Post on 12-Jan-2016
National Tobacco Control Conference Training Session
Presented by
TTAC
November 19, 2002
Today’s Objectives
• Describe TTAC training program for new employees and grantees
• Increase participants’ tobacco control knowledge to implement training programs in their state/ local organizations
• Identify areas for technical assistance
Introduction
Dearell Niemeyer Director, Tobacco Technical
Assistance Consortium
The Tobacco Technical Assistance Consortium
What is TTAC? What Does It Do?
What is TTAC?
• Unique not-for-profit organization
• National in scope
• Neutral in stance
• Flexible in approach
TTAC History
• Est. 2001 to provide state and local organizations with the necessary knowledge, abilities, tools and skills to succeed in reducing harm caused by tobacco
• Grant from the American Cancer Society, the American Legacy Foundation, and the Robert Wood Johnson Foundation
• Located in the Rollins School of Public Health at Emory University
TTAC Mission
Build capacity to achieve effective tobacco prevention and control programs and policies
TTAC Vision
Provide national leadership in technical assistance to strengthen community tobacco control programs
TTAC Services
• Provide training and technical assistance to state and local tobacco control programs and coalitions
• Maintain a cadre of skilled consultants available for on-site technical assistance
• Provide telephone consultation;• Improve coordination of technical
assistance among partner organizations
Guiding Principles
• Our environment reflects– Creativity– Inclusivity– Innovation– Continuous learning – Celebration of achievements
Guiding Principles (Cont’d)
• Our work is carried out openly, with a shared sense of :– Urgency– Spirit of respect, collaboration and trust– Enthusiasm– Commitment to public health principles and the
highest ethical standards
Philosophical Approach
• TTAC provides training and technical assistance to:– Increase knowledge and skills– Foster strong leadership– Increase organizational support– Strengthen partnerships
• The essence is capacity building
Partners
• CDC• SmokeLess States• Campaign for Tobacco-Free Kids• Latino Council on Alcohol and Tobacco• National African American Tobacco Prevention
Network• American Indian/Alaska Native support centers• Spaces available!!!
TTAC Assistance
• Technical assistance (eg, consultation, reviews)
• Information resources (especially web-based)
• Training support (planning, training activities, evaluation)
TTAC Provides Assistance On…
• Program development and implementation• Best practices and evidence-based
interventions• Program evaluation• Cultural competence, diversity and
inclusiveness• Strategic planning• Coalition building
TTAC Provides Assistance On…
• Long-term communication planning
• Advocacy development
• White Papers and legal research
• Resource identification
• Policy development and advocacy training
How Does Assistance Occur?
• Request is submitted via email, phone, or letter• TTAC staff responds and triages request• Technical assistance process begins, through
partners or through consultants• Work begins on activities• Project/activities end• TTAC receives report from consultant(s)• TTAC evaluates process and outcomes
Where You Come In
• Refer grantees or partners to us for assistance
• Refer possible consultants and experts to us to provide assistance
• Let us know what assistance you currently provide, and how we can complement your efforts
Contact TTAC
• Phone: 404-712-8474
• Email: ttac@sph.emory.edu
• Via the web: www.ttac.org
Basics of Tobacco Control
What is BOTC? What Does It Do?
