Carol L. Schmitt

Research support for effective state and community tobacco control programme response to electronic nicotine delivery systems

Objective To identify unmet research needs of state and community tobacco control practitioners pertaining to electronic nicotine delivery systems (ENDS or e-cigarettes) that would inform policy and practice efforts at the state and community levels, and to describe ENDS-related research and dissemination activities of the National Cancer Institute-funded State and Community Tobacco Control Research Initiative. Methods To determine specific research gaps relevant to state and community tobacco control practice, we analysed survey data collected from tobacco control programmes (TCPs) in all 50 US states and the District of Columbia (N=51). Survey items covered a range of ENDS issues: direct harm to users, harm of secondhand vapour, cessation, flavours, constituents and youth access. Results There is no ENDS topic on which a majority of state TCP managers feel very informed. They feel least informed about harms of secondhand vapour while also reporting that this information is among the most important for their programme. A majority (N=31) of respondents indicated needs for research on the implications of ENDS products for existing policies. Conclusions TCP managers report that ENDS research is highly important for practice and need research-based information to inform decision making around the inclusion of ENDS in existing tobacco control policies. For optimal relevance to state and community TCPs, research on ENDS should prioritise study of the health effects of ENDS use and secondhand exposure to ENDS vapour in the context of existing tobacco control policies.

Public and policy maker support for point-of-sale tobacco policies in New York.

Purpose. To compare public and policy maker support for three point-of-sale tobacco policies. Design. Two cross-sectional surveys—one of the public from the New York Adult Tobacco Survey and one of policy makers from the Local Opinion Leader Survey; both collected and analyzed in 2011. Setting. Tobacco control programs focus on educating the public and policy makers about tobacco control policy solutions. Subjects. Six hundred seventy-six county-level legislators in New Yorks 62 counties and New York Citys five boroughs (response rate: 59%); 7439 New York residents aged 18 or older. Landline response rates: 20.2% to 22%. Cell phone response rates: 9.2% to 11.1%. Measures. Gender, age, smoking status, presence of a child aged 18 years or younger in the household, county of residence, and policy maker and public support for three potential policy solutions to point-of-sale tobacco marketing. Analysis. t-tests to compare the demographic makeup for the two samples. Adjusted Wald tests to test for differences in policy support between samples. Results. The public was significantly more supportive of point-of-sale policy solutions than were policy makers: cap on retailers (48.0% vs. 19.2%, respectively); ban on sales at pharmacies (49.1% vs. 38.8%); and ban on retailers near schools (53.3% vs. 42.5%). Limitations: cross-sectional data, sociodemographic differences, and variations in item wording. Conclusions. Tobacco control programs need to include information about implementation, enforcement, and potential effects on multiple constituencies (including businesses) in their efforts to educate policy makers about point-of-sale policy solutions.

The Haverstraw Experience: The First Tobacco Product Display Ban in the United States

In April 2012, the village of Haverstraw, New York, passed the first tobacco retail display ban in the United States. Community groups funded by the New York State Department of Health Tobacco Control Program mobilized community members to support an initiative to protect youths in their area from tobacco marketing via methods consistent with a community transformation framework. The law was soon rescinded after 7 tobacco companies and the New York Association of Convenience Stores filed a federal lawsuit against the village that challenged the laws constitutionality. We discuss lessons learned and next steps for adoption of local point-of-sale policies.

Factors Involved in the Collaboration Between the National Comprehensive Cancer Control Programs and Tobacco Control Programs: A Qualitative Study of 6 States, United States, 2012

Introduction Historically, federal funding streams to address cancer and tobacco use have been provided separately to state health departments. This study aims to document the impact of a recent focus on coordinating chronic disease efforts through collaboration between the 2 programs. Methods Through a case-study approach using semistructured interviews, we collected information on the organizational context, infrastructure, and interaction between cancer and tobacco control programs in 6 states from March through July 2012. Data were analyzed with NVivo software, using a grounded-theory approach. Results We found between-program activities in the state health department and coordinated implementation of interventions in the community. Factors identified as facilitating integrated interventions in the community included collaboration between programs in the strategic planning process, incorporation of one another’s priorities into state strategic plans, co-location, and leadership support for collaboration. Coalitions were used to deliver integrated interventions to the community. Five states perceived high staff turnover as a barrier to collaboration, and all 5 states felt that federal funding requirements were a barrier. Conclusions Cancer and tobacco programs are beginning to implement integrated interventions to address chronic disease. Findings can inform the development of future efforts to integrate program activities across chronic disease prevention efforts.

Using a Theory of Change to Guide Grant Monitoring and Grantmaking.

Charitable foundations play a significant role in advancing public health, funding billions of dollars in health grants each year. Evaluation is an important accountability tool for foundations and helps ensure that philanthropic investments contribute to the broader public health evidence base. While commitment to evaluation has increased among foundations over the past few decades, effective use of evaluation findings remains challenging. To facilitate use of evaluation findings among philanthropic organizations, evaluators can incorporate the foundations theory of change—an illustration of the presumed causal pathways between a programs activities and its intended outcomes—into user-friendly products that summarize evaluation findings and recommendations. Using examples from the evaluation of the Kansas Health Foundations Healthy Living Focus Area, we present a mapping technique that can be applied to assess and graphically depict alignment between program theory and program reality, refine the theory of change, and inform grantmaking.

