Best Practices2007

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Best Practices2007
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
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Best Practices 1999

• Evidence-based
• Provided
• A blueprint for program components
• Funding formulas to implement them

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Best Practices 1999

• Community Programs
• Chronic Disease Programs
• School Programs
• Enforcement
• Statewide Programs
• Counter-Marketing
• Cessation Programs
• Surveillance and Evaluation
• Administration and Management

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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
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• Evidence Base

.
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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.

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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

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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

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Updating Best Practices

• States requested updated guidance
• Cost of living has increased 30
• Evidence-based reviews of specific strategies
• Broader range of state experience

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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

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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

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Best Practices 2007

• Funding formulas not revised
• Funding estimates increasing by an average of 30
• Cost of living
• Population
• Smoking prevalence
• School enrollment

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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

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Best Practices 2007

• Provides recommended level of annual investment
  within the funding range
• Factors in state-specific characteristics

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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

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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

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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

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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

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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.

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Designated Market Areas (DMAs)

• Please insert map of nation

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Designated Market Areas (DMAs)
New York 99 reach 3.42 per capita
New Mexico 86 reach 1.33 per capita
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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

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1-800-QUITNOW
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Cessation Interventions

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

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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

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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

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Core Surveillance Systems

• Behavioral Risk Factor
• Surveillance System
• Youth Risk Behavior
• Surveillance System
• Youth Tobacco Survey
• Adult Tobacco Survey

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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

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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

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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

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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

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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 States population, demography, and
• prevalence of tobacco use.

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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.

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• Knowing is not enough we must apply.
• Willing is not enough we must do.

- Johann Wolfgang von Goethe
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Best Practices2007
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