June 10, 2009-National Conference on Tobacco or Health: Phoenix, AZ

1. Implementing and Sustaining Effective Local Tobacco Control Programs (Using CDC’s Best Practices and NACCHO’s Guidelines) June 10, 2009-National Conference on Tobacco or Health: Phoenix, AZ Deborah Houston McCall-CDC’s Office on Smoking and Health Julie Nelson Ingoglia-National Association of County and City Health Officials Tricia Valasek-National Association of Local Boards of Health Karla Sneegas-Indiana Tobacco Prevention and Cessation Jen Morel-Columbus (OH) Public Health Department

2. Overview

3. Overview • Understand role CDC’s Best Practices plays in addressing tobacco use prevention and control • Introduce 3rd Edition of Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs (Guidelines) • Discuss advantageous partnerships with boards of health and health departments • Identify importance of Sustaining States and Locals Planning Meetings • Illustrate Indiana’s experience of securing tobacco control funding • Provide first-hand example of how state and local health departments and boards of health are engaging in tobacco control

4. TM Best Practices—2007 Centers for Disease Control and Prevention Office on Smoking and Health Deborah Houston McCall, MSPH NACCHO and NALBOH Project Officer (770) 488-1182 dmccall@cdc.gov

5. State Investment in Tobacco Control • American Journal of Public Health 2/08: Impact of Tobacco Control Programs on Adult Smoking • Peer-reviewed study examined state tobacco prevention and cessation funding levels from 1995 to 2003. • Found the greater investment states made in their state tobacco program, the larger and more rapid declines achieved in adult smoking prevalence – even when controlling for other factors.

6. State Investment in Tobacco Control • Campaign for Tobacco Free Kids Response 2/08: • The researchers also calculated that if Ohio had funded its program at the levels recommended by CDC during that period, there would have been between 14,328 and 35,665 fewer smokers in the state by 2003…. • Such smoking declines would havesaved between 4,585 and 11,413 lives…. • As well as between $136.1 M and $338.8 M in health care costs.

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

8. 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

9. 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

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

11. 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

12. Cessation Interventions • Sustain, expand, and promote services such as quitlines • Coverage of treatment under public and private insurance • Eliminating cost barriers for underserved populations • Making the PHS-recommended health care system changes

13. 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.

14. 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 “All Prevention is Local”

15. Implementing and Sustaining Effective Local Tobacco Control Programs Julie Nelson Ingoglia, MPH National Association of County and City Health Officials (NACCHO)

16. Tobacco control demonstrated over the past 15 years how we could change social norms and behaviors that cause chronic diseases... we used a whole host of strategies such as laws, media, and changing environments where we work, play, and go to school. This same framework can be used to reduce other modifiable risk factors for chronic diseases such as poor nutrition and lack of physical activity. Poki Stewart Namkung, M.D., M.P.H. Health Officer, Santa Cruz County Health Services Agency, Santa Cruz, CA Our challenge is to make policy makers and the public appreciate the extraordinary return on investment if we create an environment dedicated to preventing chronic disease. Gary Goldbaum, MD, MPH Health Officer & Director, Snohomish Health District, Everett, WA Using Tobacco Control to Alter Chronic Disease Prevention Paradigm for Local Health Departments

17. A New Chronic Disease Prevention Paradigm for Local Health Departments Guidelines can: • Fulfill the local government’s statutory responsibility to address dominant health threat • Assist state development and use of standard formula to allocate tobacco control funding to local health departments • Engage in evidence-based tobacco control • Direct leadership role articulated in Voluntary National Accreditation Standards

18. Local Health Department Role – Fulfilling Accreditation Domains with Tobacco Control Activities Protect people from health problems and health hazards (2). • Educate and inform decision-makers about the research on comprehensive clean indoor air legislation and enforce it when implemented. Engage the community to identify and solve health problems (4). • Develop or support community partnerships to address tobacco use. Develop public health policies and plans (6). • Work with community partners to develop a county plan to address tobacco use including the adoption of evidence-based policies such as expanding smoking restrictions. Enforce public health laws and regulations (7). • Conduct enforcement procedures with tobacco retailers to reduce unlawful tobacco sales to minors. Help people receive health services (8). • Provide training and coordination among all health care providers in the county to promote brief cessation interventions and referrals.

19. Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs (Guidelines)

20. Community and School Activities Development of smoke-free air policies (84%) Local counter-marketing campaigns (65%) Development of educational materials to increase excise taxes on tobacco products (20%) Evidence-based curricula in schools (67%) Developing tobacco free policies (62%) Parenal involvement and teacher training (43%) Cessation Promoting state quitline (92%) Offer cessation for adults (79%) Offer cessation for youth (65%) Enforcement Education about smoke-free air policies (82%) Education about youth possession (59%) Compliance checks (61%) Enforcement of youth possession (39%) Counter-marketing Health promotion activities (81%) Press releases and public service announcements (79%) Paid TV, radio, billboard and print advertising (64%) Local Activities and Successes

21. Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs (Guidelines)

22. Contact Information Julie Nelson Ingoglia, MPH Program Manager, Community Health National Association of County and City Health Officials 1100 17th Street, NW Second Floor Washington, DC 20036 jnelson@naccho.org 202/507-4248 (Direct) 202/783-5550 (Main)

23. Board of Health and Health Department Involvement in Tobacco Control Programs and Policies Tricia Valasek, MPH Project Director-Tobacco Use Prevention and Control

24. Board of Health Description • Boards of health are the advising, governing, or policy-making authority for a local health department or community. • Boards of health are composed of at least three elected or appointed individuals • Some board of health members are designated to sit on the board by state statute • Local boards of health may also be referred to as: • Community health boards • Health advisory councils • Medical societies • Tribal boards • County commissioners

25. Relationship Between Boards of Health and Health Departments Boards of Health Health Departments • Advise or govern health departments and/or city councils and county commissions • Act as the liaison between the health department and the public • Oversee or authorize financial budgets and expenditures • Propose health-related ordinances or statutes • Decide what clinical services are needed and can be provided • Provide common health services • Develop programs for implementation • Conduct Community Health Assessments • Provide boards of health with relevant materials and resources to make informed decisions • Conduct health inspections and other programs to protect the health of community members

26. Board of Health Roles in Tobacco Use Prevention and Control • Board of health members can be outstanding advocates for tobacco control and prevention • Contact state legislators to advocate for clean indoor air laws, sustaining funding, youth access laws, etc. • Work with local county commissioners and city councils to develop effective policies • Advocate to the public about the importance and benefit of tobacco control programs in the community • Develop and implement tobacco control policies in local communities

27. Best Practices • Boards of health have successfully enacted or supported tobacco control policies by: • Writing letters to state and local legislators • Passing local resolutions for the health agency • Working with city councils and county commissions to pass tobacco policies • Developing language for local smokefree air laws • Enforcing current laws in local restaurants, bars, and workplaces • Holding public hearings with community members

28. Role in Sustaining Tobacco Control Funding • The board of health has the decision to include or exclude tobacco use prevention and control funding from a health department’s operating budget • Informed board of health members can utilize information provided to them by health department staff to sustain local funding • Board of health members can take immediate action to sustain/increase tobacco control funding at the state level by voicing how the funding has positively affected their community

29. Participation in “Sustaining Local Tobacco Control Initiatives” Planning Meetings • NALBOH and NACCHO offer planning meetings for local tobacco control initiatives through a grant from CDC’s Office on Smoking and Health • Three (3) planning meetings were offered in the Spring/Summer 2009 • Tobacco Free Collaborative-Columbus, OH • Smokefree Chattanooga-Chattanooga/Hamilton County, TN • Fairfield Department of Health-Fairfield County, OH

30. “Sustaining Local Tobacco Control Initiatives” Planning Meetings • During these meetings, public health professionals including • board of health members • health department staff • state tobacco control program managers • hospital associates • other local coalition members gather to discuss local tobacco control funding issues and methods to overcome barriers • Work on action plans to energize local tobacco coalitions and obtain additional funding for local initiatives