Basics of Tobacco Control
• What is it?– Tobacco control training program – Introduction to background issues
Web-Based Needs Assessment Response Rate 63.6%, N=35
Technology Is Available, Though Underutilized
3234 34
12 11
31
0
5
10
15
20
25
30
35
40
CD-ROM (n=32)
Internet (n=34)
Power Point(n=34)
Have
Use
21
30
21
4 4
14
0
5
10
15
20
25
30
35
CD-ROM (n=35)
Internet (n=35)
Power Point(n=35)
Have
Use
States Grantees
CD-ROM is the Biggest Opportunity
28
23
5
22
7 6
24
12
0
5
10
15
20
25
30
Hand outs(n=35)
Overheads(n=29)
CD-ROM(n=29)
Power Point(n=34)
Use
Desire to use
Purpose of BOTC
• Provide individualized training in a flexible format
• Address specific issues of tobacco control in priority populations
• Provide comprehensive resources in one location• Standardize tobacco control training for new
employees to tobacco control– Grantees– Community level– State level
BOTC Content
IntroductionTermsEvolutionMSAPartners
ScienceDocumentsHazards PrevalenceIndustry
Foundation Social changePopulation Based Advocacy Goals/objectives
ResourcesGlossaryDocumentsLinks
Evaluation Assessment Usability
Comprehensive and Accessible
• BOTC simplifies and integrates complex information
• BOTC is practically focused• BOTC is user friendly
– Multi-dimensional format – Minimum hardware requirements– Adjustable user features– Self assessment
Special Features
• User control of training experience
• Audio and video enhanced content
• Practical examples from experts in the field
• Pre-loaded with all necessary software
• Assessment feedback
Session Overview
Johanna M. Hinman, MPH, CHESProgram Coordinator
Session Overview
• Tobacco Control Milestones
• Translating the Science Into Practice
• Making a Difference
Milestones in Tobacco Control
Perry Stevens, MPA
Consultant
Tobacco Control Timeline
1945
1955
Relationship between cigarette smoking and diseases, including lung cancer established Industry CEOs formulate “an industry response” with a concerted “public relations campaign intended to preserve their profits” “A Frank Statement to Cigarette Smokers” refuted the findings of the scientific community and glorified the history of tobacco use in America Industry secretly engaged in the “Gentleman’s Agreement”
• Companies to share discoveries re: a “safe cigarette” • No in-house biomedical research on animals
Tobacco Control Timeline
1958
1963
Creation of the Tobacco Institute (a.k.a) “the open question” debate PM concluded that a “medically acceptable low-carcinogen cigarette may be possible” (but never releases the research) PM internally discussed methods for increasing the nicotine content of cigarettes B&W general counsel stated that “nicotine is addictive” and that “we are… in the business of selling nicotine, an addictive drug”
Tobacco Control Timeline
1963
1964
The Surgeon General prepared the first report on smoking and health; asks for cooperation of the Tobacco Companies, but it is withheld
The Liggett Company joined the Tobacco Industry Research Committee and the Tobacco Institute
Recommendation by PM R&D VP: “the industry should abandon its past reticence with respect to medical research. Indeed, failure to do such research could give rise to negligence charges.”
Tobacco Control Timeline
1965
1970
Limited performance of biological research begun, but the Gentleman’s Agreement otherwise remained intact
- Reynolds researched the mechanisms of emphysema using mice, nicknamed “The Mouse House”- Reynolds dismantles and destroys all records after PM complains
PM purchased a research facility in Cologne, Germany (INBIFO)
- Repository for information and files- To avoid discovery of adverse documents in times of litigation in the US
Tobacco Control Timeline
1970
1984
Study of smoke exposure on hamsters indicated that cigarettes were addictive and caused cancer; funding threatened by The Council for Tobacco Research (CTR) if published B&W memo discussed the addictiveness of nicotine, characterized nicotine as a poison, and noted consumer naivety PM internal memo re: the psychopharmacology of nicotine noted that company lawyers did not want the research to become public because it would support regulation by the FDA Philip Morris studied the effects of nicotine on the behavior of rats to research potential nicotine analogues; found “nicotine looked like heroin”
Tobacco Control Timeline
1988
1994
U.S. Surgeon General reports: “… tobacco addiction…similar to …heroin and cocaine” Dramatic rise in teenage smoking after Reynolds begins a massive dissemination of “Joe Camel”, which was designed to counter the “Marlboro Man” Reynolds instructed its advertising agency to destroy documents in their possession related to the “Joe Camel” campaign to avoid full disclosures of its practices Tobacco CEOs testified under oath before the Congressional Health Subcommittee that nicotine was not addictive
Tobacco Control Timeline
1995
2002
“The Tobacco Whistleblower” provides State of Mississippi Tobacco Litigation landmark testimony regarding the attempts of the tobacco industry to deceive, manipulate and evade the public
Tobacco companies entered into a “Master Settlement Agreement” with 46 State Attorney Generals in an effort to achieve a “significant reduction in youth tobacco use”
TTAC Est.
