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Training on NACCHOs 2010 Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs May 31, 2010 Putting Together the Local Tobacco.

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Presentation on theme: "Training on NACCHOs 2010 Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs May 31, 2010 Putting Together the Local Tobacco."— Presentation transcript:

1 Training on NACCHOs 2010 Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs May 31, 2010 Putting Together the Local Tobacco Control and Prevention Puzzle WI-0

2 Welcome and Introduction WI-1

3 Icebreaker In filling in your puzzle pieces, consider the following: Hobbies Family Favorite travel experience Favorite book, movie, or TV show Personal experience with tobacco Family members experience with tobacco WI-2

4 Training Goal The goal of the Putting Together the Local Tobacco Prevention and Control Puzzle training is to familiarize local health departments (LHDs) and partners with the National Association of County & City Health Officials (NACCHOs) 2010 Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs so that they can expand and strengthen their tobacco control programs WI-3

5 History of Guidelines 1999: Centers for Disease Control and Prevention (CDC) develops Best Practices 2001: NACCHO publishes Guidelines to address the realities of tobacco programming at the local level 2007: CDC updates Best Practices 2010: NACCHO updates Guidelines WI-4

6 components 5 components New for 2010: Examples from LHDs across the country Discussion of tobacco control as part of larger chronic disease paradigm New funding calculations Connection to WHOs MPOWER policy framework Accreditation domains connection Local funding information Allows locals to calculate needs based on federal and national guidance in line with state best practices Allows states to consider comprehensive program needs when putting out local solicitations Shows how states and locals have worked together 2001 vs Guidelines WI-5 New and Improved!

7 Evidence Base WI-6

8 Module 1: Setting the Context 1-1

9 Module 1 Training Objectives By the end of this module, participants will be able to do the following: List three major milestones in the history of tobacco control in the U.S. Explain local health departments role in tobacco control Describe WHOs MPOWER framework and how it applies to tobacco control programs on the local level 1-2

10 Tobacco use is Americas single most preventable cause of death and disease It is also the largest modifiable risk factor for chronic disease Tobacco-related illness eats up 75% of healthcare dollars spent in the U.S.. Why Tobacco Control? Source: Anderson, G. et al. (2004) 1-3

11 In 2004, tobacco addiction cost the nation almost $200 billion in medical expenses and lost productivity In 2005, the Society of Actuaries estimated that the effects of exposure to secondhand smoke cost the U.S. $10 billion per year Source: CDC (2007) Why Tobacco Control? (continued) 1-4

12 Early 1960s: Surgeon General establishes negative health effects of smoking 1991: the National Cancer Institutes Project ASSIST funds and studies community-based tobacco control programs in 17 states Present Day: The CDCs IMPACT Program funds programs in the other 33 states and DC A Brief History of Tobacco Control in the U.S. 1-5

13 1990s: CA and MA allocate significant resources to reducing tobacco use Both states increased the cigarette excise tax and directed a portion of revenues to tobacco control programs Evaluation research from MA, CA, and other states: More resources = less tobacco use Source: CDC (2007) A Brief History of Tobacco Control in the U.S. (continued) 1-6

14 1998: The Master Settlement Agreement (MSA) Settlement with the states Attorneys General $206 billion to be distributed over 25 years Unencumbered payments for past and future damages for tobacco-related Medicaid expenditures 1999: CDC began supplementing comprehensive tobacco control programs in all 50 states, DC, and U.S. territories More Federal Funding! 1-7

15 Local governments continue to have a large stake in the MSA For example, counties play an explicit role in medical treatment and are legally responsible for indigent healthcare in more than 30 states Counties in CA, NY, and 18 other states pay part of the non-federal portion of Medicaid, including the costs for treating tobacco-related illness Source: Turnock, B.J. (1997) Local Governments and the MSA 1-8

16 Local governments have a statutory responsibility to address tobacco use as a dominant threat to the health of their communities, especially among vulnerable populations: Those experiencing tobacco-related disparities Youth Persons with lower levels of education People with substance abuse issues Local Responsibility 1-9

17 Response to the tobacco problem varies widely depending on availability of funds Local politics and pressure from the tobacco industry have also influenced the degree of government involvement Local Response 1-10

18 Gives the U.S. Food and Drug Administration (FDA) the authority to regulate tobacco Will greatly change the tobacco marketing and sales environment in this country Taking full advantage of the provisions of the FDA legislation will strengthen local tobacco control programs 2009 Family Smoking and Prevention Tobacco Control Act 1-11

