A Guide to Tobacco Prevention and Control for Racial and Ethnic Minorities and Other Vulnerable and Marginalized Populations
2006–2010 Four-Year Plan
MAPPING A STRATEGY Table of Contents
Acknowledgements
Message from the Secretary of Health ..............................1
Special acknowledgement to the staffs of the Pennsylvania Department of Health Bureau of Chronic Diseases and Injury Prevention, Division of Tobacco Prevention and Control, Bureau of Health Planning, and Bureau of Health Statistics and to the Center for Minority Health, University of Pittsburgh Graduate School of Public Health
Executive Summary............................................................2 Goals of the Plan ................................................................4 The Planning Process .........................................................6 Strategic Planning Workgroup................................................ 8 Participating Agencies ........................................................9
Other key contributors to the planning process include: Fox Chase Cancer Center and the National Cancer Institute’s Cancer Information Services, Drexel University School of Public Health, Temple University, Centers for Disease Control and Prevention (CDC), Tobacco Technical Assistance Consortium (TTAC), Kit Solutions Inc., FOB Consulting Inc., Dixon University Conference Center, and the University of Pittsburgh OfďŹ ce of Public Affairs
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Message from the Secretary of Health
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My Fellow Pennsylvanians: I am pleased to present the Strategic Plan to Eliminate Tobacco-Related Health Disparities in Pennsylvania. The mission of the Pennsylvania Department of Health (PA DOH) is to promote healthy lifestyles, prevent injury and disease, and ensure the safe delivery of quality healthcare services for all Pennsylvanians. The Strategic Plan to Eliminate Tobacco-Related Health Disparities in Pennsylvania was developed through the personal commitment of each member of the Strategic Planning Workgroup, composed of a diverse and inclusive team of Pennsylvanians. From creating a strong vision, defining the mission, and presenting detailed action steps, this plan represents the dedicated work of the Strategic Planning Workgroup and provides a practical yet multifaceted approach to reducing disparities in our commonwealth. We are extremely proud of Pennsylvania’s comprehensive tobacco control program. The disparities planning process was coordinated by PA DOH Division of Tobacco Prevention and Control in collaboration with the Centers for Disease Control and Prevention (CDC) Office on Smoking and Health and the University of Pittsburgh Graduate School of Public Health’s Center for Minority Health. Funding support was through CDC and Pennsylvania’s Tobacco Master Settlement Agreement. We invite you to learn more about our programs by visiting the PA DOH Web site at www.health.state.pa.us. Sincerely, Calvin B. Johnson, MD, MPH Secretary of the Pennsylvania Department of Health
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Executive Summary
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Cigarette smoking continues to be one of the nation’s leading causes of preventable disability and premature death, accounting for more than 440,000 deaths annually. Research shows that specific population groups are more burdened by tobacco-related death and disease than the general population. Healthy People 2010, the U.S. Department of Health and Human Services’ 10-year strategy for improving the nation’s health, is designed to achieve two overarching goals: 1) increase the quality and years of healthy life and 2) eliminate health disparities. The Pennsylvania Department of Health (PA DOH) is committed to eliminating health disparities among all segments of the population and has begun a major initiative to address tobacco-related health disparities in six identified population subgroups: African American, Latino/Hispanic, Asian/Pacific Islander, rural and Amish, Native American/American Indian, and LGBTQ (lesbian, gay, bisexual, transgender, and questioning). Such population subgroups are themselves very complex, and this strategic plan emphasizes the need for additional research and data collection to refine and narrow target populations. In particular, income and education strata are known to be key indicators for identifying health disparities across all population groups. Eliminating disparities requires a health promotion approach that emphasizes strengthening capacity and infrastructure in communities, involving multiple public agencies, promoting political action and policies that improve health, and building supportive environments. For this endeavor to be successful, significant resources must be applied comprehensively rather than with an incremental, piecemeal approach. Pennsylvania’s strategic plan to address tobacco-related disparities was developed through a broad, diverse, community-wide process, and it directs awareness and understanding to the underserved and understudied populations. The plan is designed to focus critical attention and resources towards reducing tobacco-related health disparities. As developed by a statewide tobacco-related health disparities group, in collaboration with the Center for Minority Health (CMH) in the University of Pittsburgh Graduate School of Public Health and PA DOH, the plan charts the course to address health disparities related to tobacco
use in a comprehensive, statewide fashion. The plan focuses on community competence and capacity in tobacco use, prevention, and control at community, local, and state levels. The plan maps funding, policy, research, capacity building, and the establishment of population-specific interventions as the framework for achieving the elimination of tobaccorelated disparities in Pennsylvania.
BACKGROUND AND PROCESS OVERVIEW The Centers for Disease Control and Prevention (CDC) developed specific steps that states can follow to develop a strategic plan for future programs and interventions to address tobacco-related disparities. This process, driven by Healthy People 2010, focuses on increasing representation from diverse communities in all levels of decision making related to these disparities, implementing interventions based on data, and evaluating the effectiveness of these interventions. The challenge of eliminating disparities requires concerted efforts by a wide variety of stakeholders. To address gaps in data on tobacco-related disparities and develop a comprehensive agenda aimed at reducing such disparities, PA DOH, in collaboration with CDC and CMH, convened a workgroup through a broad, community-based nominating process. Thirty-four members from diverse communities across Pennsylvania were identified to serve on the statewide Strategic Planning Workgroup to address minority health issues and disparities related to tobacco use. Initially convened in 2004, members represented community-based organizations, academic institutions, the governor’s advisory commissions, and local government.
