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Implementing and Sustaining Effective Local Tobacco Control Programs (Using CDC’s Best Practices and NACCHO’s Guidelines). June 10, 2009-National Conference on Tobacco or Health: Phoenix, AZ. Deborah Houston McCall-CDC’s Office on Smoking and Health

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June 10 2009 national conference on tobacco or health phoenix az

Implementing and Sustaining Effective Local Tobacco Control Programs (Using CDC’s Best Practices and NACCHO’s Guidelines)

June 10, 2009-National Conference on Tobacco or Health: Phoenix, AZ

Deborah Houston McCall-CDC’s Office on Smoking and Health

Julie Nelson Ingoglia-National Association of County and City Health Officials

Tricia Valasek-National Association of Local Boards of Health

Karla Sneegas-Indiana Tobacco Prevention and Cessation

Jen Morel-Columbus (OH) Public Health Department


Overview
Overview Programs (Using CDC’s


Overview1
Overview Programs (Using CDC’s

  • Understand role CDC’s Best Practices plays in addressing tobacco use prevention and control

  • Introduce 3rd Edition of Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs (Guidelines)

  • Discuss advantageous partnerships with boards of health and health departments

  • Identify importance of Sustaining States and Locals Planning Meetings

  • Illustrate Indiana’s experience of securing tobacco control funding

  • Provide first-hand example of how state and local health departments and boards of health are engaging in tobacco control


TM Programs (Using CDC’s

Best Practices—2007

Centers for Disease Control and Prevention

Office on Smoking and Health

Deborah Houston McCall, MSPH

NACCHO and NALBOH Project Officer

(770) 488-1182 [email protected]


State investment in tobacco control
State Investment in Tobacco Control Programs (Using CDC’s

  • American Journal of Public Health 2/08:

    Impact of Tobacco Control Programs on Adult Smoking

    • Peer-reviewed study examined state tobacco prevention and cessation funding levels from 1995 to 2003.

    • Found the greater investment states made in their state tobacco program, the larger and more rapid declines achieved in adult smoking prevalence – even when controlling for other factors.


State investment in tobacco control1
State Investment in Tobacco Control Programs (Using CDC’s

  • Campaign for Tobacco Free Kids Response 2/08:

    • The researchers also calculated that if Ohio had funded its program at the levels recommended by CDC during that period, there would have been between 14,328 and 35,665 fewer smokers in the state by 2003….

    • Such smoking declines would havesaved between 4,585 and 11,413 lives….

    • As well as between $136.1 M and $338.8 M in health care costs.


Updating best practices
Updating Best Practices Programs (Using CDC’s

States requested updated guidance

Cost of living has increased 30%

Evidence-based reviews of specific strategies

Broader range of state experience


Best practices 2007
Best Practices 2007 Programs (Using CDC’s

  • 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


Administration and management
Administration and Management Programs (Using CDC’s

  • 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


Core surveillance systems
Core Surveillance Systems Programs (Using CDC’s

Behavioral Risk Factor

Surveillance System

Youth Risk Behavior

Surveillance System

Youth Tobacco Survey

Adult Tobacco Survey


Surveillance and evaluation
Surveillance and Evaluation Programs (Using CDC’s

  • Current cost parameters include:

    • Maintain 10% of total program budget

  • Additional funds may be needed for:

    • Process evaluation

    • Local-level evaluation

    • Specific populations


Cessation Interventions Programs (Using CDC’s

  • 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


Health communication interventions
Health Communication Interventions Programs (Using CDC’s

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.


State and community interventions
State and Community Interventions Programs (Using CDC’s

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”


Implementing and sustaining effective local tobacco control programs

Implementing and Sustaining Effective Local Tobacco Control Programs

Julie Nelson Ingoglia, MPH

National Association of County and City Health Officials (NACCHO)


Using tobacco control to alter chronic disease prevention paradigm for local health departments

Tobacco control demonstrated over the past 15 years how we could change social norms and behaviors that cause chronic diseases... we used a whole host of strategies such as laws, media, and changing environments where we work, play, and go to school. This same framework can be used to reduce other modifiable risk factors for chronic diseases such as poor nutrition and lack of physical activity.

Poki Stewart Namkung, M.D., M.P.H.

Health Officer, Santa Cruz County Health Services Agency, Santa Cruz, CA

Our challenge is to make policy makers and the public appreciate the extraordinary return on investment if we create an environment dedicated to preventing chronic disease.

