Best Practices2007

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Best Practices2007
Centers for Disease Control and
Prevention Office on Smoking and Health

• Brenda A. Richards
• Kansas
• [phone] brichards_at_cdc.gov

Kansas Tobacco Control Summit Overland, Kansas
October 13, 2008
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OBJECTIVES

• Understand the five components of Best Practices
  .
• Identify the funding level that Kansas needs to
  achieve the goal of substantially reducing
  exposure to secondhand smoke and making tobacco
  use rare.
• Describe the ideal State comprehensive tobacco
  control program and how it would carry out Best
  Practices.

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Best Practices 1999

• Evidence-based
• Provided
• A blueprint for program components
• Community Programs
• Chronic Disease Programs
• School Programs
• Enforcement
• Statewide Programs
• Counter-Marketing
• Cessation Programs
• Surveillance and Evaluation
• Administration and Management
• Funding formulas to implement them

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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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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.

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State Investment in Tobacco Control

• Campaign for Tobacco Free Kids Response 2/08
• The researchers also calculated that if Kansas
  had funded its program at the levels recommended
  by CDC during that period, there would have been
  between 31,934 and 80,466 fewer smokers in the
  state by 2003.
• Such smoking declines would have saved between
  10,219 and 25,749 lives.
• As well as between 303,400,000 and 764,400,000
  in health care costs.

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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

• 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

• Program and budget guideline
• Describes an integrated program structure
• Provides broad funding recommendations
• 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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(No Transcript)
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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 and Community Interventions STATEWIDE
PROGRAMS

• Coalition development state coalition
• Strategic planning
• Policy interventions
• Community-specific data collection
• Culturally-appropriate interventions
• Statewide conferences and TA
• Monitor pro-tobacco influences
• Facilitate public discussion
• Support innovative demonstration projects

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State and Community InterventionsCOMMUNITY
PROGRAMS

• Funding community organizations
• Facilitating local coalitions
• Collaborating with partners to build capacity
• Supporting local strategies to educate
• Promote public discussion
• Establish local strategic plan
• Ensure support for local PH infrastructure
• Measure outcomes of social norm change

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State and Community Interventions CHRONIC
DISEASE PROGRAMS

• Collaborating with related PH programs
• Implement interventions that link to other
  programs
• Develop communications that link SHS to health
  outcomes
• Use tax revenue to fund tobacco and other chronic
  disease programs
• Link other programs to tobacco interventions
  (e.g., promoting quitline)
• Promote insurance coverage of preventive services

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State and Community Interventions
TOBACCO-RELATED DISPARITIES

• Conduct population assessment
• Seek consultation from specific populations
• Ensure disparities addressed in strategic plan
• Fund organizations that can reach and involve
  specific populations
• Provide culturally competent TA
• Provide communication to reach disparate
  populations
• Ensure quitlines can meet the required needs of
  population subgroups

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State and Community Interventions YOUTH PROGRAMS

• Increase unit price of tobacco
• Conduct mass media with community interventions
• Mobilize community to restrict minors access
• Implement school-based interventions with media
  and community efforts

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The Community Guides Tobacco Control Strategies
in Communities
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The Community Guides Tobacco Control Strategies
in Communities
Community mobilization to reduce minors access
School-based interventions coordinated with mass
media and community interventions
When combined with other interventions
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The Community Guides Tobacco Control Strategies
in Communities
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Health Communication Interventions

• Health communication interventions are powerful
  tools to prevent initiation, promote cessation,
  and shape social norms.
• Media interventions prevent tobacco use
  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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Health Communication Interventions

• Audience research to define themes and develop
  campaigns
• Market research
• Surveillance of pro-tobacco messages and tactics
• Grassroots promotions and media advocacy
• Incorporating innovative technologies and message
  development by the target audience
• Process and outcome evaluation
• Promotion of available services

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Designated Market Areas (DMAs)

• Please insert map of nation

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Kansas Designated Market Areas

• Potentially reach 59 of the states youth
  market 12-17 years of age.