Science into Practice: Making the Most Out of the Work of Others
Kathleen R. Miner, Ph.D., MPH, CHES Associate Dean for Applied Public Health
Universities are full of knowledge; the incoming students bring in a little and the graduates take none away, thus knowledge accumulates.
Adapted from: Abbott Lawrence Lowell
Challenges to Decision Making in Public Health1. Lack of alternatives: funding/regulatory
restrictions2. Decision paralysis: analyzing minutiae3. International competition: organizational caps
(FTEs, % increases or decreases)4. Impatience: solving the wrong problem5. Involving the wrong people: we make the
decisions, they do the work6. Data doubting: questioning the credibility of data
to avoid making the decision
“A great many people think that they are thinking when they are merely rearranging
their prejudices.”
William James
Sources of Credible Evidence
Program surveillance data Information management Products Fiscal expenditures
Qualitative data Stakeholder impressions Social evidence
Quantitative dataPopulation health statusBehavior changeEconomic indicators
Defensible
instrumentation
Defensible
methodology
Plausible linkages
Theory
“If the world was a logical place, it would be men that
ride side saddle”
Rita Mae Brown
Role of Theory
Theory provides:1. provides context to evidence2. links one type of evidence to another type3. connects the dots among similar programs4. extrapolates short change to longer term change 5. encourages the feedback from practice to
theory.
Sources of Information
The Program’s Own Logic Peer Reviewed Literature
On Tobacco On Similar Populations On Same Theoretical Principles On Same Organizational Settings
Sources of Information
Government PublicationsReducing Tobacco Use: A Report of the
Surgeon General Guide to Community Preventive Services:
Tobacco Use Prevention and ControlCDC’s Best Practices for Comprehensive
Tobacco Control Programs CDC’s Tobacco Control Program Goal AreasState Specific Documents
Sources of Information
Professional Publications APHA AMA NACCHO and ASTHO
Panel of Experts National Databases Proprietary Data
Sources of Information
Primary Data Collection– Medical, Hospital, and Personnel Records– Physician Visits and Charges– Program Records– Surveys (behavioral, opinion, market)– Case Studies (most similar, least similar,
typical, atypical) – Focus Groups
“If you are not a part of the solution, then you must a part of the precipitate.”
Steven Wright
Industry Tactics
Perry Stevens, MPA
Consultant
The Nine “D’s” of Tobacco Industry Survival
1. Deny the health consequences of smoking
2. Deceive consumers about the true nature of cigarettes through marketing and public relations
3. Damage the credibility of industry opponents
4. Direct advertising to women and youth, in addition to men, to maximize sales volume
5. Defeat attempts to regulate the industry or control smoking
Source: Cunningham, Rob. Smoke and Mirrors: The Canadian Tobacco War. 1996.
The Nine “D’s” of Tobacco Industry Survival (Cont’d)
6. Delay legislation if it can't be defeated
7. Destroy legislation once it passes
8. Defend lawsuits filed against the industry
9. Develop new markets around the world
Source: Cunningham, Rob. Smoke and Mirrors: The Canadian Tobacco War. 1996.
