National Tobacco Control Conference Training Session

1. National Tobacco Control Conference Training Session Presented by TTAC November 19, 2002

2. Today’s Objectives • Describe TTAC training program for new employees and grantees • Increase participants’ tobacco control knowledge to implement training programs in their state/ local organizations • Identify areas for technical assistance

3. Introduction Dearell Niemeyer Director, Tobacco Technical Assistance Consortium

4. The Tobacco Technical Assistance Consortium What is TTAC? What Does It Do?

5. What is TTAC? • Unique not-for-profit organization • National in scope • Neutral in stance • Flexible in approach

6. TTAC History • Est. 2001 to provide state and local organizations with the necessary knowledge, abilities, tools and skills to succeed in reducing harm caused by tobacco • Grant from the American Cancer Society, the American Legacy Foundation, and the Robert Wood Johnson Foundation • Located in the Rollins School of Public Health at Emory University

7. TTAC Mission Build capacity to achieve effective tobacco prevention and control programs and policies

8. TTAC Vision Provide national leadership in technical assistance to strengthen community tobacco control programs

9. TTAC Services • Provide training and technical assistance to state and local tobacco control programs and coalitions • Maintain a cadre of skilled consultants available for on-site technical assistance • Provide telephone consultation; • Improve coordination of technical assistance among partner organizations

10. Guiding Principles • Our environment reflects • Creativity • Inclusivity • Innovation • Continuous learning • Celebration of achievements

11. Guiding Principles (Cont’d) • Our work is carried out openly, with a shared sense of : • Urgency • Spirit of respect, collaboration and trust • Enthusiasm • Commitment to public health principles and the highest ethical standards

12. Philosophical Approach • TTAC provides training and technical assistance to: • Increase knowledge and skills • Foster strong leadership • Increase organizational support • Strengthen partnerships • The essence is capacity building

13. Partners • CDC • SmokeLess States • Campaign for Tobacco-Free Kids • Latino Council on Alcohol and Tobacco • National African American Tobacco Prevention Network • American Indian/Alaska Native support centers • Spaces available!!!

14. TTAC Assistance • Technical assistance (eg, consultation, reviews) • Information resources (especially web-based) • Training support (planning, training activities, evaluation)

15. TTAC Provides Assistance On… • Program development and implementation • Best practices and evidence-based interventions • Program evaluation • Cultural competence, diversity and inclusiveness • Strategic planning • Coalition building

16. TTAC Provides Assistance On… • Long-term communication planning • Advocacy development • White Papers and legal research • Resource identification • Policy development and advocacy training

17. How Does Assistance Occur? • Request is submitted via email, phone, or letter • TTAC staff responds and triages request • Technical assistance process begins, through partners or through consultants • Work begins on activities • Project/activities end • TTAC receives report from consultant(s) • TTAC evaluates process and outcomes

18. Where You Come In • Refer grantees or partners to us for assistance • Refer possible consultants and experts to us to provide assistance • Let us know what assistance you currently provide, and how we can complement your efforts

19. Contact TTAC • Phone: 404-712-8474 • Email: ttac@sph.emory.edu • Via the web: www.ttac.org

20. Basics of Tobacco Control What is BOTC? What Does It Do?

21. Basics of Tobacco Control • What is it? • Tobacco control training program • Introduction to background issues

22. Web-Based Needs Assessment Response Rate 63.6%, N=35

23. Technology Is Available, Though Underutilized States Grantees

24. CD-ROM is the Biggest Opportunity

25. Purpose of BOTC • Provide individualized training in a flexible format • Address specific issues of tobacco control in priority populations • Provide comprehensive resources in one location • Standardize tobacco control training for new employees to tobacco control • Grantees • Community level • State level

26. BOTC Content Introduction Terms Evolution MSA Partners FoundationSocial change Population Based Advocacy Goals/objectives Science Documents Hazards Prevalence Industry Resources Glossary Documents Links Evaluation Assessment Usability

27. Comprehensive and Accessible • BOTC simplifies and integrates complex information • BOTC is practically focused • BOTC is user friendly • Multi-dimensional format • Minimum hardware requirements • Adjustable user features • Self assessment

28. Special Features • User control of training experience • Audio and video enhanced content • Practical examples from experts in the field • Pre-loaded with all necessary software • Assessment feedback

29. Session Overview Johanna M. Hinman, MPH, CHES Program Coordinator 

30. Session Overview • Tobacco Control Milestones • Translating the Science Into Practice • Making a Difference

31. Milestones in Tobacco Control Perry Stevens, MPA Consultant

32. Tobacco Control Timeline Relationship between cigarette smoking and diseases, including lung cancer established Industry CEOs formulate “an industry response” with a concerted “public relations campaign intended to preserve their profits” “A Frank Statement to Cigarette Smokers” refuted the findings of the scientific community and glorified the history of tobacco use in America Industry secretly engaged in the “Gentleman’s Agreement” • Companies to share discoveries re: a “safe cigarette” • No in-house biomedical research on animals 1945 1955

