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Statewide Strategic Plan for Tobacco Prevention. New Directions for 2009-2013. Background. Background. Background. Economic Cost. In 1998/1999, Texas Smoking-Attributable Costs = $10.09 billion Direct Medical expenditures - $4.55 billion Lost Productivity costs - $5.54 billion

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economic cost
Economic Cost
  • In 1998/1999, Texas Smoking-Attributable Costs = $10.09 billion
    • Direct Medical expenditures - $4.55 billion
    • Lost Productivity costs - $5.54 billion
  • In 1998, about 15% ($1,265,000,000 or $543.87 per recipient) of all Texas Medicaid expenditures were spent on smoking-related illnesses and diseases. (includes state and federal contributions to Medicaid)
tobacco industry expenditures
Tobacco Industry Expenditures
  • In 2005 the tobacco industry spent $13.36 billion on advertising and promotion in the U.S. (more than $36.6 million per day)
  • Approximately $884.7 million was spent in Texas in 2005 (over $2.4 million every single day)
texas tobacco settlement
Texas Tobacco Settlement
  • 1998 - Texas became the 3rd state to settle with the tobacco industry
  • Settlement represented compensation for the state’s cost of tobacco-related disease
  • Texas to receive $17.3 billion over 25+ years
fy 00 01
FY 00 -01
  • $1.8 billion available from the settlement in FY 00-01
  • Texas Department of Health appropriated the interest from a $200 million endowment ($9 million) per year to implement programs to reduce the use of tobacco products
  • Special attention to populations targeted by the tobacco industry
texas tobacco task force report program elements and best practices
Texas Tobacco Task Force ReportProgram Elements and Best Practices
  • Community & School Programs
  • Media Campaigns
  • Cessation
  • Enforcement
  • Efforts Targeted to Diverse/Special Populations
  • Surveillance & Evaluation Research
initial pilot results summary
Initial Pilot Results (Summary)
  • Areas with expenditures of $3 per capita, supporting high level media campaigns and combined community programs for prevention and cessation produced significant reduction in tobacco use
    • 40% reduction in 6th and 7th grade tobacco use
    • Significant increases in teen and adult cessation
    • Significant reductions in tobacco consumption
  • Lower level media campaigns and single focus community programs did not have measurable effects on tobacco use among children and adults (there is no magic bullet)
latest results
Latest Results
  • From 2000 to 2006, current use of any tobacco products in the comprehensive program area showed a 42% reduction among middle school students (from 24.8% to 14.3%) and a 36% reduction among high school students (from 40.7% to 26.2%)
  • The prevalence of adult smoking in the comprehensive program area decreased 26.4% (from 21.6% in 2000 to 15.9% in 2004)
smoking rates for harris jefferson counties 2000 2005
Smoking Rates for Harris & Jefferson Counties 2000-2005

Reducing tobacco use requires a comprehensive & sustained approach. Gains in Harris County regressed as resources/efforts were reduced.