31. Ways to Get Involved in Future Planning Meetings • NALBOH and NACCHO plan to offer four (4) additional planning meetings across the country in the Fall 2009-Spring 2010 • Look for a Request for Proposals (RFP) to be released Summer 2009 • Applications will require local leaders to be included in the meeting including board of health members and health department staff

32. Working with Local Health DepartmentsIndiana’s Story Karla Sneegas, MPH Executive Director Indiana Tobacco Prevention & Cessation NCTOH Phoenix, AZ June 2009

33. Indiana Tobacco Prevention and Cessation State Agency • ITPC was established by the Indiana General Assembly in 2000 and opened as an independent state agency in January 2001. • Our Vision is to: • Significantly improve health of Hoosiers • Reduce tobacco-related diseases • Reduce economic costs to Indiana

34. Partnerships • Indiana Tobacco Prevention and Cessation • Community Based Partnerships • Minority Based Partnerships • Statewide Partnerships

35. ITPC’s Philosophy • Science-based, evidence-based and data-driven • Change happens “inside” Hoosier Communities • Must reach people where they live, work, worship and play • Policy drives behavior change • Media drives attitude and belief change

36. ITPC Comprehensive Tobacco Control • Community Based Programs • Cessation • Statewide Public Education • Evaluation • Administration and Management

37. 4 Statewide Priorities Reduce Youth Smoking Increase Adult Cessation Decrease Exposure to Secondhand Smoke Increase and Maintain the Infrastructure for Tobacco Control ITPC Community and Minority Based Partnerships-2008

38. Community-Based Strategy • Community Determines Grant Lead Agency • Health Departments • Hospitals • Boys & Girls Clubs • YMCA • Economic Development Corporations • Local Government • Local Community Organizations 501-c-3

39. Community-Based Strategy • Partners Apply Every 2 Years for Grant • 15 Community Indicators for Local Workplans • Contract Deliverables for Selected Indicators • Coalition Driven (Over 2400 Local Organizations Involved Statewide) • Quarterly Reporting

40. How Can Tobacco Control Help Local Health Departments?

41. Stronger Webs…Together

42. Accreditation • Protect people from health problems and health hazards (Essential Service #2) • Engage the community to identify and solve health problems (Essential Service #4) • Develop public health policies and plans (Essential Service #6) • Enforce public health laws and regulations (Essential Service #7) • Help people receive health services (Essential Service #8)

43. National Health Reform • Where does tobacco control fit into health reform? • Clinical interventions by health care providers • Community interventions by community health providers • Hospital interventions • Policy interventions that mean prevention (cost savings)

44. H1N1

45. Dr. Judy Monroe IN State Health Commissioner

46. For More Information on ITPC Visit our three (3) websites: www.itpc.in.gov www.whitelies.tv www.voice.tv Contact Indiana Tobacco Prevention and Cessation- 317.234.1787 ksneegas@itpc.in.gov

47. Local Experiences in Tobacco Use Prevention and Control Jen Morel, MPH, CHES Columbus Public Health Columbus, Ohio

48. Franklin County Tobacco Free Collaborative (TFC) • Established in 1997 • Approximately 80 community partners • Large grassroots network • Coalition structure and initiatives guided by a steering committee • Health Departments in Franklin County • American Heart Association, American Cancer Society, American Lung Association • Nationwide Children’s Hospital • Steering committee agencies rotate TFC leadership

49. Franklin County Links to Ohio Department of Health Tobacco Prevention Initiatives • Ohio Tobacco Control and Resource Group • TFC member was a past chair • Ohio Youth Tobacco Survey • Local health departments assist ODH to administer survey in schools every two years • Ohio Tobacco Use Prevention and Cessation Strategic Plan • TFC initiatives parallel state strategic plan

50. Youth initiatives 100% Tobacco Free School Districts Counter Tobacco Industry Influence ETS initiatives Smoke Free Housing Cessation Promote cessation resources 5As training for school nurses Policy SmokeFree Ohio Other Tobacco Products Tax Equalization Educate new state legislators about tobacco issues TFC Initiatives