33. Tobacco Control Timeline 1958 Creation of the Tobacco Institute (a.k.a) “the open question” debate PM concluded that a “medically acceptable low-carcinogen cigarette may be possible” (but never releases the research) PM internally discussed methods for increasing the nicotine content of cigarettes B&W general counsel stated that “nicotine is addictive” and that “we are… in the business of selling nicotine, an addictive drug” 1963

34. Tobacco Control Timeline 1963 The Surgeon General prepared the first report on smoking and health; asks for cooperation of the Tobacco Companies, but it is withheld The Liggett Company joined the Tobacco Industry Research Committee and the Tobacco Institute Recommendation by PM R&D VP: “the industry should abandon its past reticence with respect to medical research. Indeed, failure to do such research could give rise to negligence charges.” 1964

35. Tobacco Control Timeline 1965 • Limited performance of biological research begun, but the Gentleman’s Agreement otherwise remained intact  • - Reynolds researched the mechanisms of emphysema using mice, nicknamed “The Mouse House” • - Reynolds dismantles and destroys all records after PM complains • PM purchased a research facility in Cologne, Germany (INBIFO)- Repository for information and files - To avoid discovery of adverse documents in times of litigation in the US 1970

36. Tobacco Control Timeline Study of smoke exposure on hamsters indicated that cigarettes were addictive and caused cancer; funding threatened by The Council for Tobacco Research (CTR) if published B&W memo discussed the addictiveness of nicotine, characterized nicotine as a poison, and noted consumer naivety PM internal memo re: the psychopharmacology of nicotine noted that company lawyers did not want the research to become public because it would support regulation by the FDA Philip Morris studied the effects of nicotine on the behavior of rats to research potential nicotine analogues; found “nicotine looked like heroin” 1970 1984

37. Tobacco Control Timeline 1988 U.S. Surgeon General reports: “… tobacco addiction…similar to …heroin and cocaine” Dramatic rise in teenage smoking after Reynolds begins a massive dissemination of “Joe Camel”, which was designed to counter the “Marlboro Man” Reynolds instructed its advertising agency to destroy documents in their possession related to the “Joe Camel” campaign to avoid full disclosures of its practices Tobacco CEOs testified under oath before the Congressional Health Subcommittee that nicotine was not addictive 1994

38. Tobacco Control Timeline 1995 “The Tobacco Whistleblower” provides State of Mississippi Tobacco Litigation landmark testimony regarding the attempts of the tobacco industry to deceive, manipulate and evade the public Tobacco companies entered into a “Master Settlement Agreement” with 46 State Attorney Generals in an effort to achieve a “significant reduction in youth tobacco use” TTAC Est. 2002

39. Science into Practice: Making the Most Out of the Work of Others Kathleen R. Miner, Ph.D., MPH, CHES Associate Dean for Applied Public Health

40. Universities are full of knowledge; the incoming students bring in a little and the graduates take none away, thus knowledge accumulates. Adapted from: Abbott Lawrence Lowell

41. Challenges to Decision Making in Public Health • Lack of alternatives: funding/regulatory restrictions • Decision paralysis: analyzing minutiae • International competition: organizational caps (FTEs, % increases or decreases) • Impatience: solving the wrong problem • Involving the wrong people: we make the decisions, they do the work • Data doubting: questioning the credibility of data to avoid making the decision

42. “A great many people think that they are thinking when they are merely rearranging their prejudices.” William James

43. Sources of Credible Evidence • Program surveillance data • Information management • Products • Fiscal expenditures • Qualitative data • Stakeholder impressions • Social evidence • Quantitative data Population health status Behavior change Economic indicators Defensible instrumentation Theory Defensible methodology Plausible linkages

44. “If the world was a logical place, it would be men that ride side saddle” Rita Mae Brown

45. Role of Theory Theory provides: • provides context to evidence • links one type of evidence to another type • connects the dots among similar programs • extrapolates short change to longer term change • encourages the feedback from practice to theory.

46. Sources of Information • The Program’s Own Logic • Peer Reviewed Literature • On Tobacco • On Similar Populations • On Same Theoretical Principles • On Same Organizational Settings

47. Sources of Information • Government Publications • Reducing Tobacco Use: A Report of the Surgeon General • Guide to Community Preventive Services: Tobacco Use Prevention and Control • CDC’s Best Practices for Comprehensive Tobacco Control Programs • CDC’s Tobacco Control Program Goal Areas • State Specific Documents

48. Sources of Information • Professional Publications • APHA • AMA • NACCHO and ASTHO • Panel of Experts • National Databases • Proprietary Data

49. Sources of Information • Primary Data Collection • Medical, Hospital, and Personnel Records • Physician Visits and Charges • Program Records • Surveys (behavioral, opinion, market) • Case Studies (most similar, least similar, typical, atypical) • Focus Groups

50. “If you are not a part of the solution, then you must a part of the precipitate.” Steven Wright