Industry Tactic #1
• Keep tobacco use from being discussed in terms of the public’s health – Try to frame tobacco use as anything but an
issue of public health– Turn the tobacco issue into an individual rights
issue to change the subject – Try to shift the focus from science-based
evidence to personal freedom
Industry Tactic #2
• Undermine public health messages about the dangers of tobacco use through deception, misdirection, and manipulation of the facts – “Industry experts” interpret and misuse science
to muddy the waters about the deadly effects of tobacco use
Industry Tactic #3
• Discount the facts and data on the harm caused by secondhand smoke – 3,000 non-smokers die in the U.S. each year
from lung cancer caused by other people’s smoking
– 64,000 non-smokers die every year in the United States from heart failure caused by other people’s smoke
Source: 2000 SGR, Reducing Tobacco Use, CDC
Industry Tactic #4
• Divert attention from tobacco profits by heavily publicizing its charitable giving and support of community services – In 1999, Philip Morris gave $60 million dollars
to charities then spent $100 million dollars on advertising to publicize its generosity
Source: Robert Dreyfuss, “Philip Morris Money.” The American Prospect v11 n10, March 27, 2000
Industry Tactic #5
• Perpetuate the myth of a “safer cigarette” – Light, ultralight, and low tar brands were
introduced and marketed to provide smokers an alternative to quitting
– Intended to prevent smokers from quitting– Ingenious and effective
Source: Smoker Perceptions of ‘Light’ and ‘Low Tar’ Cigarettes” published by Campaign for Tobacco Free Kids
Industry Tactic #6
• Highlight youth prevention efforts to offset the perception that tobacco companies are death merchants– For instance, Philip Morris has run a highly visible
campaign, including a TV ad during the Super Bowl, which urged parents to talk to their kids about not smoking
– However, one study indicates that while the industry is telling parents to talk to their kids…through their marketing, they’re telling the kids to rebel, assert their independence, and take some risks
Source:“New Study Shows Tobacco Marketing Undermines Good Parenting Practices” 07/16/02, by the Campaign for Tobacco Free Kids
Industry Tactic #7
• Introduce alternative nicotine delivery devices, or “smoke and mirror” products – Cleverly marketed to play on the public’s
health concerns; addict new users who believe they are making a healthier choice
– No government regulation of these products – No substantiation for claims they pose any less
risk than more familiar tobacco and nicotine products
Source: “New Tobacco Products—Lower Risk or More of the Same?” published by the Campaign for Tobacco Free Kids
Industry Tactic #8
• Advertising and Promotions– An all time high of $9.57 billion was spent on
cigarette advertising and promotion in 2000– Represents an increase of 16.2% from the $8.24
billion spent in 1999, and of 42.2% from the $6.73 billion spent in 1998
Source: Federal Trade Commission Cigarette Report for 2000
“Preserve the industry's freedom…”
Givel M. Tobacco lobby political influence on US state legislatures in the 1990s. Tob Control 2001;10:124-134
"Industry volume will be negatively affected by increasing smoking restrictions, the decreasing acceptability of smoking and increasing excise taxes. Corporate affairs will use direct lobbying, the media, and industry allies to minimize state and local tax increases, promote accommodation in public places and preserve the industry's freedom to advertise and promote cigarettes to adult smokers."
Industry Tactic #9
• Test market new products in various cities around the country – Be on the lookout to determine if a new product
is being promoted in your area– Indiana produced a print ad to counter test-
marketing of a new tobacco product in Indianapolis
Industry Tactic #10
• Target young adults– From 1993 to 2000, substantial reductions in
current smoking prevalence were reported for all age groups, except 18-24 years
– This group is particularly responsive to “Retail value added” products, "buy one, get one free," and other offers
Sources: MMWR 07/26/02, Vol. 51, No. 29; Federal Trade Commission Cigarette Report for 2000
Industry Tactic #11
• Lobby the U.S. Congress – Argue against state and local legislation to
restrict smoking and to support the passage of state laws that preempt stronger local ordinances
– Spent over $43 million in lobbying in the first six months of 1998 alone