Gary Goldbaum, MD, MPH

Health Officer & Director, Snohomish Health District, Everett, WA

Using Tobacco Control to Alter Chronic Disease Prevention Paradigm for Local Health Departments


A new chronic disease prevention paradigm for local health departments
A New Chronic Disease Prevention Paradigm for Local Health Departments

Guidelines can:

  • Fulfill the local government’s statutory responsibility to address dominant health threat

  • Assist state development and use of standard formula to allocate tobacco control funding to local health departments

  • Engage in evidence-based tobacco control

  • Direct leadership role articulated in Voluntary National Accreditation Standards


Local health department role fulfilling accreditation domains with tobacco control activities
Local Health Department Role – Fulfilling Accreditation Domains with Tobacco Control Activities

Protect people from health problems and health hazards (2).

  • Educate and inform decision-makers about the research on comprehensive clean indoor air legislation and enforce it when implemented.

    Engage the community to identify and solve health problems (4).

  • Develop or support community partnerships to address tobacco use.

    Develop public health policies and plans (6).

  • Work with community partners to develop a county plan to address tobacco use including the adoption of evidence-based policies such as expanding smoking restrictions.

    Enforce public health laws and regulations (7).

  • Conduct enforcement procedures with tobacco retailers to reduce unlawful tobacco sales to minors.

    Help people receive health services (8).

  • Provide training and coordination among all health care providers in the county to promote brief cessation interventions and referrals.


Program and funding guidelines for comprehensive local tobacco control programs guidelines
Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs (Guidelines)


Local activities and successes

Community and School Activities Tobacco Control Programs (Guidelines)

Development of smoke-free air policies (84%)

Local counter-marketing campaigns (65%)

Development of educational materials to increase excise taxes on tobacco products (20%)

Evidence-based curricula in schools (67%)

Developing tobacco free policies (62%)

Parenal involvement and teacher training (43%)

Cessation

Promoting state quitline (92%)

Offer cessation for adults (79%)

Offer cessation for youth (65%)

Enforcement

Education about smoke-free air policies (82%)

Education about youth possession (59%)

Compliance checks (61%)

Enforcement of youth possession (39%)

Counter-marketing

Health promotion activities (81%)

Press releases and public service announcements (79%)

Paid TV, radio, billboard and print advertising (64%)

Local Activities and Successes


Program and funding guidelines for comprehensive local tobacco control programs guidelines1
Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs (Guidelines)


Contact information
Contact Information Tobacco Control Programs (Guidelines)

Julie Nelson Ingoglia, MPH

Program Manager, Community Health

National Association of County and City Health Officials

1100 17th Street, NW

Second Floor

Washington, DC 20036

[email protected]

202/507-4248 (Direct)

202/783-5550 (Main)


Board of health and health department involvement in tobacco control programs and policies

Board of Health and Health Department Involvement in Tobacco Control Programs and Policies

Tricia Valasek, MPH

Project Director-Tobacco Use Prevention and Control


Board of health description
Board of Health Description Control Programs and Policies

  • Boards of health are the advising, governing, or policy-making authority for a local health department or community.

  • Boards of health are composed of at least three elected or appointed individuals

    • Some board of health members are designated to sit on the board by state statute

  • Local boards of health may also be referred to as:

    • Community health boards

    • Health advisory councils

    • Medical societies

    • Tribal boards

    • County commissioners


Relationship between boards of health and health departments
Relationship Between Boards of Health and Health Departments Control Programs and Policies

Boards of Health

Health Departments

  • Advise or govern health departments and/or city councils and county commissions

  • Act as the liaison between the health department and the public

  • Oversee or authorize financial budgets and expenditures

  • Propose health-related ordinances or statutes

  • Decide what clinical services are needed and can be provided

  • Provide common health services

  • Develop programs for implementation

  • Conduct Community Health Assessments

  • Provide boards of health with relevant materials and resources to make informed decisions

  • Conduct health inspections and other programs to protect the health of community members


Board of health roles in tobacco use prevention and control
Board of Health Roles in Tobacco Use Prevention and Control Control Programs and Policies

  • Board of health members can be outstanding advocates for tobacco control and prevention

    • Contact state legislators to advocate for clean indoor air laws, sustaining funding, youth access laws, etc.

    • Work with local county commissioners and city councils to develop effective policies

    • Advocate to the public about the importance and benefit of tobacco control programs in the community

    • Develop and implement tobacco control policies in local communities


Best practices
Best Practices Control Programs and Policies

  • Boards of health have successfully enacted or supported tobacco control policies by:

    • Writing letters to state and local legislators

    • Passing local resolutions for the health agency

    • Working with city councils and county commissions to pass tobacco policies

    • Developing language for local smokefree air laws

    • Enforcing current laws in local restaurants, bars, and workplaces

    • Holding public hearings with community members


Role in sustaining tobacco control funding
Role in Sustaining Tobacco Control Funding Control Programs and Policies

  • The board of health has the decision to include or exclude tobacco use prevention and control funding from a health department’s operating budget