health impact
Health Impact

Heart Attack Deaths Decline 3 Times Faster in County with Anti-Tobacco Campaign

recent developments
Recent Developments
  • Increase in the state cigarette tax to $1.41 per pack
  • Increased compliance with youth tobacco laws (7.2% Synar buy rate for 2006)
  • Increased number of local secondhand smoke ordinances across state
  • Statewide smoking ban proposed (but not passed)
  • 2006 U.S. Surgeon General’s report on involuntary exposure to secondhand smoke
new direction from the 80 th legislature
New Direction From the 80th Legislature
  • Create competitive statewide grant program allowing health departments and school districts in communities statewide to apply for funds.
  • Dedicate $3 million in tobacco settlement funds to the Texas Education Agency for tobacco education in schools statewide.
  • Dedicate $1 million for smokeless tobacco prevention in rural communities.
  • Produce resource list identifying best practice and evidence-based interventions for use by organizations receiving state appropriated funds.
new direction
New Direction
  • DSHS and grantees must use only best practice or evidence-based tobacco prevention, cessation, and enforcement interventions.
  • DSHS or its contractor must notify Comptroller’s tobacco law enforcement grantees and local sheriff’s departments in writing when Synar violations occur during the annual survey.
  • DSHS must prepare a report on the progress of the program to the legislature.
synar requirements
Synar Requirements
  • An agreement to continue to have in effect a State law that makes it unlawful for any manufacturer, retailer or distributor of tobacco products to sell or distribute any such product to any individual under the age of 18; and to enforce such laws in a manner that can reasonably be expected to reduce the extent to which tobacco products are available to individuals under the age of 18.
synar partners
Synar Partners
  • Texas Department of State Health Services (DSHS)
    • Substance Abuse Prevention
    • Tobacco Prevention and Control Program
  • Comptroller of Public Accounts
  • Office of the Attorney General
  • Texas State University
    • Center for Safe Communities and Schools (CSCS)
    • Texas Statewide Tobacco Education and Prevention (TX STEP)
synar enforcement
Synar Enforcement
  • Comptroller of Public Accounts
    • Responsibility for the Law
      • Senate Bill 55: September 1, 1997
      • Texas Health and Safety Code Chapter 161
        • Subchapters H, K, N, O
      • Texas Tobacco Tax Code Chapter 154, 155
  • Grants to Local Communities
    • Local Law Enforcement (approx 100/yr)
    • School District Police (approx. 100/yr.)
synar enforcement1
Synar Enforcement
  • Office of the Attorney General
    • Consumer Protection and Public Health Division
    • Authority under the Texas Deceptive Trade Practices - Consumer Protection Act, Tex. Bus. & Com. Code Ann
    • Settlements: Voluntary Compliance:
      • Conoco Philips Company
      • E-Commerce Today, Ltd
      • The Walgreen Company
      • Exxon Mobil
      • BP Amoco
synar contractors
Synar Contractors
  • Texas State University – San Marcos
  • Center for Safe Communities and Schools
    • Synar Survey
    • Training
  • Texas STEP
    • Oversight of Comptroller grantees
    • Law Enforcement Training
synar retailer violation rates
Synar Retailer Violation Rates
  • Minors Access to Tobacco
    • 1995 – 53%
    • 1996 – 56%
    • 1997 – 24% (Texas law effective 9/1/97)
    • 1998 – 13%
    • 1999 – 14.6%
    • 2000 – 13.4%
    • 2001 – 12.9%
    • 2002 – 15.66%
    • 2003 – 23.8%
    • 2004 - 15.5%
    • 2005 - 12.4%
    • 2006 – 7.2%
synar survey
Synar Survey
  • To determine the retailer violation rate (or retailer noncompliance rate) for each State based on random, unannounced inspections of a sample of tobacco outlets accessible to youth
  • The sample inspected must be representative of the geographic distribution of statewide tobacco outlets
  • Results of the survey will be used to determine whether the State has met the interim target rate
  • Retailer violation rates obtained over years will help assess the State’s progress toward achieving the Synar goal of a violation rate of 20% or less
tobacco outlet inspection survey
Tobacco Outlet Inspection Survey
  • Using minors (ages 15-17) to conduct inspections of tobacco outlets within survey areas. Recruitment and selection of minors are demographically matched for the area being inspected
  • Training and technical assistance for local law enforcement and community members are provided
  • Inspection timeline is June-July of each year
  • Weights are used for the retailer violation rate estimates to reflect the statewide outlet populations
sampling frame
Sampling Frame
  • A list sampling frame of OTC tobacco outlets is used for Texas Synar survey
  • Texas Comptroller of Public Accounts (CPA) provides statewide database of licensed tobacco retailers:
    • License renewed every two years (even year)
    • Coverage study in 2007 to determine if sampling frame is accurate in terms of actually selling tobacco products and/or accurate address
sampling methodology
Sampling Methodology
  • Over 26,600 tobacco outlets across 254 counties in Texas are eligible for 2005 survey sampling
  • Rationale of sampling:
    • Non-zero probability of selection to all outlets in the state
    • Spread the sample out both literally by geography and by demographic status
    • Use stratification and other efficiency measures to minimize any major increase in complexity and cost
  • A stratified two-stage cluster sampling design is developed
    • Stage I: selection of counties or Primary Sampling Units (PSUs)
    • Stage II: selection of outlets within each selected county
sampling methodology1
Sampling Methodology
  • PSUs are stratified according to the number of tobacco outlets by county. A total of 10 strata are formed:
    • Stratum A1-A7: counties with > 500 outlets (self-representing counties)
    • Stratum B: counties with 100-500 outlets
    • Stratum C: counties with 26-99 outlets
    • Stratum D: counties with < 26 outlets
  • Select six counties in stratum B, 4 counties in stratum C, and 2 counties in stratum D by systematic or PPS sampling
  • Sample size allocation across strata is based on proportional allocation method
19 sampled counties in 2007
19 Sampled Counties in 2007