Sources: 2000 SGR, CDC fact sheets; "Blowing Smoke: Big Tobacco's 1998 Congressional Lobbying Expenses Skyrocket" by Public Citizen
Industry Tactic #12
• Contribute “soft money” to the 2 political parties – From 1995 to 2001, tobacco companies
contributed more than $20 million to the parties, and nearly half that came from Philip Morris
• $3 million to Democrats
• More than $17 million to Republicans
Source: Common Cause's Soft Money Laundromat
Industry Tactic #13
• Support bans on clean indoor air laws – The industry waged a tremendous battle against
an Environmental Protection Agency report revealing the dangerous health effects of secondhand smoke
Source: “Tobacco’s Secondhand Science of Smoke-Filled Rooms” by Rampton and Stauber. Center for Media and Democracy. PR Watch v7n3, 2000
Industry Tactic #14
• Target minority newspapers and other publications; gain financial reliance– Many minority publishers rely on tobacco
companies for advertising revenue– This reliance reduces the likelihood that these
companies be held accountable
Industry Tactic #15
• Back so-called “independent” research organizations – For example, the Cato Institute:
• Published policy reports calling the MSA unconstitutional
• Challenged the validity of CDC research that determined more than 400,000 deaths in the U.S. each year are due to smoking-related illnesses
Sources: “Constitutional and Antitrust Violations of the Multi State Tobacco Settlement” by Thomas C. O’Brien, 05/18000; “Lies, Damned Lies, and 400,000 Smoking-Related Deaths” published in Regulation v21 n4)
Industry Tactic #16
Prevent Regulation of Tobacco • Tobacco ingredients remain protected as trade
secrets and are not regulated by the FDA• The labels 'light,' 'ultralight', and 'low tar' continue
to be used even though the terms are not based on the actual known properties of the cigarettes
• The FDA is still unable to regulate tobacco products although the nicotine in cessation products is regulated
Industry Tactic #16 (Cont’d)
• The industry continues to successfully oppose attempts to make information about its products available to the people who use them
• Anything we know about the constituents of secondhand smoke has been learned from analysis of the smoke by non-industry scientists
• Until these products are regulated, it will be impossible to prevent the industry from continuing to profit at the expense the public’s health
Industry Tactic #17
• Sponsor industry meetings– Invite reputable tobacco control scientists and other
professionals to take part in industry-sponsored meetings
– For instance, in August 2002: Philip Morris funded the Life Sciences Research Office to conduct a meeting on the “relative health risks of non-tobacco ingredients added to cigarettes”
– Tobacco control forces, including the Campaign for Tobacco Free Kids, mobilized to educate potential participants that they will be manipulated
Source: Campaign for Tobacco-Free Kids, memo to Tobacco Control Community, 7/22/02
Making a Difference
Dearell Niemeyer Director, TTAC
Kathy HartyTechnical Assistance Specialist Consultant
The first step is not action; the first step is understanding.
“Communities must change…”
Source: Centers for Disease Control and Prevention. Best practices for comprehensive tobacco control programs – August 1999. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, August 1999.
“To achieve the behavior change that supports the nonuse of tobacco, communities must change the way tobacco is promoted, sold, and used while also changing the knowledge, attitudes, and practices of young people, tobacco users, and nonusers.”
0
1,000
2,000
3,000
4,000
5,000
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990
Nu
mb
er
of
Cig
are
tte
s
Source: USDA; 1986-2000 Surgeon General's Reports
Great Depression
End of WW II
Nonsmokers’Rights Movement
Begins
1st SurgeonGeneral’s Report
Fairness DoctrineMessages on TV and Radio
Federal CigaretteTax Doubles
BroadcastAd Ban
Tobacco Control Policies WorkTobacco Control Policies WorkAdult Per Capita Cigarette Consumption and Major Smoking-and-Health Adult Per Capita Cigarette Consumption and Major Smoking-and-Health Events--United States, 1900-1999Events--United States, 1900-1999
MasterSettlementAgreement
NicotineMedications Available Over the Counter
1st Smoking-Cancer Concern
1st World Conference
on Smoking and Health
Surgeon General’sReport on EnvironmentalTobacco Smoke
1st Great American Smokeout
"The problem of today cannot be solved at the same level of thinking that created them."
