CDC’s Best Practices for Comprehensive Tobacco Control

Programs

Jerelyn Jordan

Centers for Disease Control and Prevention

Office on Smoking and Health

Environment -- U.S.A.

• Master Settlement Agreement, November 23, 1998– Settled state lawsuits against tobacco industry– Extends to 46 states (4 settled individually)– Provides $206 billion over 25 years to states– Limited public health provisions– No funds specifically earmarked for tobacco

control

Basis for Lawsuits

• Recoup costs states paid to treat ill smokers

• Companies violated antitrust laws

• Violated consumer protection laws

• Conspired to withhold information about adverse health effects of tobacco

• Manipulated nicotine levels to keep smokers addicted

Post-MSA Spendingper Federal Trade Commission

0

1

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4

5

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9

1998 1999

billions on advertisingand promotion

Major Issues for States

• Funding competition between tobacco control and other state priorities

• Restrictions in state legislation (e.g., earmarking funds for youth activities only)

• Need for future renewal of legislation• Shortened start up timeline for increased

funding and activity• Increased scrutiny of programs

Best Practices for Comprehensive Tobacco Control

Programs• U.S. tobacco control resources are

expanding

• CDC/Office on Smoking and Health has received increased requests for guidance on effective programs

• Response: Best Practices for Comprehensive Tobacco Control Programs

What’s in Best Practices?

• Program recommendations

• Funding recommendations

• References for more information

• State comparison information

• State specific information, by program area

Origin of Best Practices

• Recommendations are evidence based

• Analysis of excise tax funded programs in California and Massachusetts

• CDC’s involvement in planning programs

• Activities in 4 states that individually settled with the tobacco industry

Best Practices

• Tobacco control program key attributes– Comprehensive– Sustainable– Accountable

Comprehensive Tobacco Control Programs Work

• Dose response relationship between levels of spending and program effect

• Increase in spending per capita associated with larger tobacco control program effect

• Increased efficiency from lessons learned

Best Practices

• Programmatic elements– Community programs to reduce tobacco use

and denormalize smoking– School programs– Enforcement of existing regulations and laws– Statewide programs– Cessation programs

Best Practices

• Programmatic elements (continued)– Countermarketing programs,

including paid broadcast and print media, media advocacy, public relations, public education, and health promotion activities

– Surveillance and evaluation– Administration and management

Best Practices

• Goals of community programs:– To reduce exposure to environmental tobacco

smoke– To prevent initiation in youth– To promote cessation in adults and youth– To identify and eliminate health disparities

among populations

“The potential for combined effects underscores the need for comprehensive approaches.”

Reducing Tobacco Use

A Report of the Surgeon General

August, 2000

“Young people will perceive contradictory or inconsistent messages in our prevention efforts if programs do not address the smoking behavior of parents and other adult role models and the public health risks of environmental tobacco smoke.”

Reducing Tobacco Use, 2000

Investment in Tobacco Control:State Highlights 2001

• State information:– Adult smoking rates– Youth tobacco use– Health impact and cost– Tobacco control legislation/tobacco taxes– Tobacco economy (sales, agriculture,

manufacturing)– Sources of funding for tobacco control

“Simply stated, our recent lack of progress in tobacco control is attributable more to the failure to implement proven strategies than it is to a lack of knowledge about what to do.”

Reducing Tobacco Use, 2000

CDC WebsiteHttp://www.cdc.gov/tobacco

• Best Practices for Comprehensive Tobacco Control Programs

• Investment in Tobacco Control: State Highlights 2001

• Reducing Tobacco Use: A Report of the Surgeon General, 2001