CDC s Best Practices for Tobacco Control Programs

Transcription

1 Best Practices in Tobacco Control Programs: Update Stanton Glantz, PhD Center for Tobacco Studies University of California, San Francisco Johns Hopkins Bloomberg School of Public Health CDC s Best Practices for Tobacco Control Programs Tobacco control programs should be comprehensive, sustainable, and accountable CDC recommends that states establish and sustain tobacco control programs that contain the following overarching components: State and community interventions Health communication interventions Cessation interventions Surveillance and evaluation Administration and management 2 1

2 Comprehensive Tobacco Control Programs Prevent smoking initiation Help smokers quit Educate the public, the media, and policymakers about policies that reduce tobacco use Serve as a counter to the ever-present tobacco industry 3 Recent Evidence 2007 landmark reports conclude there is overwhelming evidence that state tobacco control programs substantially reduce tobacco use Dose response relationship between levels of spending and program effect Best funded and most sustained tobacco prevention programs during the 1990s Arizona, California, Massachusetts, and Oregon reduced cigarette sales more than twice as much as the country as a whole (43 percent compared to 20 percent) Text source: National Cancer Institute. (2007). Institute of Medicine. (2007). Farrelly, M.C. et al. (2003). 4 2

3 The California Tobacco Control Program Began in the 1970s with Minnesota Clean Air Act Nonsmokers rights activism Unsuccessful efforts in state legislature Two failed ballot initiatives (1978, 1980) Created foundation for later successes 5 The California Tobacco Control Program Shifted to local organizing Takes advantage of strong public support Local politicians more sensitive to people than state or national politicians national politicians Fewer resources required to mount a successful campaign Tobacco industry weaker than at higher levels in the political system Educate then legislate 6 3

4 Need for Proactive Implementation Education of public and business Focus on nonsmokers and benefits of law Fixed grace period when focus is on education not enforcement Strong visible enforcement after grace period Image source: World Health Organization. (2007). 7 Anticipate Industry Pushback after the Law Passes Often through third parties Restaurant, bar, casino organizations Libertarian think tanks and politicians Claims of economic chaos and widespread defiance Litigation Efforts to repeal Legislative and referendum Lasts six to nine months 8 4

5 Defend the Law Positive testimonials More valuable than statistical evidence Visible public support Defend the law in court and politically Serious enforcement Many successes: California, New York City, Victoria, British Columbia, Ireland, Mexico City Some failures: Holland bars 9 A Year Later Law grows in popularity With everyone, nonsmokers and smokers Everyone will wonder what the big deal was Model for success elsewhere 10 5

6 Proposition 99 (1988) Idea came from environmental movement 25 cent tax increase 5 cents to tobacco control 1 cent to research 1 cent to environment Rest to medical services Led to the largest tobacco control program in history Image source: Glantz, A. and Balbach, E. (2000). 11 Politics of Implementation Advocates underestimated resistance Tobacco industry California Medical Association (right) Western Center on Law and Poverty (left) Agreed to small diversions to get the appropriation through 12 6

7 Program Implementation Stars lined up Governor let Health Department do its job Visionary leadership Innovative focus Identified the tobacco industry as the problem Social norm change Focused on nonsmoker Policy intervention 13 Key Elements Focused on social norm change and nonsmokers Policy orientation Not youth- or school-focused Directly confronted the tobacco industry 14 7

8 Political Attacks Governor Wilson suspended media campaign American Lung Association (ALA) sued Pitched battle over campaign content Diversions continued Big fight in 1994: American Heart Association (AHA), Americans for Nonsmokers Rights (ANR) Funding restored But ongoing battles over quality of campaign 15 It Worked: Per Capita Cigarette Consumption Data source: Fichtenberg and Glantz. (2000). 16 8

9 Heart Disease Deaths Dropped 59,000 fewer deaths (9%) 1,500 unnecessary deaths Data source: Fichtenberg and Glantz. (2000). 17 So Did Industry Sales Data source: Fichtenberg and Glantz. (2000). 18 9

10 And Lung Cancer Incidence Data source: Barnoya and Glantz. (2004). 19 The Health Cost Savings Grow with Time Data source: Lightwood, Dinno, and Glantz. (2009)

11 Over First 15 Years Over the first 15 years, the California program cost $1.4 billion It saved $86 billion These savings started appearing quickly and grew with time By 2004, the program was saving $11 billion in health costs 7.3% of all health costs Cost tobacco industry over $9 billion 21 California Adult Smoking Prevalence, Data source: California Department of Public Health, California Tobacco Control Program, March

12 The Bottom Line Large scale tobacco programs work Focus on nonsmokers, social norms, and policy change Do not focus on kids or cessation The stakes are very high Expect and deal with opposition Large and immediate health and cost benefits 23 12