The California Tobacco Control Program: A Model for Change

1. c The California Tobacco Control Program: A Model for Change TOBACCO CONTROL SECTION California Department of Health Services March 2001

2. Comprehensive Funding Evaluation 61 Local Health Departments State Administration Statewide Advertising and Publications Community Grants

3. Goal= change social norm Outcome = prevention & cessation

4. Denormalization Strategy Lasting change in youth behavior regarding tobacco can only be secured by first changing the adult world in which youth grow up.

5. Strategy to Reduce Tobacco Use in California Reduce Exposure to ETS and Tolerance to Exposure Decreased Tobacco Consumption Decreased Tobacco Use Prevalence Counter Pro-Tobacco Influences Decrease Youth Uptake of Tobacco Reduce Access to Tobacco from Retail & Social Sources Decreased Exposure to ETS Provide Cessation Services

6. DHS Tobacco Control Program Statewide Evaluation Statewide Media Campaign 4 Ethnic Networks 11 Regions 61 Health DepartmentCoalitions 83 Competitive Grantees Training/ TA CDC Clearing-house Legacy Quitline STAKE

7. Local Programs

8. Statewide Projects Direct Service Providers Impact Leaders and Institutions • Quitline • Clearinghouse • Tobacco Industry Sleuthing Project • Youth Advocacy Network • Entertainment Industry Campaign • Key Opinion Leader Project • Divestment Project • Labor Project • Ethnic Networks Training/TA Providers • Technical Assistance Legal Center • Media/PR Technical Assistance • BREATH (Smoke-free Bar Project)

9. Provides intensive telephone cessation counseling to adults and teens • Provides self-help kits and referral services • Serves approximately 3500 new clients per month and 1200 new clients counseled monthly • 26.7% success rate at one year f/u

10. Educational materials distribution • Educational materials development • Library services • Maintain web sites • Technical assistance • Serve 170 Contractors &1000 School Districts

11. Technical Assistance Legal Center • Provides California communities with free technical assistance on legal issues related to drafting and passing tobacco control policies • Provides high quality legal analyses to city attorneys, county counsels, elected officials and project directors

12. TCS Workgroups Secondhand Smoke Point-of-Sale Practices Project SMART Money Chew/Dip, Cigars & Alternative Tobacco Gardening experts….

13. Statewide Campaigns • Operation Storefront • Project SMART Money • Communities of Excellence

14. The Media Campaign

15. Mature Campaign Apathy Awareness Contentment Concern The Cycle Of A Social Issue Expectation Attitudinal Shift Social Norm Social Expectation Action/ Legislation

16. Strategies That Work • Secondhand Smoke • Educate people about the hazards, and they will take action to protect themselves • Turns public apathy into action • Gives non-smokers a voice • Cessation is an outcome--people quit to protect their families

17. Strategies That Work • Countering Pro-Tobacco Influences • Causes people to question industry motives and rallies smokers & non-smokers alike • Youth & adults rebel against industry manipulation • Supports local policy activities

18. Youth Strategic Learning Strategies that DID Motivate • “Tobacco Industry Manipulation” • Nicotine Addiction • “Secondhand smoke is more dangerous than you think” • Impactful personal stories

19. Youth Strategic Learning Strategies that DIDN’T Motivate • Long-term health effects • Short-term health effects • Short-term cosmetics effects • Romantic rejection • Smoking isn’t cool

20. Evaluation and Surveillance The Law We Live or Die By “If health education and prevention can’t show it’s effective, it doesn’t deserve the money.”

21. California and US cigarette consumption, packs per fiscal year, 80/81 - 98/99 Packs/Person US CA 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.

22. California vs. U.S. Adult Smoking Prevalence * Tax Increase and Start of the CA Tobacco Control Program * Definition change in 1996 resulted in more “occasional smokers” being counted. Sources: United States--NHIS, US Centers for Disease Control and Prevention California--CTS, 1990, 1992-3, 1996, weighted to 1990 CA population; CATS/BRFS, 1994-1998, weighted to 1990 CA population. Prepared by: California Department of Health Services, Tobacco Control Section, May 24, 2000.

23. 30-day smoking prevalence among California youth using a telephone survey, 1994-1999 Percent Source: CYTS 1994-1999. Prepared by: Tobacco Control Section, California Department of Health Services, June 2000.

24. 1999 Youth Smoking PrevalenceSubstance Abuse and Mental Health Services Administration (SAMHSA) 23.9 15.1 11.5 10.3 9

25. Cumulative Number of Cities with Smoke-Free Provisions in Ordinance California 1989-1995

26. Protection From Environmental Tobacco Smoke In The Workplace Percentage of workers protected CTS, 1998

27. Smokers with Children Under 18 Who Prohibit Smoking in Their Household

28. Relation Between Policy and Cigarette Consumption Daily Cigarette Consumption and Smoking Bans Cigarettes/Day Source: CTS 1999

29. Percent of Retailers Selling Tobacco to Youth1994-2000 Percent Attempted buy protocol 1994-1996; Actual buy protocol 1997-2000. Due to different methodologies 1994 survey results may not be comparable to the 1995-2000 results. Source: California Youth Purchase Survey, 1994-2000. Prepared by: California Department of Health Services, Tobacco Control Section, September 2000.

30. Lung and Bronchus Age-Adjusted Cancer Rates, 1988-1996 Rate per 100,000 EAPC = -0.6 1 2 EAPC = -2.3* 1United States (Surveillance, Epidemiology, End Results [SEER]) includes the following registries Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, and Atlanta. San Francisco-Oakland has been excluded. 2 California Cancer Registry, California Department of Health Services (11/99) * Estimated annual percent change (EAPC) is significantly different from zero (p<0.01)

31. Savings in Smoking Attributable Direct & Indirect Costs Billions $8.4 Billion $836 Million

32. Conclusions • A comprehensive program is most effective. • Media and local programs must be coordinated and well funded. • If you want kids to not smoke, you have to get the adults to change their behavior. • Anti-industry and secondhand smoke strategies are effective. • Empower the communities to advocate. • Be culturally sensitive • Accountability is the key to success. • Provide strong leadership and allow program flexibility.