State-Based Chronic Disease Control: The Rocky Mountain Tobacco-Free Challenge

In 1984, the Surgeon General set as a goal a "smoke-free society" in the United States by the year 2000 (1). To help meet this goal, in February 1988, the governors of eight states--Arizona, Colorado, Montana, New Mexico, North Dakota, South Dakota, Utah, and Wyoming--initiated the Rocky Mountain Tobacco-Free Challenge (RMTFC), a regional effort to reduce the prevalences of tobacco use and chronic diseases associated with tobacco use. The RMTFC will continue until the year 2000; each year, based on evaluation of efforts to reduce tobacco use, the RMTFC plans to designate one state as the challenge leader. Based on information reviewed by the evaluation panel in May 1989, North Dakota was the leader after the first year of the RMTFC.

Health education directors of the participating states developed the following objectives for each of the eight states for the year 2000: 1) a 50% reduction in the prevalence of tobacco use among adults and adolescents, 2) an overall 50% reduction in tobacco consumption, 3) a 25% reduction in tobacco-attributable mortality, and 4) statewide clean indoor air laws that eliminate environmental tobacco smoke exposure in public places and worksites. Baseline data for these objectives are available from different national and state sources (2-5) (Table 1).

For 1988-89, the RMTFC had two components. First, 12 areas for intervention were designated: coalition building and networking; community information and education; counteradvertising; economic incentives and disincentives; higher education; legislation; policy; professional education; program planning and evaluation; schools; special populations; and miscellaneous.

State health departments solicited for review descriptions of ongoing or planned tobacco-use reduction programs from local agencies, volunteer groups, and coalitions. One hundred twenty-three descriptions were submitted in the eight states. Each state then chose one program from each of the 12 areas for evaluation by the Office on Smoking and Health (OSH), Center for Chronic Disease Prevention and Health Promotion, CDC, which is providing technical assistance to the RMTFC. OSH and experts from other federal, state, and voluntary health agencies determined from all submissions the most effective program for each area.

For the second component, OSH and the eight states collected state-specific baseline data to help the panel assess the overall tobacco prevention and control activity within each state. A standard questionnaire was used to obtain information on tobacco-use surveillance, health department policies and programs, legislative activities, coalitions, school activities, demographics, and state government activities. The panel used these data to determine which states had the most effective programs for reducing the prevalence of tobacco use.

North Dakota was judged to be the leader after the first year of the RMTFC; New Mexico and Colorado ranked second and third, respectively. Most states emphasized public information programs in their efforts to reduce the prevalence of tobacco use. Because less emphasis has been placed on primary and secondary education programs and surveillance, the RMTFC demonstrated an overall need in the region for improved surveillance of adolescent smoking behavior (Table 1). Reported by: WF Young, MA, Div of Prevention Programs, Colorado Dept of Health. D Vilnius, MPA, Bur of Health Promotion and Risk Reduction, Utah Dept of Health. S Adams, MS, Div of Health Promotion and Education, North Dakota State Dept of Health. M Futa, MA, Health Risk Reduction Program, Wyoming Dept of Health and Social Svcs. B Lancaster, MA, Office of Health Promotion and Education, Arizona Dept of Health Svcs. R Moon, MPH, Preventive Health Svcs Bur, Montana Dept of Health and Environmental Svcs. L Pendley, MHS, Health Promotion Bur, New Mexico Health and Environment Dept. L Post, MPH, P Marso, Health Education/Promotion Program, South Dakota Dept of Health. Program Svcs Activity, Office on Smoking and Health, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note Key elements of the RMTFC include the active participation of the eight state governors, increased community interest, strengthened interstate and intrastate collaboration, promotion of state activities to reduce tobacco use, and implementation of long-term evaluation of tobacco-related policies. The competitive approach employed by the eight states is a model that other regions of the country can adopt for innovative tobacco-use-reduction activities.

To facilitate planning for state-based tobacco-control activities, the Association of State and Territorial Health Officials has published and distributed the Guide to Public Health Practice: State Health Agency Tobacco Prevention and Control Plans (6). Strategies for implementation of tobacco prevention and control plans outlined in this guide include use of federal resources; development of coalitions and advisory groups; assessment of tobacco use in the state through surveys; development of a mission with goals and objectives; analysis of existing tobacco-control programs and resources and the potential to expand on these programs; and presentation, evaluation, and revision of the plan.* Examples of successful tobacco prevention and control plans include those already developed by North Dakota, New Mexico, and Colorado.

Stimulation of activity at the local level (e.g., communities, counties, and coalitions) is essential to effective tobacco control and may promote national progress toward a smoke-free society. On November 16, the annual Great American Smokeout will emphasize nationwide efforts at the local level to reduce the prevalence of smoking. Sponsored each year by the American Cancer Society, this event serves as a focal point for support of smokers who are trying to quit. During the 24-hour period of the 1988 Smokeout, an estimated 18.4 million smokers tried to quit smoking, and approximately 5.4 million refrained from smoking during the entire 24-hour period (7).

References

1. Koop CE. Julia M. Jones Lecture: A smoke-free society by the year 2000. Presented at the annual meeting of the American Lung Association, Miami Beach, May 20, 1984.

2. CDC. Behavioral risk factor surveillance 1987, selected states. MMWR 1989;38:469-73.

3. Tobacco Institute. The tax burden on tobacco: historical compilation. Washington, DC: The Tobacco Institute, 1988;23:29.

4. CDC. State-specific estimates of smoking-attributable mortality and years of potential life lost--United States, 1985. MMWR 1988;37:689-93.

5. CDC. Reducing the health consequences of smoking: 25 years of progress--a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

6. 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.

7. Lieberman Research Inc. A study of the impact of the 1988 Great American Smokeout: summary report, Gallup Organization. New York: American Cancer Society, 1988. *Copies of the Guide may be obtained after January 1, 1990, from either the Cancer Com munications Branch, National Cancer Institute, telephone (301) 496-6792, or the Technical Information Center, OSH, telephone (301) 443-1690.

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