  • Informed board of health members can utilize information provided to them by health department staff to sustain local funding

  • Board of health members can take immediate action to sustain/increase tobacco control funding at the state level by voicing how the funding has positively affected their community


Participation in sustaining local tobacco control initiatives planning meetings
Participation in “Sustaining Local Tobacco Control Initiatives” Planning Meetings

  • NALBOH and NACCHO offer planning meetings for local tobacco control initiatives through a grant from CDC’s Office on Smoking and Health

  • Three (3) planning meetings were offered in the Spring/Summer 2009

    • Tobacco Free Collaborative-Columbus, OH

    • Smokefree Chattanooga-Chattanooga/Hamilton County, TN

    • Fairfield Department of Health-Fairfield County, OH


Sustaining local tobacco control initiatives planning meetings
“Sustaining Local Tobacco Control Initiatives” Planning Meetings

  • During these meetings, public health professionals including

    • board of health members

    • health department staff

    • state tobacco control program managers

    • hospital associates

    • other local coalition members

      gather to discuss local tobacco control funding issues and methods to overcome barriers

  • Work on action plans to energize local tobacco coalitions and obtain additional funding for local initiatives


  • Ways to get involved in future planning meetings
    Ways to Get Involved in Future Planning Meetings Meetings

    • NALBOH and NACCHO plan to offer four (4) additional planning meetings across the country in the Fall 2009-Spring 2010

    • Look for a Request for Proposals (RFP) to be released Summer 2009

    • Applications will require local leaders to be included in the meeting including board of health members and health department staff


    Working with local health departments indiana s story

    Working with Local Health Departments MeetingsIndiana’s Story

    Karla Sneegas, MPH

    Executive Director

    Indiana Tobacco Prevention & Cessation

    NCTOH

    Phoenix, AZ June 2009


    Indiana tobacco prevention and cessation state agency
    Indiana Tobacco Prevention and Cessation State Agency Meetings

    • ITPC was established by the Indiana General Assembly in 2000 and opened as an independent state agency in January 2001.

    • Our Vision is to:

      • Significantly improve health of Hoosiers

      • Reduce tobacco-related diseases

      • Reduce economic costs to Indiana


    Partnerships
    Partnerships Meetings

    • Indiana Tobacco Prevention and Cessation

    • Community Based Partnerships

    • Minority Based Partnerships

    • Statewide Partnerships


    Itpc s philosophy
    ITPC’s Philosophy Meetings

    • Science-based, evidence-based and data-driven

    • Change happens “inside” Hoosier Communities

    • Must reach people where they live, work, worship and play

    • Policy drives behavior change

    • Media drives attitude and belief change


    Itpc comprehensive tobacco control
    ITPC Meetings Comprehensive Tobacco Control

    • Community Based Programs

    • Cessation

    • Statewide Public Education

    • Evaluation

    • Administration and Management


    Itpc community and minority based partnerships 2008

    4 Statewide Priorities Meetings

    Reduce Youth Smoking

    Increase Adult Cessation

    Decrease Exposure to Secondhand Smoke

    Increase and Maintain the Infrastructure for Tobacco Control

    ITPC Community and Minority Based Partnerships-2008


    Community based strategy
    Community-Based Strategy Meetings

    • Community Determines Grant Lead Agency

      • Health Departments

      • Hospitals

      • Boys & Girls Clubs

      • YMCA

      • Economic Development Corporations

      • Local Government

      • Local Community Organizations 501-c-3


    Community based strategy1
    Community-Based Strategy Meetings

    • Partners Apply Every 2 Years for Grant

    • 15 Community Indicators for Local Workplans

    • Contract Deliverables for Selected Indicators

    • Coalition Driven (Over 2400 Local Organizations Involved Statewide)

    • Quarterly Reporting


    How Can Meetings

    Tobacco Control

    Help

    Local Health Departments?



    Accreditation
    Accreditation Meetings

    • Protect people from health problems and health hazards (Essential Service #2)

    • Engage the community to identify and solve health problems (Essential Service #4)

    • Develop public health policies and plans (Essential Service #6)

    • Enforce public health laws and regulations (Essential Service #7)

    • Help people receive health services (Essential Service #8)


    National health reform
    National Health Reform Meetings

    • Where does tobacco control fit into health reform?

