthefourgoalsoutlinedinBest

Practices?Whataresomestrategiesfromthislessonthatyourstatecouldusetoimproveprogress?FeelfreetoreferencethisinfographicandchartfromtheTobaccoControlNetworktogetstarted.

Answerswillvary.5. Whatpopulationismostaffectedbytobaccorelateddisparitiesinyourownstate?Whydoyou

thinkthatis?FeelfreetoreferencetheCDC’swebsitetocheckthedataforyourstate.

Answerswillvary.


SourcesThroughout:CentersforDiseaseControlandPrevention.Bestpracticesforcomprehensivetobaccocontrolprograms,2007.Availableat:http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htmThroughout:CommunityPreventiveServicesTaskForce:TheCommunityGuide–Tobacco.Availableat:http://www.thecommunityguide.org/tobacco/index.htmlSlide3,4,5:FawcettSB,Paine-AndrewsA,FranciscoVT,SchultzJA,RichterKP,LewisRK,WilliamsEL,HarrisKJ,BerkleyJY,FisherJL,LewisCM.Usingempowermenttheoryincollaborativepartnershipsforcommunityhealthanddevelopment.AmericanJournalofCommunityPsychology.23(5):1995:677-697.Slide3,4,5:CentersforDiseaseControlandPrevention.BestPracticesforComprehensiveTobaccoControlPrograms:UserGuide–Coalitions:StateandCommunityInterventions.(n.d.)Availableat:http://www.cdc.gov/tobacco/stateandcommunity/bp_user_guide/pdfs/user_guide.pdfSlide9,10:CentersforDiseaseControlandPrevention.SustainingStateProgramsforTobaccoControl:OSHStrategicPriority.Availableat:http://www.cdc.gov/tobacco/tobacco_control_programs/program_development/sustainingstates/pdfs/strategic.pdfSlide11:CentersforDiseaseControlandPrevention.SustainingStateProgramsforTobaccoControl:AStoryfromColorado.Availableat:http://www.cdc.gov/tobacco/tobacco_control_programs/program_development/sustainingstates/pdfs/colorado.pdf

Slide13:CampaignforTobacco-FreeKids.TobaccoUseamongYouth.Availableat:http://www.tobaccofreekids.org/research/factsheets/pdf/0002.pdfSlide13:CenterforPublicHealthandTobaccoPolicy.CauseandEffect:TobaccoMarketingIncreasesYouthTobaccoUse-Findingsofthe2012SurgeonGeneral’sReport.Availableat:http://www.tobaccopolicycenter.org/documents/SGR%20NY%205-25-12.pdfSlide13:CampaignforTobacco-FreeKids.FederalBanonCandyandFruit-FlavoredCigarettes.Availableat:http://www.tobaccofreekids.org/Script/DisplayPressRelease.php3?Display=1176Slide13,14:U.S.DepartmentofHealthandHumanServices.PreventingTobaccoUseAmongYouthandYoungAdults:AReportoftheSurgeonGeneral.Atlanta,GA:U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention,NationalCenterforChronicDiseasePreventionandHealthPromotion,OfficeonSmokingandHealth,2012.Availableat:http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/index.htmlSlide13,14:CentersforDiseaseControlandPrevention.BestPracticesUserGuide:YouthEngagement–StateandCommunityInterventions.Atlanta:U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention,NationalCenterforChronicDiseasePreventionandHealthPromotion,OfficeonSmokingandHealth,2010.Availableat:http://www.cdc.gov/tobacco/stateandcommunity/bp_userguide_youth/pdfs/youth_engagement.pdfSlide13,14,15:CampaignforTobacco-FreeKids.RaisingCigaretteTaxesReducesSmoking,EspeciallyAmongKids(andtheCigaretteCompaniesKnowit).Availableat:http://www.tobaccofreekids.org/research/factsheets/pdf/0146.pdf


