tomorrow will not be like yesterday
TRANSCRIPT
Tomorrow will not be like
yesterday….
What’s next in tobacco control ?
April Roeseler Minnesota Tobacco Control Conference
December 6, 2010
Tomorrow will not be like yesterday Global economic meltdown
Tomorrow will not be like yesterday
Overconsumption
Tomorrow will not be like yesterday
Highly effective interventions
• Tobacco tax
increases
•Secondhand
smoke policies
•Media
interventions
Tomorrow will not be like yesterday
Health Inequities
Yesterday
California Tobacco Control Program Begins
1988 –California voters
pass Proposition 99.
Tobacco tax increases
from 10¢ to 35¢ per
cigarette pack and
earmarks 5¢ (20%) of
the revenues for a
tobacco control
program.
CTCP Prop 99 Budget 1989-90 to 2010-11
95.3
62.1
52.6 50.9
43.1 41.0 36.6
89.5
105.3
72.5
60.3
87.4
107.3
61.2 62.8
55.9 57.8
64.2
55.7 54.6 54.7 53.8
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120
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Mill
ions
Fiscal Year
Strategy
Goal = change social norm
Outcome = prevention & cessation
Social Norm Change Strategy
Creates a social milieu and legal climate, where tobacco becomes:
Less Desirable
Less Acceptable
Less Accessible
Denormalization Strategy
Lasting change in youth behavior regarding
tobacco can only be secured by first changing
the adult world in which youth grow up.
High Level Logic Model
Reduce Exposure to
Secondhand Smoke
(SHS)
Support
Cessation
Decrease Tobacco
Consumption
Decrease
Tobacco
Use Prevalence
Decrease Youth
Uptake of
Tobacco
Decrease
Exposure to
SHS
Counter Pro-
Tobacco Influences
Outcomes Goals
Program Implementation
Technical
Assistance
Legal
Center
37 Community Non-profit Agency Projects
61 Health Department Projects
& Community Coalitions
Statewide Evaluation/Surveillance
California Tobacco Control Program
Statewide Media Campaign
Center
for Policy & Community
Organizing
Clearinghouse
Tobacco
Control
Evaluation
Center
Cessation Quitline
& Training
Center
California Youth
Advocacy
Network
Statewide Infrastructure & Training & Technical Assistance Projects Capacity
Building Center
for
Diverse
Populations
STAKE Youth
Recruitment Team Lab
Materials
Development
Media
Community Involvement
+
=
Social Norm Change
A Powerful Equation
Role of Media
• To be ahead of
the of the wave
(public opinion)
• To use the
energy at the
front of the wave
to pull public
opinion forward
Attitudes Influence Behavior
Secondhand Smoke Strategy
• Increases support
for local policies
• Provides smokers
a reason to quit
Secondhand Smoke (SHS)
• Positive SHS attitudes predict quitting
– Smokers are 70% more likely to have made a recent quit attempt
– Smokers are over 2 times more likely to have intentions to quit smoking in the next 6 months
California Tobacco Control Program, California Department of Public Health, A Confirmatory Factor Analysis of
a Social Norm Change Paradigm for the California Tobacco Control Program, May 2006.
Anti-Industry Strategy
• Motivates smokers to quit; inoculates them against advertising and marketing
• Undermines tobacco industry’s point of view
• Holds the industry accountable for their marketing practices
• Increases non-smoker’s empathy towards smokers
Countering Pro-
tobacco Influences
• Californians with highly negative attitudes
about the tobacco industry are:
– Among smokers, 67% were more likely to
have made a recent quit attempt
– Among smokers, 62% are more likely to have
intentions to quit in the next six months
California Tobacco Control Program, California Department of Public Health, Evaluation of California’s Anti-tobacco Media Campaign,
Waves 6, 7 and 8. February 2008.
Cessation Strategy
Call 1-800-NO BUTTS
• Demonstrates
empathy for
smokers
• Provides
resources and
encouragement to
quit
Smoking Cessation Ads
• Are effective at
generating motivated
smokers to call the
Quitline, they do not
make an impact on
smokers who are
unmotivated to quit.