19 New restrictions on tobacco marketing to children Enhanced enforcement of the federal prohibition on sales to persons younger than 18 No vending machine sales or self-service displays of cigarettes or smokeless tobacco except in adult-only facilities No branded product tie-ins, such as T-shirts, with purchases 2009 Family Smoking and Prevention Tobacco Control ActProvisions 1-12

20 No free samples of cigarettes or smokeless tobacco products, except in certain restricted situations No outdoor advertising within 1,000 feet or schools, parks, or playgrounds No sponsorship of athletic or cultural events by tobacco product manufacturers, distributors, or retailers All advertising at point of sale must be black text on white background only Source: CTFK, Campaign for Tobacco Free Kids (2009) 2009 Family Smoking and Prevention Tobacco Control ActProvisions (cont.) (continued) 1-13

21 5.4 million deaths a year are attributed to worldwide tobacco use Unless urgent action is taken, there will be more than 8 million tobacco-related deaths every year by 2030 Investing in comprehensive tobacco use prevention and control = saving money and lives Source: WHO (2008) The Worldwide Crisis 1-14

22 2008: The World Health Organization (WHO) releases a package of policy strategies: Are intended to assist countries in prioritizing limited resources Can also easily be effectively implemented by state and local governments Are consistent with the CDC and NACCHO recommendations Source: WHO (2008) Says WHO? 1-15

23 M onitor tobacco use and prevention policies P rotect people from tobacco smoke O ffer help to quit tobacco use W arn about the dangers of tobacco use E nforce bans on tobacco advertising, promotion, and sponsorship R aise taxes on tobacco Source: WHO (2008) WHOs MPOWER Framework 1-16

24 Pieces of the Puzzle: Comprehensive Local Tobacco Control Programs Community Interventions Health Communications Cessation Interventions Program Administration Surveillance & Evaluation Budgeting 1-17

25 Anderson, G. et al. (2004). Chronic Conditions: Making the Case for Ongoing Care: Partnership for Solutions. CDC (2007). Best Practices for Comprehensive Tobacco Control Programs. CTFK, Campaign for Tobacco Free Kids (2009). FDA Regulation of Tobacco Products: A Common-Sense Plan to Protect Kids and Save Lives Retrieved 7/24/09, from NACCHO (2010) Program and Funding Guidelines for Comprehensive Local Tobacco Programs. Washington, DC: National Association of County & City Health Officials. Turnock, B.J. (1997). Public Health: What it is and How it Works. Gaithersburg, MD: Aspen Publishers. WHO (2008). WHO Report on the Global Tobacco Epidemic 2008: Key Facts and Findings Relating to the MPOWER Package. Retrieved January 26, 2010 from Module 1 References 1-18

26 Module 2: Influencing Tobacco UseCommunity Interventions, Health Communications, and Cessation Interventions 2-1

27 Module 2 Training Objectives By the end of this module, participants will be able to do the following: Summarize the rationale for and provide examples of these components: Community interventions Health communications Cessation interventions Explain the importance of using evidence-based approaches in a tobacco control program 2-2

28 Community Interventions Health Communications Cessation Interventions Program Administration Surveillance & Evaluation Budgeting 2-3

29 Effective community programs involve and influence people in their homes, work places, schools, and public places. Community interventions influence societal organizations, systems, networks, and social norms to help many people make behavior changes Sources: CDC (2007); CDC (2000b) Community Interventions: Rationale 2-4

30 To achieve individual behavior change, whole communities must change the way tobacco products are marketed, sold, and used Changing policies takes the involvement of community partners and buy-in from local decision-makers Local coalitions have been a powerful and effective tool Sources: CDC (2007); CDC (2000b) Community Involvement 2-5

31 Specific populations experience a disproportionate health and economic burden from tobacco use and exposure to secondhand smoke: Racial and ethnic minorities Women Youth Blue-collar workers People with less formal education Source: The Tobacco Research Network on Disparities (2010). Disproportionate Burden 2-6

32 Establishing partnerships with local organizations Educating decision-makers about changing systems and environments to de-normalize tobacco use Encouraging policies that support tobacco use prevention and cessation Examples of Community Interventions 2-7

33 Educating parents on the hazards of secondhand smoke to children Promoting smoke-free restaurants and bars Engaging youth in the planning of tobacco control activities Examples of Community Interventions (continued) 2-8

