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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 $$ (continued)
CDC “Best Practices for Comprehensive Tobacco Control Programs” released in 1997
NACCHO Guidelines replace CDC Best Practices in 2001.
Using NACCHO Guidelines
Publications perfectly timed to be used to secure MSA funds.
Disseminated Best Practices to local elected officials.
Used NACCHO Best Practice recommendations to set tobacco control funding priorities.
Using NACCHO Guidelines
INVEST 25% of MSA $$ 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