Measuring infrastructure: A key step in program evaluation and planning

State tobacco prevention and control programs (TCPs) require a fully functioning infrastructure to respond effectively to the Surgeon Generals call for accelerating the national reduction in tobacco use. The literature describes common elements of infrastructure; however, a lack of valid and reliable measures has made it difficult for program planners to monitor relevant infrastructure indicators and address observed deficiencies, or for evaluators to determine the association among infrastructure, program efforts, and program outcomes. The Component Model of Infrastructure (CMI) is a comprehensive, evidence-based framework that facilitates TCP program planning efforts to develop and maintain their infrastructure. Measures of CMI components were needed to evaluate the models utility and predictive capability for assessing infrastructure. This paper describes the development of CMI measures and results of a pilot test with nine state TCP managers. Pilot test findings indicate that the tool has good face validity and is clear and easy to follow. The CMI tool yields data that can enhance public health efforts in a funding-constrained environment and provides insight into program sustainability. Ultimately, the CMI measurement tool could facilitate better evaluation and program planning across public health programs.

Support for a ban on tobacco powerwalls and other point-of-sale displays: findings from focus groups

This study uses focus group data to document consumer perceptions of powerwall and other point-of-sale (POS) tobacco displays, and support for a ban on tobacco displays. Four focus groups were conducted in 2012 by a trained moderator. The study comprised 34 adult residents of New York State, approximately half with children under age 18 years living at home. Measures used in the study were awareness and perceptions of powerwall and other POS displays, and level of support for a ban on tobacco displays. Analysis focused on perceptions of powerwall and other POS displays, level of support for a ban on tobacco displays and reasons participants oppose a display ban. This study documents a general lack of concern about tobacco use in the community, which does not appear to be associated with support for a ban on POS tobacco displays. Although all participants had seen tobacco powerwalls and most considered them to be a form of advertising, participants were divided as to whether they played a role in youth smoking. Additional research is warranted to determine what factors individuals weigh in assigning value to a ban on POS tobacco displays and other tobacco control policies and how educational efforts can influence those assessments.

Public Attitudes and Support for a Sugar-Sweetened Beverage Tax in America’s Heartland

Background. Policy and environmental strategies are part of a comprehensive approach to obesity prevention. We investigated the association between public attitudes about how the environment influences health and support for a sugar-sweetened beverage (SSB) tax in Kansas. Method. We collected data via a 2014 representative dual-frame (cellular and landline) telephone survey of 2,203 adult Kansans regarding healthy eating policy support and beliefs about obesity causes and solutions. Results. A significant proportion of Kansas adults (40%) support an SSB tax. Support was significantly stronger among females, young people, and liberals. Causal and responsibility attributions of obesity were significantly associated with policy support. Individuals who attribute more responsibility for the solution to the obesity epidemic to environmental factors were more likely to support a tax, regardless of their political affiliation. Conclusions. Messaging that focuses on the role of the environment in creating opportunities for health may be useful in framing discussions around SSB taxes.

How Low-Income Smokers in New York Access Cheaper Cigarettes

Purpose: To understand the tobacco acquisition practices of low-income smokers in New York State in light of high cigarette prices due to high cigarette taxes. Design: Eight focus groups with low-income smokers were conducted in spring 2015 and 2016 (n = 74). Setting: New York City (NYC) and Buffalo, New York. Participants: Low-income adults aged 18 to 65 who smoke cigarettes regularly. Method: Qualitative analysis of focus group transcripts that explored differences and similarities by region. We used the interview guide—which covered the process of acquiring cigarettes and the impact of cigarette prices—as a framework for analysis to generate themes and subthemes (deductive coding). We also generated themes and subthemes that emerged during focus group discussions (inductive coding). Results: Some smokers in Western New York have switched to untaxed cigarettes from Native American reservations, whereas low-income smokers in NYC described convenient sources of bootlegged cigarettes (packs or loosies) in their local neighborhood stores, through acquaintances, or on the street. Familiarity with the retailer was key to accessing bootlegged cigarettes from retailers. Conclusions: Smokers in this study could access cheaper cigarettes, which discouraged quit attempts and allowed them to continue smoking. The availability of lower priced cigarettes may attenuate public health efforts aimed at reducing smoking prevalence through price and tax increases.

Public and Opinion Leader Willingness to Fund Obesity-Focused Policies in Kansas:

Obesity increases the risk for leading causes of death, including cardiovascular disease and some cancers. Midwestern and southern states have the highest obesity rates—in Kansas, one in every three adults is obese. We compared the willingness of Kansas adults and opinion leaders to pay more in taxes to fund obesity prevention policies. In 2014, we asked a representative sample of 2,203 Kansas adults (response rate 15.7%) and 912 opinion leaders (response rate 55%) drawn from elected office and other sectors, including business and health, whether they would pay an additional