34 Developing and implementing tobacco-free school grounds policies Promoting risk-reduction curricula, teacher training, and in-school cessation support services School-Based Community Interventions 2-9

35 Conducting vendor and retail organization education Employing retailer compliance checks to reduce tobacco sales to youth Investigating and penalizing those that violate clean indoor air laws Enforcement-Focused Community Interventions 2-10

36 Community Interventions Health Communications Cessation Interventions Program Administration Surveillance & Evaluation Budgeting 2-11

37 Paid anti-smoking advertisements are effective in reducing tobacco consumption Sustained media campaigns, combined with other interventions and strategies, decrease the likelihood of tobacco initiation and promote smoking cessation A well-coordinated mass media campaign can promote quitting and prevent initiation in both the general population and specific populations Sources: CDC (2000a); CDC (2000b); Farrelly, Pechacek, Thomas, and Nelson (2008); Frieden, et al. (2008); Goldman and Glantz (1998); McAlister, et al. (2004) Health Communications: Rationale 2-12

38 Media messages can also have a powerful influence on public support for tobacco control policy and help bolster school and community efforts Health Communications: Rationale (continued) Sources: CDC (2000a); CDC (2000b); Farrelly, M. C., Pechacek, T. F., Thomas, K. Y., and Nelson, D. (2008); Frieden, T. R., Bassett, M. T., Thorpe, L. E., and Farley, T. A. (2008); Goldman, L. K., and Glantz, S. A. (1998); McAlister, A., Morrison, T. C., Hu, S., Meshack, A. F., Ramirez, A., Gallion, K., et al. (2004) Your Message Here 2-13

39 Deliver strategic, culturally appropriate, and high- impact messages in adequately funded campaigns that are integrated into the overall state and local tobacco program Are professionally designed and scientifically based Source: CDC (2007) Effective Health Communications Campaigns 2-14

40 Local television public service announcements and paid educational spots Community access cable productions Television, radio, print, billboards, and other types of paid advertisements Reducing or counteracting tobacco industry advertising, sponsorship, and promotions Examples of Health Communications Strategies 2-15

41 Community Interventions Health Communications Cessation Interventions Program Administration Surveillance & Evaluation Budgeting 2-16

42 More than 2/3 of adult smokers report a desire to quit More than 40% of smokers try to quit each year Current estimates: most smokers who try to quit will do so several times before succeeding Both tobacco dependence and desire to quit appear to be prevalent across racial and ethnic groups Source : Fiore, M. (2008) Cessation Interventions: Rationale 2-17

43 May offer the best short-term benefit of all program components Can decrease premature mortality and tobacco- related healthcare costs in the short-term Sources: CDC (2000a); CDC (2007); Fiore, M. (2008) Effectiveness of Cessation Interventions 2-18

44 Top-ranked clinical preventive service for health impact and cost savings System changes needed: ongoing clinician training, tobacco use screening, and eliminating cost barriers Special emphasis needed on African American and Hispanic smokers; may be less aware of Medicaid and benefits, more skeptical of treatments Sources: Cokkinides, Vilma E Halpern, Michael T Barbeau, Elizabeth M Ward, Elizabeth Thun, Michael J. (2008); Fiore, M. (2008) Screening and Intervention by Clinicians 2-19

45 Promoting the state quitline Facilitating cessation policy development and implementation of brief clinical interventions among healthcare providers Increasing access to and use of nicotine replacement therapies (NRT) and other cessation medications Encouraging full coverage of cessation treatment by employers and inclusion as a standard benefit in all health plans Examples of Cessation Strategies 2-20

46 Supporting evidence-based tobacco cessation interventions in the community Promoting systems-level changes to more effectively track tobacco use by patients and to more consistently refer tobacco users to cessation services Increasing the use of culturally sensitive, linguistically appropriate cessation interventions for specific underserved populations Examples of Cessation Strategies (continued) 2-21

47 Assume that your tobacco control program is funded 25% of the CDC/NACCHO recommended amount Work together in your group to put your activities in the order they should be undertaken based on evidence of effectiveness Post your cards on the wall in order Select a reporter You will have 15 minutes to work in your small group Ranking Activity 2-22

