Health Equity for All:

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Health Equity for All

• A Leadership Summit to Reduce the Burden of
  Tobacco Use among Low SES Populations
• November 5-6, 2008

La Roux Pendleton, MPH LaRoux.Pendleton_at_cdph.ca.go
v California Tobacco Control Program Local
Programs and Priority Populations Unit
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Promising and Innovative Practices from Other
States
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California Tobacco Control Program
Statewide Evaluation
Statewide Media Campaign
Capacity Building Network
California Youth Advocacy Network
61 Health DepartmentCoalitions
35 Competitive Grantees Including 18 Priority
Population Grantees
Legal Center
Policy CO Center
Clearing-house
Evaluation Center
Quitline/ Cessation Center
STAKE Youth Recruitment
Secondhand Smoke
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Goal change social norms
Outcome prevention cessation

• Using a comprehensive approach that strives to
  change broad social norms around the use of
  tobacco by indirectly influencing current and
  potential future tobacco users by creating a
  social milieu and legal climate in which tobacco
  becomes less desirable, acceptable, and
  accessible.

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Social Issue Campaign Cycle

Apathy
Contentment
Awareness
Expectation
Concern
The Cycle of a Social Issue
Social Norm
Attitudinal Shift
Action/ Legislation
Social Expectation
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California Tobacco Control Program Priority Areas

• Reduce Exposure to ETS and Tolerance to Exposure
• Counter Pro-Tobacco Influences
• Reduce Availability of Tobacco Products from
  Retail Social Sources
• Provide Cessation Services

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California Prevalence Data
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Smoking prevalence among California adults,
1984-2005
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Source Behavioral Risk Factor Surveillance
System (BRFSS) 1984-1992, BRFSS and California
Adult Tobacco Survey data is combined for
1993-2005. The data is weighted to the 2000
California population. Note change of smoking
definition in 1996 that included more occasional
smokers. Prepared by California Department of
Health Services, Tobacco Control Section,
February 2006.
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Smoking Prevalence Among California Adults by
SES, 1996-2005
Low SES
Middle SES
Declining 40 faster than Low SES and 30 faster
than Middle SES
High SES
Source Behavioral Risk Factor Surveillance
System and California Adult Tobacco Survey data
is combined for 1993-2005. The data is weighted
to the 2000 California population. Note change
of smoking definition in 1996 that included more
occasional smokers. Prepared by California
Department of Health Services, Tobacco Control
Section, February 2006.
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Adult smoking prevalence by race/ethnicity and
SES, 2004-2005
Prevalence
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SHS exposure at the workplace among California
adults by SES, 2001-2005
Low SES
Middle SES
Percent
High SES
Source California Adult Tobacco Survey,
2001-2005. The data is weighted to the 2000
California population. Prepared by California
Department of Health Services, Tobacco Control
Section, February 2006.
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Low SES Social Norm Change Approach in California

• Policy (Scope of Work Objectives)
• Cessation
• Media
• Evaluation

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• Policy
• Cessation
• Media
• Evaluation

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Policy

• Create critical mass and aim to pass tobacco
  control policies at the local level.
• Legislative and voluntary policy adoption

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Policy Cont.

• Examples of objectives at the local level that
  affect low SES populations
• Reducing Availability of Tobacco Products
• Pursuing Conditional Use Permits to reduce the
  number of tobacco retailers in low income
  communities
• Ban to sell tobacco products in stores that have
  pharmacies (San Francisco Example)
• Reducing Exposure to Secondhand Smoke
• County health departments and competitive
  grantees have objectives to target low income
  housing complexes to adopt a policy which
  designates a minimum of 50 smoke free units.
• Forming policies to address loophole in labor
  code
• Smoke free outdoor worksites (migrant,
  agricultural, construction workers)
• Secondhand Smoke policies in outdoor venues
  frequented by low SES populations (swap meets,
  flea markets, bus stops)

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• Policy
• Cessation
• Media
• Evaluation

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Cessation

• California Smokers Helpline (Free Cessation
  Services for all Californians)
• Low SES status not obtained directly through
  intake
• Measures such as insurance status and education
  are collected during intake
• Analysis from intake questions suggest that low
  SES smokers heavily utilize the helpline services
  
• 50 of callers have MediCalMedicaid
• If callers have MediCal they are eligible to
  receive pharmacotherapy that is coupled with the
  behavior modification counseling available
  through the helpline
• 25 of callers have no medical insurance
• Only 20 of callers have a college degree or
  higher
• MediCal quit rates are comparable to quit rate of
  individuals with private insurance

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• Policy
• Cessation
• Media
• Evaluation

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Media

• Countering Pro-Tobacco Influences
• General Market Media
• Goal of the media campaign is to change the
  social norms around tobacco use
• Secondary goal is to drive calls to the helpline
• Ads that are created for general market media are
  focus group tested on both general, multi-ethnic,
  and priority populations
• Our ads aim to identify the Tobacco Industry as
  an industry that targets special populations

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Examples of Ads that Target Low SES Smokers
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Examples continued
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• Policy
• Cessation
• Media
• Evaluation

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Evaluation

• Culture in Evaluation
• Tobacco Control Evaluation Center has created
  evaluation resources for programs working in
  specific priority populations
• http//tobaccoeval.ucdavis.edu/Priority_Population
  s/

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Thank you!