Pennsylvania 2000 Population By Race/Ethnicity
White* 84.1%
African American* 9.8% Latino 3.2% Asian* 1.8% Two or more races* 0.9% All others* 0.2% *Non-Latino
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During a nine-month planning period, workgroup participants, divided into subcommittees representing the six target populations, reviewed current research and existing data in order to develop population profiles and increase understanding of tobacco-related disparities among specific affected groups. Workgroup members also participated in population assessments in their local area and a SWOT (strengths, weaknesses, opportunities, threats) analysis for Pennsylvania. The workgroup identified existing gaps in data and discussed addressing issues of underrepresentation of these groups in current statewide data collection systems usually used to assess population-specific health status and disease burden in light of their findings. Once the workgroup knew more about the challenges to identifying and eliminating tobacco-related health disparities, vision and mission statements were created.
Vision Statement A Pennsylvania free of tobacco-related health disparities.
Mission Statement To identify and eliminate tobacco-related health disparities among targeted population groups. The workgroup defined critical issues, and recommendations for a strategy were prioritized to address underserved and understudied populations. This led to the establishment of six strategic planning priority areas: • • • • • •
Information surveillance and evaluation Population-specific interventions Policy Capacity building in communities and population groups Capacity building in state and local governments Funding
Priority areas focused the plan, led to identified action steps, and facilitated the development of the Strategic Plan to Eliminate Tobacco-Related Health Disparities in Pennsylvania. The plan includes action steps outlined in a work plan, an evaluation plan, and a communication plan for use by multiple agencies in Pennsylvania. The recommendations outlined in the strategic plan will help guide Pennsylvania in reducing and eliminating tobaccorelated health disparities and facilitating healthy lifestyle behaviors for all.
The workgroup suggested the plan represent a two-prong approach to address and eliminate disparities in underserved and understudied populations: 1) present data defining the health impact and demographic context to describe tobaccorelated health disparities in Pennsylvania and 2) provide a strategic framework to guide population-specific interventions and evaluation measures.
DATA The Strategic Plan Workgroup recognized the importance of examining and refining existing data as well as opening new avenues of data collection to measure tobacco-related disparities in all targeted population subgroups. The plan proposes to identify data gaps and to collect and analyze data to further understand how to effectively address population segments disproportionately affected by tobaccorelated illnesses, including disparately impacted racial and ethnic groups. Additional data will be collected to identify and broaden understanding of the extent of burden among rural residents (including the Amish), Native Americans, LGBTQ populations, and lower income persons. The plan also proposes assurance that the identified tobacco burden is addressed through culturally competent interventions—an important capacity that must be built at the local and state level among both public and private groups.
OUTCOME—THE STRATEGIC PLAN This strategic plan is a guide for the administration of the statewide tobacco programs in Pennsylvania, providing solid direction to state, regional, and community partners. It is particularly important in directing the State Health Improvement Plan (SHIP) partners and primary contractors toward the development of effective and relevant local work plans. Community leaders, agencies, community-based organizations, and funding organizations can use this document to examine the special health issues faced by minority populations within their communities, to determine local health improvement priorities, to set priorities for supporting community health improvement initiatives, and to develop measurable goals for improving the health status of minority members within the community. The strategic plan will also launch a statewide needs and resource assessment. A manageable, targeted approach to reduce and eliminate tobacco-related health disparities in Pennsylvania’s underserved and understudied populations is suggested for a four-year period.
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Goals of the Plan
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The strategic plan outlines six major goals and specific activities designed to attain each goal. Goal 1. Improve the quality of existing data to enhance identification, monitoring, and evaluation of tobaccorelated disparities. a. Assess current data to determine where health disparities exist geographically and demographically. b. Review data collection processes to identify gaps in knowledge. c. Institute data collection procedures to ensure inclusion of underrepresented populations experiencing tobaccorelated health disparities. Goal 2. Ensure that program providers, funding agencies, and communities share in the decision-making process to design, implement, and evaluate prevention and cessation programs and to establish contractual responsibilities. a. Establish an Intervention Advisory Council composed of program providers, funding agencies, and community advocates to provide a quarterly forum whereby state tobacco use and chronic disease prevention representatives can assess existing program outcome evaluation measures and new program initiatives. b. Create a mass multimedia campaign utilizing social marketing concepts and strategies that address tobaccorelated health disparities. c. Provide culturally competent tobacco use prevention, cessation, relapse, and second-hand smoke programs in Pennsylvania.
