A Brief History of NC’s Tobacco Initiatives: Building Partnerships and Bridges for Success

1. A Brief History of NC’s Tobacco Initiatives:Building Partnerships and Bridges for Success Adam O. Goldstein, MD, MPHOctober 22, 2009

2. Partners in Success Question Why American Lung Association in North Carolina Tobacco Prevention and Control Branch Free & Clear NC Prevention Partners Local Health Departments American Cancer Society Colleges Grantees NC Health and Wellness Trust Fund ALE Teen Grantees RTI Clubhouses Southern Regional AHEC American Heart Association Alliance for Health SAVE UNC Center for Maternal and Infant Health NC Spit Tobacco Education Program

3. Prevalence of Adult Smoking in North Carolina2001-2008

4. NC Middle School Smoking Prevalence, 1999 – 2007

5. NC High School Smoking Prevalence, 1999 - 2007

6. Smoking Prevalence and Policy Change, 2001-2004

7. Smoking Prevalence and Policy Change, 2005-2008

8. HWTF Funding to Date, in millions by fiscal year Over $80 million invested

9. Funding Comparison to Other States

10. Grantees Work across North Carolina Alleghany Ashe Stokes Rockingham Caswell Person Northampton Gates Surry Currituck Camden Warren Vance Hertford Pasquotank Halifax Perquimans Watauga Granville Wilkes Forsyth Guilford Chowan Orange Yadkin Franklin Bertie Avery Alamance Caldwell Mitchell Davie Durham Nash Alexander Yancey Madison Edgecombe Iredell Davidson Martin Tyrrell Burke Randolph Wilson Wake Washington Dare Chatham Pitt McDowell Catawba Beaufort Rowan Haywood Buncombe Hyde Johnston Swain Greene Lincoln Cabarrus Rutherford Lee Harnett Henderson Wayne Graham Montgomery Stanly Gaston Moore Polk Jackson Craven Lenoir Cleveland Mecklenburg Macon Cherokee Transylvania Cumberland Pamlico Clay Sampson Hoke Jones Anson Richmond Union Duplin Onslow Scotland Carteret Bladen Robeson Key Pender New Columbus Counties with a HWTF grant Hanover Brunswick Counties with a HWTF Teen grant Counties with a HWTF Pilot Project Counties with a HWTF Colleges grant updated 2009-9-22

11. 2009 Key Events in Tobacco Control for NC • The HWTF “You Quit, Two Quit” pilot for pregnant women • The HWTF launches “Breathe Easy, Live Well” pilot for adults with mental illness • Legislation prohibiting smoking in bars and restaurants • State preemption of local tobacco policies ends • 30 NC colleges tobacco-free

12. 2009 Key Events in Tobacco Control for NC • 100% of NC acute care hospitals go smoke-free • State cigarette excise tax increases by 10 cents • FDA gains authority to regulate tobacco • Federal excise tax on cigarettes increases by 62 cents

13. FY2006-2009Program Highlights

14. Major Accomplishments • Program outcomes show that the HWTF Tobacco Initiatives affect NC youth, young adults and adults broadly, reaching every county in the state. • Strong policy successes have occurred for preventing teen and young adult tobacco use and for reducing exposure to secondhand smoke. • A sustained media presence (TRU campaign) promoting tobacco use prevention has played an important role supporting successful program outcomes. • Support for cessation outcomes continues to grow, and increased success appears to have occurred in targeting disparate populations. • Some HWTF funded programs (e.g., Colleges Initiative) are recognized as national models.

15. Teen Tobacco Use Prevention and Cessation Program

16. Teen Initiative Accomplishments • Growth in number of policy outcomes and organizations involved. • The Teen Initiative - major source of statewide tobacco prevention and cessation resources for North Carolina youth. • 42 grantees serving youth in 74 of NC’s 100 counties, and 3 grantees providing services statewide. • Policy successes include adoption of 100% tobacco-free schools statewide and significant reductions in youth tobacco rates.

17. North Carolina TRU Media Campaign Awareness Source: 2009 TRU Media Evaluation Survey

18. North CarolinaMedia Brand Awareness Source: 2007 NC Youth Tobacco Survey

19. Tobacco-Free Colleges

20. Percent of NC Colleges/Universities Adopting Tobacco-Free Policies,Sept. 2009 Phase II Jan. 2008 - Jun. 2010 Phase I Jan. 2006 - Dec. 2007 Launch of state-wide outreach to non-funded campuses.