48 CDC (2000a). Reducing tobacco use: a report of the Surgeon General. Washington D.C.: Dept. of Health and Human Services For sale by the Supt. of Docs., U.S. G.P.O. CDC (2000b). Strategies for reducing exposure to environmental tobacco smoke, increasing tobacco-use cessation, and reducing initiation in communities and health-care systems. A report on recommendations of the Task Force on Community Preventive Services. MMWR Recommendations Report, 49(RR-12), CDC (2007). Best Practices for Comprehensive Tobacco Control Programs. Atlanta, GA: Centers for Disease Control and Prevention. Cokkinides, Vilma E Halpern, Michael T Barbeau, Elizabeth M Ward, Elizabeth Thun, Michael J. (2008) Racial and ethnic disparities in smoking-cessation interventions - Analysis of the 2005 National Health Interview Survey in American Journal of Preventive Medicine. 34 (5): Emory University School of Public Health (2008). Using Best Practices: Practical Lessons in Building and Sustaining Comprehensive Tobacco Control Programs (CD-ROM). Tobacco Technical Assistance Consortium. Farrelly, M. C., Pechacek, T. F., Thomas, K. Y., and Nelson, D. (2008). The impact of tobacco control programs on adult smoking. American Journal of Public Health, 98(2), Module 2 References 2-23

49 Fiore, M. (2008). Treating tobacco use and dependence : 2008 update (2008 update ed.). Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service. Frieden, T. R., Bassett, M. T., Thorpe, L. E., and Farley, T. A. (2008). Public health in New York City, : confronting epidemics of the modern era. International Journal of Epidemiology, 37(5), Goldman, L. K., and Glantz, S. A. (1998). Evaluation of antismoking advertising campaigns. Journal of the American Medical Association, 279(10), Guide to Community Preventive Services (2010). Tobacco Use: Downloaded April 11, Downloaded April 11 McAlister, A., Morrison, T. C., Hu, S., Meshack, A. F., Ramirez, A., Gallion, K., et al. (2004). Media and community campaign effects on adult tobacco use in Texas. Journal of Health Communication, 9(2), NACCHO (2010) Program and Funding Guidelines for Comprehensive Local Tobacco Programs. Washington, DC: National Association of County & City Health Officials. The Tobacco Research Network on Disparities (2010). Home page: Module 2 References (continued) 2-24

50 Module 3: Ensuring Program SuccessProgram Administration, Surveillance and Evaluation, and Budgeting 3-1

51 Module 3 Training Objectives By the end of this module, participants will be able to do the following: List three characteristics of effective program administration Describe the role of surveillance and evaluation within a comprehensive tobacco program List two resources for creating local tobacco program budgets 3-2

52 Community Interventions Health Communications Cessation Interventions Program Administration Surveillance & Evaluation Budgeting 3-3

53 Implementation of an effective tobacco control program requires strong administrative and management structures for performance of strategic planning, staffing, and fiscal management functions Sufficient capacity enables programs to provide strong leadership and foster collaboration among the state and local tobacco control community Source : CDC (2007) Program Administration: Rationale 3-4

54 Adequate funding to ensure that the necessary planning and coordination take place Well-trained work force that has the leadership and project management skills to carry out program activities and functions Effective Administration and Management 3-5

55 Access to local tobacco control data about the local tobacco use problem and effective policies and strategies to reduce tobacco use An adequate number of skilled staff to perform program oversight, technical assistance, and training Effective Administration and Management (continued) 3-6

56 Management and coordination of comprehensive initiatives presents a challenge to involve and effectively collaborate with multiple organizations Administration and management staff provide the stable foundation on which any program is built and maintained A minimum base level of staffing that is dedicated to tobacco control is recommended, even for LHDs with the lowest population densities Lessons Learned from State Programs 3-7

57 Recruitment and staff development Awarding and monitoring program contracts Strategic planning Developing and maintaining a web site and media resources Program Administration Functions 3-8

58 Provision of technical assistance and training of coalition members and other partners Establishment and maintenance of sound fiscal management systems Integration of tobacco control program components Coordination with the state health department and other partner organizations Program Administration Functions (continued) 3-9

59 Community Interventions Health Communications Cessation Interventions Program Administration Surveillance & Evaluation Budgeting 3-10

60 Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health For tobacco control programs, this means keeping tabs on tobacco use within the programs jurisdiction Source: CDC (2001) Surveillance 3-11

61 Assessing use of tobacco in the catchment area of the LHD Identifying local factors contributing to tobacco use Examples of Surveillance Activities 3-12