Wichita-Hutchinson Plus DMA
Topeka DMA
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Further Research Needed

• We need to continue to look for more effective
  strategies and approaches
• Health Communications
• Health communication message testing
• More efficient campaign structure
• Efficacy of innovative technologies

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Cessation Interventions
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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
• Recommended level of intensity
• 6 of tobacco users enrolled into counseling

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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

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The Community Guides Tobacco Control Strategies
in Health Care Systems
When combined with other interventions
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The Community Guides Tobacco Control Strategies
in Health Care Systems
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Further Research Needed

• We need to continue to look for more effective
  strategies and approaches
• Cessation
• Effective and efficient quitline recruitment
• Better counseling and pharmacologic interventions
  
• Improved methods for ensuring cessation attempts
  include effective treatments

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Surveillance and Evaluation

• Publicly financed programs should be accountable
• and demonstrate effectiveness
• Cost parameters include
• Maintain recommendation of 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

• Complex, integrated programs require
• experienced staff to provide fiscal management,
  accountability, and coordination
• Cost parameters include
• Maintain recommendation of 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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Burden of Tobacco

• Approximately 438,000 deaths in U.S. each year
• For every death, another 20 suffer from a
  tobacco-related disease or disability
• Economic impact over 193 billion per year

• SHS also causes death and disease
• Economic impact of SHS exposure over
• 10 billion per year

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Trends in Current Cigarette Smoking by High
School Students and AdultsUnited States,
1965-2006
High school students
HP2010 Goal
Adults
Youth 16
Adults 12
High school students who smoked on 1 gt/ of the
30 days preceding the survey--United States, CDC.
Youth Risk Behavior Survey, 1991-2005. Total
population adults who were current cigarette
smokers, National Health Interview Surveys,
1965-2006.
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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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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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• HOW MUCH??

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Border State Examples Recommended Annual
Investment

• Kansas 11.60 per capita 32.1
  million
• Colorado 11.46 per capita 54.4
  million
• Missouri 12.52 per capita 73.2
  million
• Nebraska 12.20 per capita 21.5
  million
• Oklahoma 12.54 per capita 45.0
  million
• Iowa 12.29 per capita 36.7
  million
• Tennessee 11.89 per capita 71.7
  million
• New Mexico 11.95 per capita 23.4
  million

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Are You Serious?
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Kansas funding recommendations for 2007
Per Capita State Totals

• State and Community Interventions
• II. Health Communication Interventions
• Cessation Interventions
• Surveillance and Evaluation
• Administration and Management
• TOTAL

5.31 14.7 M 1.30
3.6 M 3.48 9.6 M
1.01 2.8 M 0.50
1.4 M 11.60 32.1 M
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This is what it would look like
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32.1 Million in Context
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Kansas Tobacco Burden

• Annual average deaths in KS
• Smoking attributable deaths 3900
• Youth projected to die 54,000
• Annual costs in KS
• Total Medical 927 million
• Medicaid 196 million
• Lost Productivity 863 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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The cost to end the tobacco epidemic in Kansas?
11.60/per person annually A bargain price for
the benefits and rewards
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• Knowing is not enough we must apply.
• Willing is not enough we must do.

- Johann Wolfgang von Goethe
Never doubt that a small group of thoughtful,
committed citizens can change the world. Indeed,
it is the only thing that ever has.
- Margaret Mead
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Summary

• The five components of a Best Practices are
• State and Community Interventions
• Cessation Interventions
• Health Communications Interventions
• Surveillance Evaluation
• Administration Management
• The CDC recommended funding level that Kansas
  needs to eliminate the tobacco problem is 32.1
  million dollars annually (based on todays data)

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Comprehensive Tobacco Control Programs
Centers for Disease Control and Prevention Office
on Smoking and Health
Brenda A. Richards, RN, MHS Program Consultant,
Office on Smoking and Health Centers for Disease
Control
Kansas Tobacco Control Summit Overland, KS
October 13, 2008
The findings and conclusions in this presentation
have not been formally disseminated by the
Centers for Disease Control and Prevention and
should not be construed to represent any agency
determination or policy.