21. Tobacco-Free Colleges in NC, Sept. ‘09 Alleghany Surry Stokes Rockingham Caswell Person Northampton Gates Currituck Ashe Warren Camden Vance Hertford Pasquotank Watauga Halifax Perquimans Granville Wilkes Forsyth Yadkin Guilford Chowan Orange Franklin Bertie Avery Alamance Caldwell Mitchell Davie Durham Nash Alexander Yancey Madison Edgecombe Iredell Davidson Martin Tyrrell Randolph Wilson Wake Washington Dare Burke Chatham Pitt McDowell Catawba Beaufort Rowan Haywood Buncombe Hyde Johnston Swain Lincoln Greene Cabarrus Rutherford Lee Harnett Henderson Wayne Graham Montgomery Gaston Stanly Moore Polk Jackson Craven Lenoir Cleveland Mecklenburg Macon Cherokee Transylvania Cumberland Pamlico Clay Sampson Jones Anson Richmond Hoke Union Duplin Onslow Scotland Carteret Bladen Robeson Key Pender Type of Campus New Columbus Hanover NC Community College System (n=58) Brunswick NC Independent Colleges & Universities (n=36) UNC System (n=16) Type of Tobacco-Free Policy Maximum protection from second-hand smoke policy Partial or no protection policy

22. List of Colleges with Tobacco-Free Policies in North Carolina Elizabeth City State University, Jun. 08 UNC-Pembroke, Jul. 08 Peace College, Sept. 08 High Point University, Sept. 08 Catawba Valley Community College, Oct. 08 Blue Ridge Community College, Nov. 08 Central Carolina Community College, Nov. 08 Wayne Community College, Nov. 08 Davidson County Community College, Jan. 09 Cape Fear Community College, Jan. 09 Richmond Community College, Jan. 09 Western Piedmont Com. College, Feb. 09 Vance-Granville Community College, Mar. 09 Craven Community College, Apr. 09 Central Piedmont Community College, Sept. 09 Forsyth Technical Community College, Sept. 09 Bennett College, 2004 Gardner-Webb University, Nov. 06 College of the Albemarle, Dec. 06 Stanly Community College, Jan. 07 Asheville-Buncombe Technical, Feb. 07 Cleveland Community College, Mar. 07 Haywood Community College, Jul. 07 Greensboro College, Aug. 07 Wake Tech. Com. College, Aug. 07 Roanoke-Chowan Com. College, Aug. 07 UNC-Chapel Hill, Oct 07 Guilford Tech. Com. College, Oct. 07 Winston Salem State Univ., Dec. 07 Wingate University, Jan. 08 Montreat College, Jan. 08 Louisburg College, Apr. 08

23. QuitlineNC

24. QuitlineNC – 2005-2009 • Reached nearly 10,000 callers from HWTF target populations • Average monthly caller volume: • Years 1&2: 149 • Year 3: 287 • Year 4: 293

25. QuitlineNC Total HWTF Callers

26. QuitlineNC HWTF Caller Fax Referrals

27. Overall Recommendations • Expand to protect more North Carolina adults, particularly those at risk. • Increase funding to one-quarter of the CDC’s recommendation to put NC in the top 50% of states. • Continue to disseminate the successes of the HWTF Tobacco Initiative broadly. • Continue to maintain media based activities to support all Tobacco Initiative programs.

28. Specific Recommendations • Fund Phase III of the Colleges Initiative. • Examine if legislative successes of TFS movement can inform the Tobacco-Free Colleges movement. • Expand youth empowerment by establishing shared, annual statewide policy outcomes for youth empowerment activities. • Support new pilot tobacco cessation activities for high risk adults.

29. “That's all the more reason to salute the progress made by North Carolina's Health and Wellness Trust Fund in dissuading young people from lighting up. […] Gov.-elect Beverly Perdue, who has headed the trust fund as lieutenant governor, should be proud.” - “So Not Cool.” News & Observer Editorial. Jan. 05, 2009. Thank You Visit http://www.tpep.unc.edu for additional information.