Slide15:Wilson,N,Sertsou,G,Edwards,R,Thomson,G,Grigg,M,andLi,J.ANewNationalSmokefreeLawIncreasedCallstoaNationalQuitline.BMCPublicHealth.2007;7:75.Slide15:Shields,M.SmokingBans:InfluenceonSmokingPrevalence.HealthReports(StatisticsCanada,Catalogue82-003)2007;18(3):9-25.Slide15,16,17:CentersforDiseaseControlandPrevention(CDC).SmokingandTobaccoUse:SmokingCessation.Availableat:www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/index.htmSlide15,16,17:FioreMC,JaénCR,BakerTB,etal.TreatingTobaccoUseandDependence:2008Update.ClinicalPracticeGuideline.Rockville,MD:U.S.DepartmentofHealthandHumanServices.PublicHealthService.May2008.Availableat:http://www.ncbi.nlm.nih.gov/books/NBK63952/Slide18:OfficeoftheSurgeonGeneral.TheHealthConsequencesofInvoluntaryExposuretoTobaccoSmoke:AReportoftheSurgeonGeneral,2006.Availableat:http://www.surgeongeneral.gov/library/secondhandsmoke/report/index.htmlSlide19,20,21:AmericanforNonsmokers’Rights.FundamentalsofSmokefreeWorkplaceLaws.Availableat:http://www.no-smoke.org/pdf/CIA_Fundamentals.pdfSlide19,20,21:TobaccoTechnicalAssistanceConsortium(TTAC).DevelopingSmokefreeImplementationRegulations.Availableat:http://www.ttac.org/services/DSIR/index.htmlSlide20:AmericansforNonsmokers’Rights.StateswithanyTypeofPreemptionofSmokefreeAirLaws.Availableat:http://www.no-smoke.org/pdf/preemptionmap.pdfSlide21:AmericansforNonsmokers’Rights.WhattoExpectDuringImplementation.Availableat:http://goingsmokefree.org/overview/expectations.htmlSlide22:AmericanLungAssociation.Smoke-FreeMulti-UnitHousing:BringingHealthyAirHome.Availableat:http://www.lung.org/assets/documents/healthy-air/smuh-policy-brief-update.pdfSlide22:DrachLL,MorrisD,CushingC,RomoliC,HarrisRL.Promotingsmoke-freeenvironmentsandtobaccocessationinresidentialtreatmentfacilitiesformentalhealthandaddictions,Oregon,2010.Availableat:http://www.cdc.gov/pcd/issues/2012/pdf/11_0080.pdfSlide22:UniversityofMichiganTobacco-freeCollegeCampusInitiative.Availableat:http://sph.umich.edu/tfcci/partners.htmlSlide23:CentersforDiseaseControlandPrevention(CDC).ChronicDiseasePreventionandhealthPromotion:HealthEquity.Availableat:http://www.cdc.gov/chronicdisease/healthequity/index.htmSlide23,24:CentersforDiseaseControlandPrevention,SpecificPopulations.Availableat:http://www.cdc.gov/tobacco/data_statistics/by_topic/populations/index.htmSlide26:MassachusettsDepartmentofPublicHealthTobaccoCessationandPreventionProgram.MassHealthSmokingCessationBenefitBriefingNotes.Availableat:http://makesmokinghistory.org/uploads/Briefing%20Notes%20on%20MassHealth%20Smoking%20Cessation%20Benefit%201-6-12.pdfSlide26:Legacy.Legacy’sHeadStartTobaccoCessationInitiative.Availableat:http://www.legacyforhealth.org/4070.aspx


Slide27:TobaccoTechnicalAssistanceConsortium.CommunitiesofExcellencePlus:Afreshapproachtobuildingtobaccocontrolcapacity.Availableat:http://www.ttac.org/services/pdfs/Communities_Excellence_Plus.pdf

ImagesSlide9:CentersforDiseaseControlandPrevention.SustainingStateProgramsforTobaccoControl:OSHStrategicPriority.Availableat:http://www.cdc.gov/tobacco/tobacco_control_programs/program_development/sustainingstates/pdfs/strategic.pdfSlide12:CentersforDiseaseControlandPrevention.Bestpracticesforcomprehensivetobaccocontrolprograms,2007.Available:http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm

Slide12:CommunityPreventiveServicesTaskForce:TheCommunityGuide–Tobacco.Availableat:http://www.thecommunityguide.org/tobacco/index.html

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