Role of Community
• Amplifies the message
• Ties the program to the
community
• Diversifies expertise,
influence, & connections
• Results in policy change
Local Data Collection Drives
Policy
Chico & San Francisco ban free
tobacco & coupons
Tobacco Retail Licensing 1.0
TRL 2.0: San Francisco bans tobacco
sales in pharmacies
San Francisco drugstore before midnight
October 1, 2008
San Francisco drugstore after midnight
October 1, 2008
Tobacco Litter: 1.0 Policies
Cigarette Litter: 2.0 Policies
A funny thing happened on the way
to the forum (aka State Capitol)
Sacramento News and Review
May 27, 1993
Sacramento Bee
February 21, 2008
“We didn’t get to
where we are on
tobacco cessation
by working
cooperatively with
the industry.”
Senator Alex Padilla
Outcomes
30-day smoking prevalence for California and United States high school (9th-12th grade) students,
2000-2010
28.1
22.5 21.7 19.7
17.2
21.6
16.0
13.2 15.4 14.6 13.8
0
5
10
15
20
25
30
2000 2002 2004 2006 2008 2009 2010
Perc
ent
High School U.S. (9-12th graders)
High School CA (9-12th graders)
Source: The 2000 California data is from the National Youth Tobacco Survey (NYTS) collected by the American Legacy Foundation, which used passive parental consent. The 2002, 2004, 2006, 2008, and 2010 data are from the California Student Tobacco Survey. The 2002 and 2004 data collection used active parental consent while the 2006, 2008, and 2010 used a mixed parental consent procedure. The United States data are from the NYTS collected by the American Legacy Foundation and the Centers for Disease Control and Prevention. Note that the NYTS was conducted in 2009 thus 2008 and 2010 United States data are unavailable. Prepared by: California Department of Public Health, California Tobacco Control Program, April 2011.
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Pa
ck
s/p
er
ca
pit
a
CaliforniaUS-CaliorniaPoly. (California)Poly. (US-Caliornia)
California 160 156 149 142 139 133 128 123 110 102 95 92 86 81 79 76 74 71 62 55 51 48 46 45 45 44 41 41 38 35
US-Caliornia 183 180 173 167 165 161 157 153 147 139 134 130 126 123 123 120 120 117 112 108 104 101 95 92 89 85 82 77 73
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Source: Behavioral Risk Factor Surveillance System (BRFSS) 1984-1992, BRFSS and California Adult Tobacco Survey data is combined for
1993-2008. The smoking prevalence is adjusted from 1984 to 1995 to account for the change in smoking prevalence that includes more
occasional smokers. The data is weighted to the 2000 California population. California State Board of Equalization (packs sold) and US
Census (population).
Prepared by: California Department of Public Health, California Tobacco Control Program, July 2010.
California Adult per Capita Cigarette Pack Consumption
1984 to 2009
Proposition 99
20%
48%
0
5
10
15
20
25
30
Perc
en
t
CA 25.9 27.7 26.6 22.4 23.7 22.1 20.4 20.2 21.0 19.2 17.6 16.9 17.8 17.4 17.5 17.1 16.3 16.4 15.8 15.4 14.6 14.0 13.3 13.8 13.3 13.1
US-CA 24.0 23.6 23.4 23.1 23.0 23.6 23.5 23.0 21.6 21.3 20.3 20.2 19.1
84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09
Adult Smoking Prevalence among California
and US (- CA)
1984-2009
Source: Behavioral Risk Factor Surveillance System (BRFSS) 1984-1992, BRFSS and California Adult Tobacco Survey data is combined for 1993-2008. The data is weighted to the 2000 California population. State BRFSS data is weighted to 2000 national population based on each states population.
Note an adjustment was made to address the change of smoking definition in 1996 that included more occasional smokers. Prepared by: California Department of Public Health, California Tobacco Control Program, March 2010.
