Best Practices for Tobacco Control: Funding, Programs, and Interventions

1. TM Best Practices—2007 Centers for Disease Control and Prevention Office on Smoking and Health Terry F. Pechacek, PhD Associate Director for Science Nicole A. Blair, MPH Health Scientist Mulligan II: Regional Meetings on 2007 Best Practice Recommendations Salt Lake City, UT January 12, 2008

2. Best Practices 1999 • Evidence-based • Provided: • A blueprint for program components • Funding formulas to implement them

3. Best Practices 1999 • Community Programs • Chronic Disease Programs • School Programs • Enforcement • Statewide Programs • Counter-Marketing • Cessation Programs • Surveillance and Evaluation • Administration and Management

4. Total Funding for State Programs(adjusted to July 2007 dollars) Best Practices released Source: Project ImpacTEEN; CDC/Office on Smoking and Health; Campaign for Tobacco Free Kids; Research Triangle Institute; University of Illinois at Chicago; University at Buffalo, State University of New York

5. Evidence Base .

6. 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.

7. Further Research Needed • We need to continue to look for more effective strategies and approaches • State and Community Interventions • The most effective community strategies • Integrating chronic disease and youth programs into the community • Continue policy research • Effective strategies to reach diverse communities

8. Further Research Needed • Health Communications • Health communication message testing • More efficient campaign structure • Efficacy of innovative technologies • Cessation • Effective and efficient quitline recruitment • Better counseling and pharmacologic interventions • Improved methods for ensuring cessation attempts include effective treatments

9. Updating Best Practices • States requested updated guidance • Cost of living has increased 30% • Evidence-based reviews of specific strategies • Broader range of state experience

10. Evaluation of Best Practices • States restructured programs around the recommended comprehensive format • Additional evidence indicates these programs are effective in decreasing: • consumption • youth prevalence • adult prevalence • Saint Louis University study provided rich feedback on how budget categories were modified and implemented

11. Expert Panel Meeting • December 6, 2006 • Reviewed funding models for estimating budget recommendations • Reviewed new data and state experience relevant to potential changes in update • Meeting summary available on OSH Web site: www.cdc.gov/tobacco

12. Best Practices 2007 • Funding formulas not revised • Funding estimates increasing by an average of 30% • Cost of living • Population • Smoking prevalence • School enrollment

13. 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

14. Best Practices 2007 • Provides recommended level of annual investment within the funding range • Factors in state-specific characteristics

15. 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

17. 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

18. State and Community Interventions • State-specific characteristics • Smoking prevalence • Proportion of the population at or below 200% of the poverty level • Number of local health departments/units • Average wage for staff to implement PH programs • Geographic size of the state

19. State Examples • Recommended Annual Investment: State and Community Interventions Florida: $4.35 per capita $78.6 million Virginia: $4.37 per capita $33.4 million N. Carolina: $4.84 per capita $42.9 million Kentucky: $5.50 per capita $23.1 million Alaska: $7.93 per capita $5.3 million

20. 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.

21. Designated Market Areas (DMAs) • Please insert map of nation

22. Designated Market Areas (DMAs) New York: 99% reach $3.42 per capita New Mexico: 86% reach $1.33 per capita

23. State Examples • Recommended Annual Investment: Health Communication Interventions New Mexico: $1.33 per capita $2.6 million Florida: $2.00 per capita $36.2 million New York: $3.42 per capita $66.1 million S. Carolina: $3.87 per capita $16.7 million Delaware: $3.90 per capita $3.3 million

24. 1-800-QUITNOW

25. Cessation Interventions • Current cost parameters include: • Updating 1999 cost parameters for health system changes and quitlines • State-specific characteristics • State population • Smoking prevalence

26. State Examples • Recommended Annual Investment: Cessation Interventions Utah: $2.04 per capita $5.2 million New York: $3.37 per capita $65.1 million Georgia: $3.46 per capita $32.4 million Oklahoma: $4.18 per capita $15.0 million Kentucky: $4.67 per capita $19.6 million

27. 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

28. Core Surveillance Systems • Behavioral Risk Factor Surveillance System • Youth Risk Behavior Surveillance System • Youth Tobacco Survey • Adult Tobacco Survey

29. 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

30. 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

31. State Examples • Total Recommended Annual Investment Utah: $9.23 per capita $23.6 million Florida: $11.66 per capita $210.9 million Alabama: $12.31 per capita $56.7 million New York: $13.15 per capita $254.3 million Delaware: $16.32 per capita $13.9 million

32. Each day in the United States: • The tobacco industry spends $36 million to market and promote its products • Almost 4,000 youth start smoking • Approximately 1,200 smokers die prematurely • The nation spends $260 million in direct medical costs related to smoking • The nation experiences $270 million in lost productivity due to premature death

33. IOM Recommendation “Each state should fund state tobacco control activities at the level recommended by CDC. A reasonable target for each State is in the range of $15 to $20 per capita, depending on the State’s population, demography, and prevalence of tobacco use.”

35. Ending the Tobacco Use Epidemic • The tobacco use epidemic can be stopped. • If states sustained their recommended level of funding for 5 years, there would be an estimated 5 million fewer smokers. • Hundreds of thousands of premature deaths would be prevented. • Longer-term investments would have even greater effects.

36. “Knowing is not enough; we must apply. Willing is not enough; we must do.” - Johann Wolfgang von Goethe

37. TM Best Practices—2007 Centers for Disease Control and Prevention Office on Smoking and Health Terry F. Pechacek, PhD Associate Director for Science Nicole A. Blair, MPH Health Scientist Florida Tobacco Education and Use Prevention Advisory Council Tallahassee, Florida January 14, 2008