State Tobacco-Use Prevention and Control Plans
In October 1989, the Association of State and Territorial Health Officials (ASTHO) surveyed health agencies in all 50 states and the District of Columbia to assess activities related to control of tobacco use. The survey focused on the extent to which planning efforts met criteria listed in Guide to Public Health Practice: State Health Agency Tobacco Prevention and Control Plans (1).* Respondents submitted copies of existing plans for tobacco-use prevention and control. This report summarizes the analysis of specific plans to control tobacco use (free-standing plans) or plans that form a discrete section on tobacco-use-control in a more general health-planning document.
Plans were evaluated in terms of the following components: 1) involvement of a tobacco-and-health coalition or advisory group comprising representatives from both the private and public sectors; 2) inclusion of an analysis of state-specific tobacco-use behavior; 3) presentation of detailed objectives and specific strategies for reducing tobacco use in the state; 4) presence of an outline of a specific workplan identifying individuals and organizations responsible for implementing the plan; 5) description of outcome evaluation measures, including tobacco-use surveillance systems; 6) description of process evaluation measures of program/plan activities (e.g., integrity of programs and models); and 7) presence of state funding for reducing tobacco use (Table 1).
As of December 31, 1989, 12 states (Colorado, Massachusetts, Michigan, Minnesota, Nebraska, New Jersey, North Dakota, Oregon, Pennsylvania, Utah, Vermont, and Virginia) had published plans for tobacco-use prevention and control (Table 1). Minnesota published the first plan in 1984, and five states (Colorado, Michigan, New Jersey, Vermont, and Virginia) published their plans during 1989. Alabama, Connecticut, Idaho, Illinois, Indiana, and Rhode Island reported that smoking prevention was included in their general plans for health service. Colorado, North Dakota, and Utah have plans as part of the Rocky Mountain Tobacco-Free Challenge, an eight-state effort to reduce the prevalences of tobacco use and chronic diseases associated with tobacco use (2).
All the state plans addressed the seven critical components of planning as well as high-risk populations, health care, smoking cessation issues, worksite policies, public education activities, and school and adolescent program strategies. Nine of the 12 states with plans funded activities for tobacco-use prevention and cessation. Workplans to implement listed objectives and process measures were the most frequently omitted critical elements.
Of the nine plans that included state-specific assessment of tobacco-use behavior, six assessed adolescent smoking prevalence, and eight assessed adult smoking prevalence (Table 2). Seven states included an economic analysis, including tax data or other economic issues. Four states included state legislation and policies in their plans, and three included using state/local resources for tobacco-use prevention and control. Reported by: KM Marconi, PhD, JW Colborn, MS, National Cancer Institute, National Institutes of Health. Program Svcs Activity, Office on Smoking and Health, Center for Chronic Disease Prevention and Health Promotion, CDC.
Editorial Note: Elements essential to the control of tobacco use include comprehensive planning, evaluation, funding, and community support. The ASTHO survey provides baseline information for measuring progress in these areas during the 1990s. This information will be particularly important in 1993, when the National Cancer Institute and the American Cancer Society will sponsor the American Stop Smoking Intervention Study (ASSIST) (3). This multistate effort will provide funding, coordination, training, and evaluation for tobacco-use prevention and control in 20 geographic areas (which could include entire states or large metropolitan areas) through 1998.
One indication of the growth in state-based tobacco-use-control activities is the number of states that reported developing plans to address this problem. Ten additional states (Arkansas, Delaware, Maine, Missouri, New Mexico, Ohio, Rhode Island, Texas, West Virginia, and Wisconsin) are expecting to publish plans.
Tobacco use is a public health problem that may be approached at the state level through community involvement. A conference on the Public Health Practice of Tobacco Prevention and Control on March 8 and 9, 1990, in Houston will address these issues. This conference will provide state-based tobacco-control specialists a forum for information exchange and technical assistance on a wide range of tobacco-control activities. These activities will direct the national efforts toward a smoke-free society by the year 2000. Further information on the conference is available from ASTHO at (703) 556-9222 or CDC at (770) 488-5701.
Association of State and Territorial Health Officials/National Cancer Institute. Guide to public health practice: state health agency tobacco prevention and control plans. McLean, Virginia: Association of State and Territorial Health Officials, 1989.
CDC. State-based chronic disease control: the Rocky Mountain Tobacco-Free Challenge. MMWR 1989;38:749-52.
CDC. Trends in lung cancer incidence--United States, 1973-1986. MMWR 1989;38:505-6, 511-3. *Copies are available from the National Cancer Institute, 9000 Rockville Pike, Building 31, Room 10A24, Bethesda, MD 20892; or the Technical Information Center, Office on Smoking and Health, Center for Chronic Disease Prevention and Health Promotion, CDC, 5600 Fishers Lane, Park Building, Room 1-16, Rockville, MD 20857.
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