Change in Smoking Prevalence Among California Adults
by Race/Ethnicity and Gender, 1990-2005
1990
2005
Percent Decline
Male African American
28.9 21.0 27.3%
Non-Hispanic White
21.4 16.0 25.2%
Hispanic 23.3 16.7 28.3%
Asian/Pacific Islander
21.8 16.1 26.1%
Female African American
24.2 17.1 29.3%
Non-Hispanic White
18.5 13.1 29.2%
Hispanic 11.7 6.8 41.9%
Asian/Pacific Islander
7.3 6.5 11.0%
Lung and Bronchus Cancer Mortality Rates per 100,000 for
California and the US minus California, age 35 years and
older, 1970 to 2007
0
20
40
60
80
100
120
140
1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006
Year
Ag
e-A
dju
ste
d R
ate
s p
er
10
0,0
00
US-CA Age-Adjusted Rates
CA Age-Adjusted Rates
Poly. (US-CA Age-AdjustedRates)Poly. (CA Age-AdjustedRates)
Rates are per 100,000 and age adjusted to the 2000 US std population (19 age groups-Census-P25-1130) standard.
Source: California Cancer Registry, California Department of Public Health.
Prepared by the Cancer Surveillance Section, California Cancer Registry.
On the edge of a new beginning
Tomorrow’s
Manifesto
Do work that matters Price
• Earmarked tax increases
• Minimum price laws
• Tobacco mitigation fees
• Tighten definition of tobacco products
• Ensure equivalent tax on OTP
• Advocate for an encrypted federal tax
stamp
Do work that matters Secondhand Smoke
• Eliminate exemptions & loopholes in
smoke-free local/state/tribal policies
• Expand smoke-free MUH policies
• Expand outdoor smoke-free policies
• Eliminate tobacco use from all acute and
long term health care facility campuses
Do work that matters Tobacco marketing
• Increase tobacco retail density and zoning policies
• Eliminate tobacco sales where health care services are provided (e.g., drug stores, grocery stores, big box stores)
• Use tobacco waste issue to leverage tobacco marketing policies & healthier community campaigns
• Maximize use of FDA marketing restrictions
• Aggressively monitor & enforce FDA legislation
Do work that matters Cessation
• Expand partners in motivating & promoting
cessation
• Aggressively promote & encourage use of
cessation benefits
• Systematize use of EMR to promote
cessation & SHS protection
Performance Matters
Technical assistance powers
social change
• Public health, efforts are more likely to be successful if scientific evidence is incorporated into decisions, policies, and programs.
• While there is evidence about what works, agencies may not uniformly embrace or effectively implement control interventions in a way that produces uniform results.
• TA facilitates rapid dissemination and the uptake of a single policy to statewide scale.
Report Cards Matter
“We’ve got a lot of threats to public health in Richmond said City Councilman Tom Butt who said both his parents died of smoking-related illnesses. We’ve got air pollution problems. We’ve got high asthma rates. We’ve got high diabetes rates. We need to start getting rid of the ones we have control over, and this is one place where we have full control where we can make a significant difference in the health of Richmond residents.”
February 9, 2009
Richmond bans smoking in
MUH, July 2009
Create heath equity
Two criteria to measure every policy
1. “Goodness”: The best attainable goal
that moves public health interests
forward
2. “Fairness” : Achieve the smallest feasible
differences among individuals and
groups
Capitalize on the
“responsibility revolution”
• Tobacco control creates value • 1 million lives saved
• $86 billion in health care costs saved
• Tobacco use is not beneficial to us as a
society, it does not pay the costs
– Tobacco industry causes disease, death, and
it pollutes the environment
Efficiency Matters Adapt Technology
Identify positive
deviance….amplify
Innovate, but have a path to
scale
• Scale is simply something that is so
pervasive or large enough that it makes a
dent in the problem you are trying to solve
• Success will depend on the ability to
amplify the efforts of individuals so that
small successes can be catalyzed for
broad impact
Build sustainable ventures
Sustainability is something that endures
Keys to Sustainability
1. Simple
2. Systematic
3. Adaptable to a broad range of settings
4. Not too many “moving” parts
Grasp that marketing has changed
“Today’s marketers lead tribes”
Create a culture of collaboration
• Develop the “power of pull”…the ability to
draw out people & resources as needed to
address opportunities & challenges
• Learn from others, adapt & adopt
• Stay close with others working in your field
• Be the first to give when building new
relationships
Ideas that Spread Win
“Trapped”: Commercial Image
Award of the Year
California ads on DVDs of 6 movie studios
Tomorrow will not be
like yesterday….