- Albert Einstein
Federal programs, national partners,
litigation and other inputs
Inputs Activities Outputs Short-term Intermediate Long-term
Counter-marketing
Exposure to no-smoking and pro-health messages
Changes knowledge, attitudes and
behaviors
Smoking denormalized
Decreased smoking
Outcomes
State tobacco control
programs
Community and state
partners and organizations
Communitymobilization
Policy & regulatory
action
Effortstargeted todisparate
pops
Increase availability and use of cessation
and related services
Training andprofessionaldevelopment
Creation of smoking bans,
and no-smoking regulations and
policies
Community and state
partners and organizations
Reduce initiation among youth
Increase cessation among youth &
adults Reduce exposure to
ETS
Reduced tobacco-related
morbidity & mortality
Increased environments with
no smoking
Tobacco Prevention and Control Logic Model – OverviewGoal: Decrease Smoking
Decreased tobacco-related
disparity
Making a Difference
• Systems Change
• Legislation & Policy Making
• Your Information System
Guide to Community Preventive Services
• Provides scientific evidence for which tobacco control interventions do/don’t work
• Allows state and local programs to focus time and resources efficiently and effectively
• Lets state and local programs know which efforts to avoid
Primary Sources for Evidence- Based Strategies• Reducing Tobacco Use: A Report of the Surgeon
General• The Guide to Community Preventative Services:
Tobacco Use Prevention and Control• Treating Tobacco Use and Dependence: Clinical
Practice Guideline• Best Practices for Comprehensive Tobacco
Control Programs
Rationale for Evidence-Based Interventions• Policies are interventions
• Polices are effective interventions
• Evidence is available
• Evidence supports adoption
Policies are Interventions
Policy Intervention
Reduce Exposure to ETS
Increase Cessation
Reduce Initiation
Reduced Morbidity
&Mortality
Source: California State Board of Equalization (packs sold) and California Department of Finance (population). U.S. Department of Agriculture. Note that CA data is by fiscal year (July 1-June 30) and U.S. data is by calendar year. Prepared by: California Department of Health Services, Tobacco Control Section, June 2000.
Pac
ks/P
erso
n
Smokers Smoke LessCalifornia and US Cigarette Consumption Packs Per Fiscal Year, 80/81 - 00/01
US
0
50
100
150
200
CA 162.3 158.8 152.5 144.6 141.4 136.4 131.1 126.6 112.6 103.2 94.7 91.1 84 79.3 77.5 74.8 72.7 69.2 61.3 50.6
US 192 187.7 175.1 173.1 168.5 163.7 159.9 154.8 146.3 141.3 136 132.1 127.2 126.2 125.3 124.1 121.1 116 106.8 101.5
80/81 81/82 82/83 83/84 84/85 85/86 86/87 87/88 88/89 89/90 90/91 91/92 92/93 93/94 94/95 95/96 96/97 97/98 98/99 00/01
CA
Smoking Among Adults DeclinesAdult Smoking Prevalence
1977-2000 California and US
0
5
10
15
20
25
30
35
40
Perc
en
t
US CA
Sources: United States--NHIS, US Centers for Disease Control and Prevention; California--CTS, 1990, 1992-3, 1996, weighted to 1990 CA population; CATS/BRFS, 1994-2000, weighted to 1990 CA population. Prepared by: California Department of Health Services, Tobacco Control Section.
Tax Increase and Start of
the CA Tobacco Control Program
* Definition change in 1996 resulted in more “occasional smokers” being counted.
*
77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00
One Team’s Victory is Another’s Loss…
“In California our biggest challenge has not been the anti-smoking advertising created with cigarette excise tax dollars. Rather, it has been the creation of an anti-smoking infrastructure, right down to the local level. It is an infrastructure that for the first time has the resources to tap into the anti-smoking network at the national level.”
