The Evidence Base for Comprehensive Tobacco Control Programs

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The Evidence Base for Comprehensive Tobacco
Control Programs

• National Conference on Tobacco or Health
• San Francisco, California
• November 21, 2002

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Making Sense of What WorksHow to use the
Tobacco Guidelines
CDC Best Practices
PHS Clinical Practice Guidelines
Tobacco User
Provider
Health Care System
Community
Community Guide
Clinical Guide
SGR Reducing Tobacco Use
NCI Population Based Smoking Cessation
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National Tobacco Control Program Goals and
Program Components
Promote
Eliminate
Identify and
Prevent
Quitting
Exposure
Eliminate
Initiation
Among
to ETS
Disparities
Among
Adults
Among
Youth
Populations
Community
Interventions
Counter-
Marketing
Policy/
Legislation
Surveillance/
Evaluation
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Making Sense of What WorksBuilding a
Comprehensive Tobacco Program

• Combines the nine key program components of Best
  Practices
• Incorporates evidence-based decision-making to
  identify or justify effective interventions and
  to help determine funding levels
• Relies on strong infrastructure development and
  technical assistance for implementation and
  evaluation
• Relates to declines in tobacco use and tobacco
  related diseases, disabilities, and deaths

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• Narrative reviews of the evidence (without formal
  recommendations) for
• Current tobacco use
• Effective educational strategies
• Individual and clinical strategies
• Regulatory efforts
• Economic approaches
• Comprehensive tobacco use prevention programs

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Reducing Tobacco Use -- A Report of the Surgeon
General

• Our lack of greater progress in tobacco control
  is more the results of failure to implement
  proven strategies than the lack of knowledge
  about what to do
• Educational, clinical, regulatory, economic and
  comprehensive approaches recommended

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• Led by the Task Force on Community Preventive
  Services
• Focus on population-based interventions
• Recommendations based on systematic reviews of
  published intervention studies

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• Looks at both effectiveness and economic
  efficiency
• Tool for program and policy decision-making
• Building blocks for a comprehensive tobacco
  control program

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Recommendations of the Task Force on Community
Preventive ServicesStrategies for Reducing
Initiation by Children and Adolescents

• Increase unit price of tobacco products
• Mass media education - campaigns combined with
  other interventions

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Recommendations of the Task Force on Community
Preventive ServicesStrategies for Increasing
Tobacco-Use Cessation

• Increase unit price of tobacco products
• Mass media education campaigns combined with
  other interventions
• Multi-component cessation interventions
• Telephone cessation support

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Recommendations of the Task Force on Community
Preventive ServicesStrategies for Reducing
Exposure to Environmental Tobacco Smoke

• Smoking bans and restrictions

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• A guidance document developed by CDC
• Recommendations based on experiences with state
  programs and some published intervention studies
• Identifies 9 components of a comprehensive
  tobacco program
• Provides budget estimates for implementation of
  each component

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CDC Program and Cost Guidelines

• Programs to Reduce Tobacco Use
• Programs to Reduce the Burden of Tobacco-Related
  Disease
• School Programs
• Enforcement
• Partnership Grants
• Countermarketing
• Cessation
• Surveillance and Evaluation
• Administration and Management

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Community Programs to Reduce Tobacco Use

• For meaningful change to occur, community
  involvement is essential
• Involvement must extend to local levels where
  people live, work, worship, and play
• Leadership must be diverse and inclusive

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Community Programs to Reduce the Burden of
Tobacco-related Diseases

• Smoking contributes to deaths related to
• Cardiovascular disease
• Cancer
• Stroke
• Oral cancers
• Asthma

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Youth Tobacco Use Rates and Level of Community
Partnership Performancein Florida Tobacco Pilot
Program
Declines in tobacco use have been greatest in
areas where partnerships are most active
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School Programs

• School-based tobacco use prevention programs can
  be an effective element in comprehensive program
• Teach skills to identify and resist social
  influences
• Consistently support non-tobacco use for faculty,
  staff and students at all school-related events
  and facilities
• Link school-based efforts with counter-marketing
  and community activities

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School Programs

• 20 to 40 reductions in smoking rates
• Booster sessions and community-wide programs
  increase long-term efficacy
• Media campaigns can enhance school-based programs
• Policy changes reinforce educational activities

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Oregon
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Enforcement

• Broad public support for programs to reduce youth
  access to tobacco
• Enforcement efforts need to be integrated into
  overall community programs
• Should focus on all policy areas, including clean
  indoor air legislation

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Enforcement

• Conduct frequent retailer compliance checks
• Impose a graduated series of civil penalties
• Eliminate vending and self-service displays
• Provide comprehensive merchant education

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Partnership Grants

• Statewide partnerships needed to aid local
  community programs
• More efficiently reach minority and other
  populations targeted by tobacco industry

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Partnership Grants

• Percentage of Massachusetts population covered by
  clean indoor air restrictions increased from 17
  to over 75
• Involving culturally diverse communities in
  program planning and implementation can increase
  community quit rates

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Countermarketing

• Create supportive environment for community and
  school programs
• Counter legacy of industry promotions
• Promote quitting among youth and adults
• Reinforce prevention and enforcement efforts
• Increase awareness of ETS risks

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Countermarketing

• 1967-1970 Fairness Doctrine campaign
  significantly reduced smoking rates
• Statewide and national campaigns have
  demonstrated efficacy in preventing youth
  initiation
• Media campaigns can significantly enhance the
  efficacy of school and community based programs

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Cessation

• Media, community and policy changes can increase
  youth and adult smokers motivation and readiness
  to quit
• Utilization of effective programs will increase
  success rates
• Smoking attributable disease rates can only be
  decreased in the near term by increased cessation
  rates

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Cessation

• Both behavioral counseling and pharmacotherapy
  significantly increase quit rates
• Maximum of 10 of smokers will use full therapy
  options
• Minimizing access and cost barriers will increase
  population quit rates

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Surveillance and Evaluation

• Per capita consumption
• Adult and Youth Prevalence
• Behaviors and Intentions
• Attitudes and Social Norms
• Program Monitoring Indicators

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Administration and Management

• Strong management structure is essential to
  program effectiveness
• Accountability requires monitoring and oversight
  of all funding
• 5 of total annual program funding for central
  administration

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For More Information...

• Terry Frank Pechacek, Ph.D.
• Associate Director for Science
• Office on Smoking Health
• Centers for Disease Control and Prevention
• Atlanta, Georgia
• Phone [phone]
• Fax [phone]
• E-mail txp2_at_cdc.gov
• Internet www.cdc.gov/tobacco