62 Formative evaluation Process evaluation Outcome evaluation Impact evaluation Types of Evaluation 3-13

63 Assesses the strengths and weaknesses of materials and/or intervention strategies before full implementation Provides a change to field test elements such as the following: Approach/activities Materials Cultural appropriateness Source: Agency for Toxic Substances and Disease Registry (1997) Formative Evaluation 3-14

64 Examines the procedures and tasks involved in implementing an intervention, including the following: Number of staff involved Schedule of activities Number of materials distributed Attendance at events Source: Agency for Toxic Substances and Disease Registry (1997) Process Evaluation 3-15

65 Used to asses a programs or interventions effectiveness in achieving its objectives and document the immediate effects of the project on the target audience, including the following: Changes in knowledge and attitudes Behavioral intentions Immediate or short-term changes in behavior Source: Agency for Toxic Substances and Disease Registry (1997) Outcome Evaluation 3-16

66 Focuses on the long-range results of the program and changes or improvements in health status as a result: Impact Evaluation Changes in morbidity and mortality Long-term maintenance of desired behavior Source: Agency for Toxic Substances and Disease Registry (1997) 3-17

67 Tobacco programs often emphasize process and outcome evaluation: Process evaluationhow is the program implemented? Outcome evaluationhow effective is the program in changing knowledge, attitudes, policies, practices, and ultimately tobacco use prevalence and exposure to secondhand smoke? Evaluation of Tobacco Control Programs 3-18

68 Is integrated with all other program components and activities Uses data to illustrate the value of the program Is tied to clearly defined program objectives Is performed by LHD staff, contractors, and/or local university staff or students Effective Program Evaluation 3-19

69 Community Interventions Health Communications Cessation Interventions Program Administration Surveillance & Evaluation Budgeting 3-20

70 More Spending = Less Smoking Smoking 3-21

71 Per capita funding estimates were used for all program components Spending recommendations for the 2010 Guidelines are based on funding formulas adjusted for LHDs The Guidelines include recommended funding levels in addition to funding ranges based on a number of factors Basis for Funding Recommendations 3-22

72 Community Interventions: $3.99 to $6.75 per person, per year Health Communications: $.65 to $1.95 per person, per year Cessation Interventions: $2.04 to $5.94 per adult, per year Funding Recommendations 3-23

73 Program Administration and Management: the larger of 5% of program budget or one quarter to one full time equivalent (FTE) dedicated staff Surveillance and Evaluation: 10% of program budget when fully funded; more resources may be required when tobacco control is not fully funded Funding Recommendations (continued) 3-24

74 1. Register on the NACCHO Website at =verify =verify 2. Go to 3. Click on the …xls file link in the Download this Tool box on the right side of page NACCHO Tobacco Control Program Funding Table 3-25

75 NACCHO Funding Table 3-26

76 Agency for Toxic Substances and Disease Registry. A Primer for Evaluating Health Risk Communication. Washington, DC: U.S. Department of Health and Human Services, CDC (2001). Updated Guidelines for Evaluating Public Health Surveillance Systems: Recommendations from the Guidelines Working Group. MMWR Morbidity and Mortality Weekly Report, 50(RR-13), CDC (2007). Best Practices for Comprehensive Tobacco Control Programs. Atlanta, GA: Centers for Disease Control and Prevention. McAlister, A., Morrison, T. C., Hu, S., Meshack, A. F., Ramirez, A., Gallion, K., et al. (2004). Media and community campaign effects on adult tobacco use in Texas. Journal of Health Communication, 9(2), Meshack, A. F., Hu, S., Pallonen, U. E., McAlister, A. L., Gottlieb, N., and Huang, P. (2004). Texas Tobacco Prevention Pilot Initiative: processes and effects. Health Education Res, 19(6), Module 3 References 3-27

77 Module 4: Next Steps Planning 4-1

78 Module 4 Training Objectives By the end of this module, participants will be able to list three concrete action steps they will take to expand or improve their comprehensive local tobacco control programs 4-2

79 Take a few minutes to read through the boxed lessons from the field that are included throughout Guidelines Work on your own or with colleagues to complete the Next Steps Planning Worksheet You will identify 3 program areas or components and the following for each: A description of where your program is (current reality) Where you want to go (goal) How you plan to get there (action steps) How you will know that youve arrived (evaluation) Next Steps Planning 4-3

80 Summary, Closing, and Evaluation SCE-1


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