NACCHO’sTobacco Control Guidelines:

Successful Use of the Recommendations

presented by

Dawn M. Dunn, MPHProgram Administrator

Santa Barbara County Public Health Dept.

Presentation Overview

Share successful use of CDC/ NACCHO’s Guidelines in Santa Barbara County.

Showcase results from local tobacco control efforts.

Discuss future implications of their use. Respond to questions and answers.

Advocate to use local MSA funds for their intended purpose—health & tobacco control.

MSA funds can be used for any purpose. Successfully compete against other high

priority projects. Address active opposition from the

County Executive Officer.

The Challenge

Utilize the strength of the existing community tobacco control coalition.

Leadership and staff at Public Health Department join forces.

Learn from the experiences of others who had been successful.

Develop a strategy and an extended partnership.

The Process

The passage of Proposition 99 (the original CA tobacco tax) mandated the creation of a community coalition.

The CA Tobacco Control Program anticipated that a grass-roots community group would be needed.

A coalition, with its autonomy and diversity, can take actions that some agency representatives cannot.

Provides broad-based support.

The Community Coalition

In 1998, the Master Settlement Agreement (MSA) was reached between 47 state’s Attorney Generals and the tobacco industry.

The MSA paid billions of dollars to states to compensate for unreimbursed medical care for treating tobacco-related illnesses.

MSA payments are general funds dollars and may be allocated for any expenditure; they are not earmarked to fund health programs.

The Tobacco Settlement Story

California and New York are the only two states whose counties receive monies directly.

In SB County, approximately 4 million dollars is received annually.

The Tobacco Settlement Story(continued)

TIMING WAS CRITICAL TO OUR SUCCESS

Understood that the anti-tobacco coalition alone, would be insufficient to influence the Board.

Recruited for, and created an expanded coalition, known as the Health Partnership, with a diverse broad-base of support.

Steps to Securing the $$

Santa Barbara County Medical Society Local Hospitals Santa Barbara Community Clinics Santa Barbara League of Women Voters Santa Maria League of Women Voters CEASE (Coalition Engaged in a Smoke-Free Effort)

American Lung Association American Cancer Society American Heart Association Santa Barbara Regional Health Authority Santa Barbara City College

The Health Partnership

CEASE (Coalition Engaged in a Smoke-Free Effort) Santa Barbara Council on Alcoholism and Drug Abuse Tri-County Regional Team UCSB-Student Health Services Santa Barbara and Ventura County Dental Societies

SEIU 620 Lompoc Valley Community Healthcare Council Santa Maria Health Council Human Services Association Faith Initiative of Santa Barbara County Latinos for Better Government

The Health Partnership(continued)

Planned strategies within the Health Department. Secured unwavering commitment from the Public

Health Director. Learned from other counties’ experiences.

Conducted a teleconference with a county that had been successful in securing these funds.

Assessed allies and opponents. Key opponents included the County Administrator &

other county departments.

Steps to Securing the $$ (continued)

Framed the issue from our perspective: Stuck to the intent of the lawsuit, knowing that

selling the issue on the tobacco treatment and prevention platform was key to our success.

Educated on the benefits of prevention.. Appealed to lawmakers’ emotions, not

solely relying on the facts. Understood that all change occurs in a

political and social context.

Steps to Securing the $$ (continued)

And the Funding Goes to Tobacco &

Health

CDC “Best Practices for Comprehensive Tobacco Control Programs” released in 1997

NACCHO Guidelines replace CDC Best Practices in 2001.

Using NACCHO Guidelines

Publications perfectly timed to be used to secure MSA funds.

Disseminated Best Practices to local elected officials.

Used NACCHO Best Practice recommendations to set tobacco control funding priorities.

Using NACCHO Guidelines

INVEST 25% of MSA $$ in TOBACCO CONTROL

Realities of Tobacco Use in Santa Barbara County

Recommendation to Invest 25%of the Settlement Monies in Tobacco Control

Program Category Dollars Allocated in 1st

Year

Percent CDC Guideline(minimum-maximum)

Media Campaign $ 245,000 29% $200,000-$600,000

Cessation and Adjunct Support $135,000 17% $555,500

Enforcement $ 55,000 7% $172,000-$320,000

Youth and Special Populations Outreach/ Intervention Includes subcontractors/CBO’s

$ 210,000 26% $280,000-$800,000

Evaluation, Administration and Surveillance $ 170,000 21% $211,125-$341,325

TOTAL:

$815,000 100% $1,418,625-$2,616,825

The table on the previous slide shows the format used annually to ask for the funds.

A two-page needs paper was presented, with needs and program solutions.

Customized funding recommendations to local needs and program and community strengths.

Used the comprehensive approach to tobacco control established by CA TCP as a guide along with CDC/ NACCHO recommendations.

Using NACCHO Guidelines (continued)

School-based recommendations were not followed for several reasons. Local schools networks and programs in tobacco

prevention presented challenges. Funding levels were insufficient to fully fund this aspect

of the program. Allowed agencies to apply for grant funds to do

augment their services or activities. Assisted with grant applications Funded other CBO’s already working in the

schools.

Using NACCHO Guidelines (continued)

Salaries and administrative costs have are above recommendations. Considered to give monies to CBO to reduce costs,

but community supports County playing this role. Adjust programming as funding decreases. Managing grantees has proved both rewarding

and challenging. Showing prevention program results is difficult. Media and outreach activities are always under

attack.

The Guidelines—Modified

Received one of the largest per capita allocation of tobacco settlement dollars.

Established an Advisory Committee to make funding recommendations to the Board.

Avoided a cumbersome RFP allocation process to award local MSA funds.

Created an endowment for 20% of the funds annually.

Local MSA Outcomes

Funding Allocation Graph

2008-2009 Tobacco Program Funding By Priority Area - No Cuts $575,093 (Total Program Costs)

Cessation & Pharmaceuticals

$190,832

Media & Promotions

$106,726

Administration $19,566

Evaluation $32,614

Prevention & Outreach$159,589

Enforcement$65,766

3%

28%

11%

33%

19%

6%

Helped over 3,000 people with their attempts to quit smoking. Funded between 7-12 agencies/individuals

to provide services. Reimburse financially eligible clients’ for

FDA-approved pharmaceuticals. FY 07-08 quit rates were 51% at 3 months

and 39% at 6 months.

Local MSA Outcomes (continued)

Provided outreach and education to over 10,000 youth and young adults annually. Funded local CBO’s, the County Education Office,

schools, colleges and the university. These groups provided prevention, cessation, and

evaluation activities.

Funded enforcement efforts. Increased compliance with smoke-free bar law Decreased sales to minors from 38% to 11%

Local MSA Outcomes (continued)

Developed and placed numerous local media campaigns: Aimed at young adult tobacco use Reducing cigarette butt litter Promoting specific cessation services and creating

a positive climate for quitting. Campaign recall rates at 53%, with 63%

stating that the campaign would affect their behavior.

Local MSA Outcomes (continued)

Program funding levels cut from 25% to 15% over the years, with more cuts anticipated.

County costs continue to escalate. Specific shortfalls in other critical programs

threaten continued tobacco control funding. Political will and climate, coupled with the

dismantling of the TSAC Advisory Committee, make future funding tentative at best.

Next Steps—Rough Road Ahead

Best practices and data to prove that tobacco control works, assist local programs in making their case for comprehensive programs!

Best Practices and Data Needed