NACCHO’s Tobacco Control Guidelines:

1. NACCHO’sTobacco Control Guidelines: Successful Use of the Recommendations presented by Dawn M. Dunn, MPH Program Administrator Santa Barbara County Public Health Dept.

2. PresentationOverview • Share successful use of CDC/ NACCHO’s Guidelines in Santa Barbara County. • Showcase results from local tobacco control efforts. • Discuss future implications of their use. • Respond to questions and answers.

3. The Challenge • Advocate to use local MSA funds for their intended purpose—health & tobacco control. • MSA funds can be used for any purpose. • Successfully compete against other high priority projects. • Address active opposition from the County Executive Officer.

4. The Process • Utilize the strength of the existing community tobacco control coalition. • Leadership and staff at Public Health Department join forces. • Learn from the experiences of others who had been successful. • Develop a strategy and an extended partnership.

5. The Community Coalition • The passage of Proposition 99 (the original CA tobacco tax) mandated the creation of a community coalition. • The CA Tobacco Control Program anticipated that a grass-roots community group would be needed. • A coalition, with its autonomy and diversity, can take actions that some agency representatives cannot. • Provides broad-based support.

6. The Tobacco Settlement Story • In 1998, the Master Settlement Agreement (MSA) was reached between 47 state’s Attorney Generals and the tobacco industry. • The MSA paid billions of dollars to states to compensate for unreimbursed medical care for treating tobacco-related illnesses. • MSA payments are general funds dollars and may be allocated for any expenditure; they are not earmarked to fund health programs.

7. The Tobacco Settlement Story(continued) • California and New York are the only two states whose counties receive monies directly. • In SB County, approximately 4 million dollars is received annually.

8. Steps to Securing the $$ TIMING WAS CRITICAL TO OUR SUCCESS • Understood that the anti-tobacco coalition alone, would be insufficient to influence the Board. • Recruited for, and created an expanded coalition, known as the Health Partnership, with a diverse broad-base of support.

9. The Health Partnership • Santa Barbara County Medical Society • Local Hospitals • Santa Barbara Community Clinics • Santa Barbara League of Women Voters • Santa Maria League of Women Voters • CEASE (Coalition Engaged in a Smoke-Free Effort) • American Lung Association • American Cancer Society • American Heart Association • Santa Barbara Regional Health Authority • Santa Barbara City College

10. The Health Partnership(continued) • CEASE (Coalition Engaged in a Smoke-Free Effort) • Santa Barbara Council on Alcoholism and Drug Abuse • Tri-County Regional Team • UCSB-Student Health Services • Santa Barbara and Ventura County Dental Societies • SEIU 620 • Lompoc Valley Community Healthcare Council • Santa Maria Health Council • Human Services Association • Faith Initiative of Santa Barbara County • Latinos for Better Government

11. Steps to Securing the $$ (continued) • Planned strategies within the Health Department. • Secured unwavering commitment from the Public Health Director. • Learned from other counties’ experiences. • Conducted a teleconference with a county that had been successful in securing these funds. • Assessed allies and opponents. • Key opponents included the County Administrator & other county departments.

12. Steps to Securing the $$ (continued) • Framed the issue from our perspective: • Stuck to the intent of the lawsuit, knowing that selling the issue on the tobacco treatment and prevention platform was key to our success. • Educated on the benefits of prevention.. • Appealed to lawmakers’ emotions, not solely relying on the facts. • Understood that all change occurs in a political and social context.

13. And the Funding Goes to Tobacco & Health

14. Using NACCHO Guidelines • CDC “Best Practices for Comprehensive Tobacco Control Programs” released in 1997 • NACCHO Guidelines replace CDC Best Practices in 2001.

15. Using NACCHO Guidelines • Publications perfectly timed to be used to secure MSA funds. • Disseminated Best Practices to local elected officials. • Used NACCHO Best Practice recommendations to set tobacco control funding priorities. INVEST 25% of MSA $$ in TOBACCO CONTROL

16. Realities of Tobacco Use in Santa Barbara County

17. Using NACCHO Guidelines(continued) • The table on the previous slide shows the format used annually to ask for the funds. • A two-page needs paper was presented, with needs and program solutions. • Customized funding recommendations to local needs and program and community strengths. • Used the comprehensive approach to tobacco control established by CA TCP as a guide along with CDC/ NACCHO recommendations.

18. Using NACCHO Guidelines(continued) • School-based recommendations were not followed for several reasons. • Local schools networks and programs in tobacco prevention presented challenges. • Funding levels were insufficient to fully fund this aspect of the program. • Allowed agencies to apply for grant funds to do augment their services or activities. • Assisted with grant applications • Funded other CBO’s already working in the schools.

19. The Guidelines—Modified • Salaries and administrative costs have are above recommendations. • Considered to give monies to CBO to reduce costs, but community supports County playing this role. • Adjust programming as funding decreases. • Managing grantees has proved both rewarding and challenging. • Showing prevention program results is difficult. • Media and outreach activities are always under attack.

20. Local MSA Outcomes • Received one of the largest per capita allocation of tobacco settlement dollars. • Established an Advisory Committee to make funding recommendations to the Board. • Avoided a cumbersome RFP allocation process to award local MSA funds. • Created an endowment for 20% of the funds annually.

21. Funding Allocation Graph

22. Local MSA Outcomes (continued) • Helped over 3,000 people with their attempts to quit smoking. • Funded between 7-12 agencies/individuals to provide services. • Reimburse financially eligible clients’ for FDA-approved pharmaceuticals. • FY 07-08 quit rates were 51% at 3 months and 39% at 6 months.

23. Local MSA Outcomes (continued) • Provided outreach and education to over 10,000 youth and young adults annually. • Funded local CBO’s, the County Education Office, schools, colleges and the university. • These groups provided prevention, cessation, and evaluation activities. • Funded enforcement efforts. • Increased compliance with smoke-free bar law • Decreased sales to minors from 38% to 11%

24. Local MSA Outcomes (continued) • Developed and placed numerous local media campaigns: • Aimed at young adult tobacco use • Reducing cigarette butt litter • Promoting specific cessation services and creating a positive climate for quitting. • Campaign recall rates at 53%, with 63% stating that the campaign would affect their behavior.

28. Next Steps—Rough Road Ahead • Program funding levels cut from 25% to 15% over the years, with more cuts anticipated. • County costs continue to escalate. • Specific shortfalls in other critical programs threaten continued tobacco control funding. • Political will and climate, coupled with the dismantling of the TSAC Advisory Committee, make future funding tentative at best.

29. Best Practices and Data Needed • Best practices and data to prove that tobacco control works, assist local programs in making their case for comprehensive programs!