— Philip Morris, Overview of State ASSIST programs, undated
Source: PM document 2021253353/3357
Analysis of InterventionsIntervention
Designed To
Strongly
Supported
Tactics
Sufficiently
Supported
Tactics
Insufficiently
Supported
Tactics*
Reduce Youth Initiation
•Increasing the unit price for tobacco products
•Mass media campaigns**
•School-based education programs based on the social influence resistance model
•Community
•Youth access restrictions
•Peer-based interventions
•Penalties for possession and use by minor
•School policies to prohibit tobacco use on school grounds
*Does not mean the they have been found to be ineffective, rather there was insufficient evidence to conclude effectiveness**When combined with other interventions
Analysis of Interventions
Intervention
Designed To
Strongly
Supported
Tactics
Sufficiently
Supported
Tactics
Insufficiently
Supported
Tactics*
Reduce ETS
Exposure
•Laws and ordinances that ban smoking in public buildings, worksites etc.
•Community education on ETS exposure in the home
*Does not mean the they have been found to be ineffective, rather there was insufficient evidence to conclude effectiveness
Analysis of Interventions
Intervention Designed To
Strongly
Supported
Sufficiently
Supported
Insufficiently Supported*
Increase Cessation
•Provider counseling to patients, including brief advice
•Health Care system interventions to assess for tobacco use and counseling to patients
•Pharmacologic treatment of nicotine addiction•Increase the price (tax) •Mass media campaigns**•Telephone Quit lines**•Smoking bans
•Reminders to prompt providers to discuss cessation with patients
•Reduced out-of-pocket costs for effective cessation therapies
•Mass media cessation series
•Cessation contests using mass media for promotion
•Provider education on tobacco and cessation
•Smoking cessation programs for youth
*Does not mean the they have been found to be ineffective, rather there was insufficient evidence to conclude effectiveness**When combined with other interventions
Evidence-Based Lessons
• Focus the program where change must take place
• Provide sharply focused RFPs with clear indications of types of activities needed
• Link local programs to overall goals
• Provide assistance in proposal writing preparation
Evidence-Based Lessons
• Provide ongoing technical assistance and training
• Link local programs to statewide media campaigns and state media advocacy activities
• Maintain flexibility to allow local agencies to adjust to unforeseen developments
“Never doubt that a small group of thoughtful citizens can change the world. Indeed, it’s the only thing that ever has.”
- Margaret Mead
The Art of Tobacco Control
• Highlight advocacy, policy, and politics
• Promotes issues to influence policy-makers
• Encourages social change
• Educates the public
• Sways public opinion
• Influences policy makers
Tobacco control is not about changing an information gap; its about changing a power gap
Tobacco Industry Hates…
• Clean indoor air
• Aggressive media campaigns
• Community-based programs that undermine the social acceptability of tobacco
• Tax increases
Tobacco Industry Accepts…
• Youth access programs
• School programs
• Comprehensive health education
• Pregnant women should not smoke
Politicians Respond to 2 Things …
1. Money …
2. … and pain
…. And you don’t have any money
Politicians Must…
• Fear and respect you
• Worry about what crazy thing you will do next
• Know that you do not care what they do to your other programs
The Tobacco Industry Has Learned…
• It is getting better at hiding
• It owns the Republican Party and rents the Democrats
• It has totally infiltrated:– Hospitality industry– ASHRAE and ventilation– Grocers associations
Beating the Tobacco Industry
• Leverage the public (public health’s best asset)
• Keep the fight public and the public engaged
• Confront tobacco industry groups that work in the shadows and through intermediaries and force them away from the tobacco industry
Beating the Tobacco Industry
• Early phases of tobacco control implementing legislation are very important
• Bad precedents, once set, are exceptionally hard to reverse
• Avoid compromises early in the process
• Do not be afraid of controversy; use it
Beating the Tobacco Industry
• Press for and defend high-quality programs
• Beware of reasonable sounding compromises in the anti-tobacco program, even when these suggestions come from “friends” in the health department
Beating the Tobacco Industry
• The battle does not end when a tobacco control initiative is passed
• The battle does not end when Legislature enacts implementing legislation, even if it is a good bill
• The battle does not end when the health department or schools implement a good program
• The battle never ends….
Beating the Tobacco Industry
• Coalitions are a good thing
• But leadership is more important
Leadership is Not Tidy
Most of the time most things are out of hand. No leader enjoys that reality, but every leader know it.
Thank you!