June 10, 2009-National Conference on Tobacco or Health: Phoenix, AZ Deborah Houston McCall-CDCs Office on Smoking and Health Julie Nelson Ingoglia-National.

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

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

Overview

Overview

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

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Best Practices—2007

Centers for Disease Control and Prevention

Office on Smoking and Health

Deborah Houston McCall, MSPHNACCHO and NALBOH Project Officer(770) 488-1182 [email protected]

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State Investment in Tobacco Control

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.

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State Investment in Tobacco Control

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 have saved between 4,585 and 11,413 lives….

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

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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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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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Core Surveillance Systems

Behavioral Risk Factor

Surveillance System

Youth Risk Behavior

Surveillance System

Youth Tobacco Survey

Adult Tobacco Survey

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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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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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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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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”

The National Connection for Local Public Health

Implementing and Sustaining Effective Local Tobacco Control Programs

Julie Nelson Ingoglia, MPHNational Association of County and

City Health Officials (NACCHO)

Wednesday, June 10, 2009National Conference on Tobacco or Health

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

Wednesday, June 10, 2009National Conference on Tobacco or Health

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

Wednesday, June 10, 2009National Conference on Tobacco or Health

Local Health Department Role – Fulfilling Accreditation Domains with Tobacco Control ActivitiesProtect 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.

Wednesday, June 10, 2009National Conference on Tobacco or Health

Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs (Guidelines)

Wednesday, June 10, 2009National Conference on Tobacco or Health

Local Activities and Successes

Community and School Activities•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%)

Wednesday, June 10, 2009National Conference on Tobacco or Health

Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs (Guidelines)

Wednesday, June 10, 2009National Conference on Tobacco or Health

Contact Information

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 POLICIESTricia Valasek, MPHProject Director-Tobacco Use Prevention and Control

Board of Health Description

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

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

Boards of Health Health Departments

Board of Health Roles in Tobacco Use Prevention and Control 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

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 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 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 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 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

Karla Sneegas, MPHExecutive Director

Indiana Tobacco Prevention & CessationNCTOH

Phoenix, AZ June 2009

Indiana Tobacco Prevention Indiana Tobacco Prevention and Cessation State Agencyand Cessation State Agency

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

PartnershipsPartnerships Indiana Tobacco Prevention and CessationIndiana Tobacco Prevention and Cessation Community Based PartnershipsCommunity Based Partnerships Minority Based PartnershipsMinority Based Partnerships Statewide PartnershipsStatewide Partnerships

ITPC’s PhilosophyITPC’s Philosophy

Science-based, evidence-based and data-driven

Change happens “inside” Hoosier Change happens “inside” Hoosier CommunitiesCommunities

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

Policy drives behavior changePolicy drives behavior change Media drives attitude and belief changeMedia drives attitude and belief change

ITPCITPC Comprehensive Tobacco Comprehensive Tobacco

ControlControl1.1. Community Community

Based ProgramsBased Programs

2.2. CessationCessation

3.3. Statewide Public Statewide Public EducationEducation

4.4. EvaluationEvaluation

5.5. Administration Administration and and ManagementManagement

ITPC Community and ITPC Community and Minority Based Minority Based

Partnerships-2008Partnerships-2008 4 Statewide Priorities

Reduce Youth Smoking

Increase Adult Cessation

Decrease Exposure to Secondhand Smoke

Increase and Maintain the Infrastructure for Tobacco Control

Community-Based Strategy

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 Strategy

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 CanHow Can

Tobacco ControlTobacco Control

HelpHelp

Local Health Local Health Departments?Departments?

Stronger Webs…Together

AccreditationAccreditation Protect people from health problems and Protect people from health problems and

health hazards health hazards (Essential Service #2)(Essential Service #2) Engage the community to identify and Engage the community to identify and

solve health problems solve health problems (Essential Service #4)(Essential Service #4) Develop public health policies and plans Develop public health policies and plans

(Essential Service #6)(Essential Service #6) Enforce public health laws and regulations Enforce public health laws and regulations

(Essential Service #7)(Essential Service #7) Help people receive health services Help people receive health services

(Essential Service #8)(Essential Service #8)

National Health ReformNational Health Reform

Where does tobacco control fit into Where does tobacco control fit into health reform?health reform? Clinical interventions by health care Clinical interventions by health care

providersproviders Community interventions by community Community interventions by community

health providershealth providers Hospital interventionsHospital interventions Policy interventions that mean Policy interventions that mean

prevention (cost savings) prevention (cost savings)

H1N1H1N1

Dr. Judy Monroe IN State Health Commissioner

For More Information on For More Information on ITPCITPC

Visit our three (3) websites:Visit our three (3) websites: www.itpc.in.gov www.whitelies.tv www.voice.tv

Contact Indiana Tobacco Prevention Contact Indiana Tobacco Prevention and Cessation- 317.234.1787and Cessation- 317.234.1787

[email protected]@itpc.in.gov

Local Experiences in Local Experiences in Tobacco Use Tobacco Use

Prevention and Prevention and ControlControl

Jen Morel, MPH, CHES

Columbus Public Health

Columbus, Ohio

Franklin County Tobacco Free Collaborative (TFC)

• Established in 1997

• Approximately 80 community partnerso Large grassroots network

• Coalition structure and initiatives guided by a steering committeeo Health Departments in Franklin Countyo American Heart Association, American Cancer Society,

American Lung Associationo Nationwide Children’s Hospital

• Steering committee agencies rotate TFC leadership

Franklin County Links to Ohio Department of Health Tobacco Prevention Initiatives

• Ohio Tobacco Control and Resource Groupo TFC member was a past chair

• Ohio Youth Tobacco Surveyo Local health departments assist ODH to administer survey in

schools every two years

• Ohio Tobacco Use Prevention and Cessation Strategic Plano TFC initiatives parallel state strategic plan

TFC Initiatives

• Youth initiativeso 100% Tobacco Free School

Districts

o Counter Tobacco Industry Influence

• ETS initiativeso Smoke Free Housing

• Cessationo Promote cessation

resourceso 5As training for school

nurses• Policy

o SmokeFree Ohio

o Other Tobacco Products Tax Equalization

o Educate new state legislators about tobacco issues

Local Planning Meeting

• 10 coalition partners attended

• Identified 2 major needs for the coalitiono Fund a full time coordinator

o Increase capacity of membership to work on TFC initiatives

Tobacco Prevention Best Practice- Columbus 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.o Legislation withstood two ballot initiatives which threatened to

weaken it.

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

Tobacco Prevention Best Practice- Columbus 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

• Free smoking cessation utilizing the Mayo Clinic model of nicotine dependence treatment.o 7,000 clients (2003-2008). 57% reported quitting successfully

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

• 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.o 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 Teams

• APLAT activities include:o completed over 1500 passive and punitive tobacco compliance

checks

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

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

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

Contact Information