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Best Practices—2007

Centers for Disease Control and Prevention

Deborah Houston McCall, MSPH, Program Consultant

Program Services Branch Office on Smoking and Health National Associations of County and City Health Officials (NACCHO) and the National Associations of Local Boards of Health (NALBOH)

Webcast: Attacking the #1 Cause of Preventable Death and Disease: Using the CDC Best Practices for Comprehensive Tobacco Control Programs December 8, 2008

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Best Practices 1999 Evidence-based providing:

—A blueprint for program components

Community Programs Chronic Disease Programs School Programs Enforcement Statewide Programs Counter-Marketing Cessation Programs Surveillance and Evaluation Administration and Management

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Evidence Base

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Comprehensive Programs Work

Integrated programs influence social norms, systems, and networks.

The more states invest, the greater the reductions in smoking prevalence and consumption.

The longer states invest, the greater and faster the impact.

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Updating Best Practices

States requested updated guidance Cost of living has increased 30% Evidence-based reviews of specific

strategies Broader range of state experience

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Best Practices 2007

State and Community Interventions—Statewide Programs—Community Programs—Tobacco-Related Disparities—Youth (Schools and Enforcement)—Chronic Disease Programs

Health Communication Interventions Cessation Interventions Surveillance/Evaluation Administration/Management

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Best Practices 2007

Provides recommended level of annual investment within the funding range

Factors in state-specific characteristics

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State and Community Interventions

Community resources must be the foundation of sustained solutions to pervasive problems like tobacco use

Making tobacco less desirable, less accepted, and less accessible

Importance of grassroots support for social norm change

“All Prevention is local”

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State and Community Interventions

Consolidates Statewide, Community, School, Enforcement, and Chronic Disease into one category

Cost parameters include:—Duplication of 1999 cost parameters

—Adjusting for cost of living increases, population shifts, smoking prevalence, and school enrollment

More explicit integration of policy interventions Emphasis on eliminating disparities

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State and Community Interventions:COMMUNITY PROGRAMS

Funding community organizations Facilitating local coalitions Collaborating with partners to build capacity Supporting local strategies to educate Promote public discussion Establish local strategic plan Ensure support for local PH infrastructure Ensure grantees measure social norm

change outcomes

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State and Community Interventions: YOUTH PROGRAMS

Increase unit price of tobacco Conduct mass media with community

interventions Mobilize community to restrict minors’

access Implement school-based interventions with

media and community efforts

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The Community Guide’s Tobacco Control Strategies in Communities

Goal Recommended Interventions When Implemented ALONE

IncreaseCessation Increase the price (excise

tax)

Reduce Initiation Increase the price (excise

tax)

Reduce SHS Exp

Smoking bans

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The Community Guide’s Tobacco Control Strategies in Communities

Goal Interventions with Insufficient Evidence

IncreaseCessation

Smoking cessation contests

Broadcast smoking cessation series

Reduce Initiation

Retailer education

Youth point of purchase laws

Active enforcement

Community education / access

Student delivered community education

ReduceSHS Exp

Community-wide efforts to reduce SHS exposure in the home

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State and Community Interventions: CHRONIC DISEASE PROGRAMS

Collaborating with related PH programs Implement interventions that link to other

programs Develop communications that link SHS to

health outcomes Use tax revenue to fund tobacco and other

chronic disease programs Link other programs to tobacco

interventions (e.g., promoting quitline) Promote insurance coverage of preventive

services

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State and Community Interventions: TOBACCO-RELATED DISPARITIES

Conduct population assessment Seek consultation from specific populations Ensure disparities addressed in strategic

plan Fund organizations that can reach and

involve specific populations Provide culturally competent TA Provide communication to reach disparate

populations Ensure quitlines can meet the required

needs of population subgroups

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Health Communication Interventions Health communication interventions are

powerful tools to prevent initiation, promote cessation, and shape social norms.

Effective messages can stimulate public support and create a supportive climate for policy change.

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Cessation Interventions

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1-800-QUITNOW

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Cessation Interventions

Sustain, expand, and promote services such as quitlines

Coverage of treatment under public and private insurance

Eliminating cost barriers for underserved populations

Making the PHS-recommended health care system changes

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Current cost parameters include:—Updating 1999 cost parameters for

health system changes and quitlines State-specific characteristics

—State population

—Smoking prevalence Recommended level of intensity:

—6% of tobacco users enrolled into counseling

Cessation Interventions

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Surveillance and Evaluation

Current cost parameters include:—Maintain 10% of total program budget

Additional funds may be needed for:—Process evaluation

—Local-level evaluation

—Specific populations

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Core Surveillance Systems

Behavioral Risk Factor

Surveillance System

Youth Risk Behavior

Surveillance System

Youth Tobacco Survey

Adult Tobacco Survey

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Administration and Management

Current cost parameters include:

—Maintain 5% of total program budget

Should fund:

—Coordinated guidance and TA across program elements

—Collaboration and coordination with other state agencies in public health programs

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Disparities

Costs captured in multiple budget categories State and Community Interventions

—Fund local organizations to reach diverse populations—Support participation in coalitions—Fund multi-cultural organizations and networks

Health Communication Interventions—Use culturally appropriate messages and targeted

media channels Cessation Interventions

—Develop culturally appropriate and translated materials

—Provide access to multi-lingual quitline counselors Administration and Management

—Support participation in strategic planning

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State Examples

Recommended Annual Investment

Louisiana: $12.46 per capita $53.5 million

Alaska:$16.11 per capita $10.7 million

Utah: $9.23 per capita $23.6 million

Oklahoma:$12.54 per capita $45.0 million

New York: $13.15 per capita $254.3 million

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“Knowing is not enough; we must apply. Willing is not enough; we must do.”

- Johann Wolfgang von Goethe

“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”

- Margaret Mead

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Best Practices—2007

Centers for Disease Control and Prevention

Office on Smoking and Health

Deborah Houston McCall, MSPH Program Consultant

770-488-1182dmccall@cdc.gov