Highlights: Comprehensive Programs

Rationale for Comprehensive Intervention

• Statewide programs have emerged as the new laboratory for developing and evaluating comprehensive plans to reduce tobacco use.
• Initial results from statewide tobacco control programs are encouraging, particularly in per capita declines of tobacco consumption.
• State findings also suggest that youth behaviors regarding tobacco use are more difficult to change than adult ones.
• People do not make behavior choices in isolation, but rather in a larger, complex context that includes the family, community, and culture; the economy and physical environment; formal and informal government policy; and the prevailing legal atmosphere. Programs to reduce tobacco use will be most effective if they address all the components that may influence the individual’s behavior choices.
• There are several advantages to shifting from an approach that targets the individual to a population approach that uses social, policy, and environmental strategies.
• First, by recognizing that many environmental determinants of health behavior are not under the direct control of the individual, the population approach avoids blaming persons who fail to change their behavior.
• Second, many individual efforts may fail to reach those in greatest need. Because many of these strategies are most effective with better-educated, wealthier persons, the disparities in health between population groups may widen.
• Third, making regulatory and policy changes can be more cost-effective than conducting numerous interventions to modify individual behavior.

CDC's National Tobacco Control Program

• In May 1999, CDC launched the National Tobacco Control Program (NTCP), bringing the various federal initiative activities into one national program. In fiscal year 2000, the NTCP distributed $59 million for comprehensive tobacco control efforts in all states, the District of Columbia, seven U.S. territories, and Native American tribal organizations.
• CDC recommends four program goals in its comprehensive framework for statewide programs
  1. Prevent initiation of tobacco use among young people.
  2. Promote quitting among adults and young people.
  3. Eliminate exposure to environmental tobacco smoke (ETS).
  4. Identify and eliminate health disparities among population groups.
• Each program goal would be fully addressed by implementing four program components:
  1. Community interventions, which include diverse entities such as schools, health agencies, city and county governments, and civic, social, and recreational organizations
  2. Countermarketing, which includes using media advocacy, paid media, pro–health promotions, and other media strategies to change social norms related to tobacco use
  3. Program policy and regulation, which addresses such issues as minors’ access, tobacco pricing, advertising and promotion, clean indoor air, product regulation, and tobacco use treatment
  4. Surveillance and evaluation, which includes monitoring the tobacco industry’s promotional campaigns, evaluating the economic impact of ETS laws and policies, conducting surveys of public opinion on program interventions, and making ongoing refinements that lead to more effective prevention strategies
• The elimination of health disparities among population groups remains a challenge due to the lack of culturally appropriate programs of proven efficacy. However, in recent years, a number of people and organizations with more diverse backgrounds have assumed a greater role in efforts to reduce tobacco use. Particularly in view of the tobacco industry’s targeted marketing to women, young people, and racial/ethnic populations, such heightened activity is critically important for ensuring that nonsmoking becomes the norm within diverse communities.
• To be effective, comprehensive programs should include campaigns that include the following:
  1. Target young people and adults with complementary messages
  2. Highlight nonsmoking as the majority behavior
  3. Communicate the dangers of tobacco while providing constructive alternatives
  4. Use multiple nonpreachy voices in a complementary, reinforcing mix of media and outdoor advertising
  5. Include grassroots promotions, local media advocacy, event sponsorships, and other community tie-ins
  6. Encourage youth empowerment and involvement