      • Clinical interventions by health care providers

      • Community interventions by community health providers

      • Hospital interventions

      • Policy interventions that mean prevention (cost savings)


    H1N1 Meetings



    For more information on itpc
    For More Information on ITPC Meetings

    Visit our three (3) websites:

    www.itpc.in.gov

    www.whitelies.tv

    www.voice.tv

    Contact Indiana Tobacco Prevention and Cessation- 317.234.1787

    [email protected]


    Local experiences in tobacco use prevention and control

    Local Experiences in Tobacco Use Prevention and Control Meetings

    Jen Morel, MPH, CHES

    Columbus Public Health

    Columbus, Ohio


    Franklin county tobacco free collaborative tfc
    Franklin County Tobacco Free Collaborative (TFC) Meetings

    • Established in 1997

    • Approximately 80 community partners

      • Large grassroots network

    • Coalition structure and initiatives guided by a steering committee

      • Health Departments in Franklin County

      • American Heart Association, American Cancer Society, American Lung Association

      • Nationwide Children’s Hospital

    • Steering committee agencies rotate TFC leadership


    Franklin county links to ohio department of health tobacco prevention initiatives
    Franklin County Links to Ohio Department of Health Tobacco Prevention Initiatives

    • Ohio Tobacco Control and Resource Group

      • TFC member was a past chair

    • Ohio Youth Tobacco Survey

      • Local health departments assist ODH to administer survey in schools every two years

    • Ohio Tobacco Use Prevention and Cessation Strategic Plan

      • TFC initiatives parallel state strategic plan


    Tfc initiatives

    Youth initiatives Prevention Initiatives

    100% Tobacco Free School Districts

    Counter Tobacco Industry Influence

    ETS initiatives

    Smoke Free Housing

    Cessation

    Promote cessation resources

    5As training for school nurses

    Policy

    SmokeFree Ohio

    Other Tobacco Products Tax Equalization

    Educate new state legislators about tobacco issues

    TFC Initiatives


    Local planning meeting
    Local Planning Meeting Prevention Initiatives

    • 10 coalition partners attended

    • Identified 2 major needs for the coalition

      • Fund a full time coordinator

      • Increase capacity of membership to work on TFC initiatives


    Tobacco prevention best practice columbus clean indoor air ordinance
    Tobacco Prevention Best Practice- Prevention InitiativesColumbus Clean Indoor Air Ordinance

    • Smoke free legislation overturned in 1992

    • TFC and partners educated decision makers and the public about the health impact of secondhand smoke in 2004 and passed one of the strongest Smokefree ordinances in the nation for an urban city.

      • Legislation withstood two ballot initiatives which threatened to weaken it.

      • Neighboring suburbs began to follow Columbus’ lead and passed similar smoke free ordinances.


    Tobacco prevention best practice columbus clean indoor air ordinance1
    Tobacco Prevention Best Practice- Prevention InitiativesColumbus Clean Indoor Air Ordinance

    • In 2006, the momentum of so many centrally located communities enacting smoke free laws contributed to the grassroots campaign for SmokeFree Ohio.

    • Passed in 2006 with majority support of voters in 72 of 88 Ohio counties (approximately 2.2 million people).

    • Prohibits the smoking and burning of tobacco in enclosed public spaces and places of employment

    • Grassroots effort


    Tobacco prevention best practice quit for good project ofg 2003 2008
    Tobacco Prevention Best Practice- Prevention InitiativesQuit for Good Project (OFG) 2003-2008

    • Free smoking cessation utilizing the Mayo Clinic model of nicotine dependence treatment.

      • 7,000 clients (2003-2008). 57% reported quitting successfully

    • Columbus Public Health (CPH)-1of 16 QFG sites in Central Ohio

      • Reached 500+ Perinatal Clinic clients, staff and visitor, and 4800 new mothers through the Help Me Grow Welcome Home well baby visits provided by Columbus Public Health Nurses

    • Trained over 1,000 health care professionals according to tobacco cessation guidelines since 2002.


    Tobacco prevention best practice local stand teams
    Tobacco Prevention Best Practice- Prevention InitiativesLocal stand Teams

    • African American Peer Leadership Alliance Against Tobacco control voice for African American youth in Franklin County since 2002

    • Implemented stand model- social marketing campaign encouraging youth to counter the tobacco industry’ influence on youth- former Tobacco Use Prevention Foundation program.

      • Social movement that enables youth to “stand up, speak out against tobacco.”

    • African American Peer Leadership Alliance Against Tobacco continues their tobacco prevention efforts in inner city Columbus neighborhoods despite loss of funding from the Ohio Tobacco Prevention Foundation


    Tobacco prevention best practice local stand teams1
    Tobacco Prevention Best Practice- Prevention InitiativesLocal stand Teams

    • APLAT activities include:

      • completed over 1500 passive and punitive tobacco compliance checks

      • changed public attitudes about youth tobacco use through billboard campaigns, service learning and community outreach projects

      • set an example of tobacco prevention initiatives for other Franklin County stand teams

      • Incorporated tobacco prevention messages into step-team performances, poetry slams, talent shows, pledge campaigns, and peer leadership trainings


    Contact information1
    Contact Information Prevention Initiatives


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