Texas: 254 counties/PSU clusters

synar survey inspection protocols
Synar Survey Inspection Protocols
  • Synar Inspection Survey is conducted in a scientifically sound manner
  • Training of Synar inspectors (law enforcement officers) and youth inspectors ensures the same procedures and protocols are used to collect data
  • Protocol ensures changes in the buy rate over time or between counties are not due to extraneous factors
  • Youth inspectors - judged to younger than 18 years old
    • Equal number of male and female
    • Equal number of inspections
  • Minor asks for tobacco product
  • Minor doesn’t carry ID but tells the truth about their ageif asked
synar challenges
Synar Challenges
  • Size, diversity & location of Texas presents logistical challenge
  • Texas law does not penalize courts for not following through in processing Final Proceeding Report for disposition of violations/penalties
  • Staff shortages are an obstacle to departments’ tobacco enforcement programs
  • School Resource Officers (SRO’s) in the school/education environments are reluctant to write MIP tobacco citations
  • Language barrier is a major challenge in training retail employees in some areas
  • Financial resources to provide a comprehensive approach in Texas are lacking
strategic plan process
Strategic Plan Process
  • DSHS staff, partners and stakeholders met to assess program and develop future direction
  • Evaluated progress, areas for improvement and available resources
  • Drafted strategic plan for 2009-2013
  • Your input is encouraged
goal 1 prevent tobacco use among young people
Goal 1: Prevent Tobacco Use Among Young People
  • Educate young people & families about effects of tobacco use.
  • Increase compliance with tobacco laws and policies.
  • Support increased enforcement of minor access laws.
  • Decrease tobacco industry influence on youth.
  • Mobilize communities to prevent tobacco use.
  • Use evidence-based, culturally appropriate programs.
  • Evaluate changes in youth’s knowledge, skills and attitudes about tobacco use.
goal 2 promote compliance and enforcement of tobacco laws
Goal 2: Promote Compliance and Enforcement of Tobacco Laws
  • Educate communities on youth access laws, retailer regulations and local clean indoor air ordinances.
  • Support Comptroller and local law enforcement agencies in enforcement and compliance activities to reduce minors’ access to tobacco.
  • Increase number of law enforcement agencies actively enforcing tobacco laws.
  • Support enforcement and compliance activities to reduce public exposure to secondhand smoke.
goal 3 increase cessation
Goal 3: Increase Cessation
  • Educate youth and adults on benefits of quitting tobacco and resources for quitting.
  • Increase awareness, availability and access to cessation resources.
  • Increase number of health professionals who assess, counsel, refer and treat patients for cessation.
  • Increase social support for youth cessation.
goal 3 increase cessation1
Goal 3: Increase Cessation
  • Mobilize youth-serving organizations to promote tobacco cessation activities.
  • Work with Texas Medicaid/Medicare and Texas Department of Insurance for increased coverage for cessation services.
  • Implement evidence-based, culturally appropriate programs to increase tobacco cessation.
goal 4 eliminate exposure to secondhand smoke
Goal 4: Eliminate Exposure to Secondhand Smoke
  • Educate the public about the harmful effects of secondhand smoke and clean indoor air laws.
  • Educate health professionals to assess and counsel patients/clients about eliminating secondhand smoke exposure.
  • Increase enforcement and compliance with federal, state and local secondhand smoke laws.
  • Implement evidence-based, culturally appropriate programs to reduce exposure to secondhand smoke.
goal 5 reduce tobacco use among disparate populations
Goal 5: Reduce Tobacco Use Among Disparate Populations
  • Educate populations with the highest burden of tobacco-related health disparities about tobacco prevention, cessation, secondhand smoke hazards, and clean indoor air laws.
  • Increase awareness, availability and access to cessation resources among populations with tobacco-related health disparities.
  • Provide technical assistance for local organizations that serve populations having the highest burden of tobacco-related health disparities.
goal 5 reduce tobacco use among disparate populations1
Goal 5: Reduce Tobacco Use Among Disparate Populations
  • Mobilize key stakeholders to develop partnerships to promote elimination of tobacco-related health disparities.
  • Enhance data systems to capture information on priority populations.
  • Identify populations with the greatest burden of tobacco-related health disparities.
goal 6 develop and maintain statewide infrastructure
Goal 6: Develop and Maintain Statewide Infrastructure
  • Build and sustain state, regional and local capacity for effective tobacco prevention and control initiatives.
  • Maximize capacity by integrating with the state’s substance abuse prevention services delivery system.
  • Identify and distribute information about evidence-based tobacco prevention and control activities, resources and opportunities.
  • Provide training and technical assistance to communities on programs that build local tobacco control infrastructure.
goal 6 develop and maintain statewide infrastructure1
Goal 6: Develop and Maintain Statewide Infrastructure
  • Use research findings to plan and implement effective initiatives.
  • Maintain and enhance surveillance of tobacco use among youth and young adults, adults and high-risk populations.
  • Use evaluation findings to modify programs.
  • Evaluate use of the statewide strategic plan.
contact information
Contact Information

Joe Vesowate

Assistant Commissioner

Division for Mental Health and

Substance Abuse Services

(512) 206-5797

Phil Huang, MD, MPH

Medical Director, Chronic Disease Prevention Branch

Division of Prevention and Preparedness

(512) 419-2290