d. Recruit healthcare providers to serve diverse communities to provide brief intervention or information about tobacco use prevention and cessation. Goal 3. Incorporate and address tobacco-related health disparity needs at all levels of legislative and public health programming. a. Incorporate CDC Best Practices and the needs of disparately affected populations in all tobacco legislation, policies, contracts, and programs. b. Engage community-based organizations and community members through education and resources to advocate and influence legislation that would result in the reduction of tobacco use and related health disparities. c. Provide a smoke-free workplace environment for all Pennsylvanians. d. Ensure that state-sponsored tobacco prevention and control media campaigns, communication networks, and other mediums are designed and implemented in partnership with local initiatives. e. Ensure access to tobacco use prevention, cessation, and relapse services by disparately affected groups. Goal 4. Increase the capacity of community-based organizations serving the identified population groups to reduce tobacco-related health disparities and to change cultural and social norms of tobacco use acceptance. a. Develop community-based advisory boards, representative of disparately affected populations, to review and recommend program guidelines.
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b. Maintain a resource clearinghouse that provides information relevant to disparately affected populations.
Goal 6. Identify and secure funding to sustain programs for the elimination of tobacco-related health disparities.
c. Provide training, resources, and information on effective countermarketing.
a. Identify and communicate existing and new funding sources that support tobacco use prevention and cessation initiatives and/or the elimination of health disparities.
d. Focus on youth from disparately affected populations, starting in preschool years, by collaborating with educational authorities and other youth-serving organizations to prevent initiation of tobacco use. Goal 5. Enhance the capacity of state and local governments to promote and sustain tobacco use prevention and control initiatives in order to reduce tobacco-related health disparities. a. Provide training and technical assistance to state and local representatives to assist them in the development of community-speciďŹ c strategies to eliminate tobaccorelated health disparities. b. Monitor and evaluate the impact of legislative action, at the state and local level, as related to the Pennsylvania Strategic Plan to Eliminate Tobacco-Related Health Disparities. c. Collaborate with state and local government-funded human services organizations and programs to assist them in developing a comprehensive tobacco control program that reects and supports the Pennsylvania Strategic Plan to Eliminate Tobacco-Related Health Disparities though action steps.
b. Provide grant writing training and technical assistance to community-based organizations and other interested parties serving disparately affected populations. c. Identify existing and prospective funding sources to sustain and enhance statewide youth and adult tobacco information surveillance and evaluation activities.
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The Planning Process
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Beginning in 2003, the Pennsylvania Department of Health (PA DOH) established the Pennsylvania Diversity and Tobacco-Related Disparities Initiative. The initial planning process was guided by the principle that the most effective tobacco prevention and control programs are comprehensive and multifaceted and require a state-coordinated approach that funnels resources into communities through competent, knowledgeable organizations and individuals. The strategic planning process recognized that identifying and addressing disparities is an ongoing process that requires qualitative and quantitative data to discover gaps, trends, and other inequalities that adversely affect specific population groups. PA DOH, in collaboration with the Centers for Disease Control and Prevention (CDC) and the University of Pittsburgh Graduate School of Public Health’s Center for Minority Health (CMH), implemented the disparities initiative. The initial focus was on the development of a multiyear strategic plan to address tobacco-related disparities within the commonwealth. The strategic planning process was driven by Healthy People 2010’s focus on disparities. The goal of the strategic plan is to guide the efforts of individuals, organizations, and decision makers in Pennsylvania to collaboratively eliminate tobacco-related disparities.
Following is a brief chronology of the initiative: November 2003 • Held a planning meeting with Kevin Collins, CDC program consultant; CMH staff; Pennsylvania Bureau of Health Statistics staff; and PA DOH Division of Tobacco Prevention and Control staff to discuss the CDC Office of Smoking and Health (CDC/OSH) disparities pilot project and logic model. • Established a process the department would follow to ensure that the disparities initiative would focus on increasing diversity (inclusively, from populations at all levels of decision making about tobacco-related health issues), implement interventions based on the data available, and evaluate the effectiveness of the interventions.
December 2003–February 2004 • With the assistance of CDC and the Tobacco Technical Assistance Consortium (TTAC), selected Laurie Mettam to assist the initiative. Mettam successfully led North Carolina’s CDC/OSH minority health and disparities pilot planning project. • Using the resources of CMH; county-level, communitybased tobacco control program lead agencies (or primary contractors); their service providers; the Governor’s Advisory Commission on African American Affairs; and the Governor’s Advisory Commission on Latino Affairs, established a 34-member diverse and inclusive Strategic Planning Workgroup representing organizations that serve communities of various racial and ethnic populations; low socioeconomic status poplulations; rural and Amish populations; and lesbian, gay, bisexual, transgender, and questioning individuals.
March–July 2004 • The Strategic Planning Workgroup held a series of nine full-day meetings at the Dixon University Conference Center in Harrisburg, Pa., during this five-month period.
Following are summaries of the meetings: Meeting 1 The first workgroup meeting began with participant introductions and brief background profiles. Members received an overview of the planning process, which included enlarged, population-specific, county-bycounty maps showing census demographics and chronic disease rates. The workgroup was briefed on relevant reports, statewide tobacco prevention and control efforts already in place, resources data on population groups known to be disparate in terms of smoking prevalence (based on surveillance data), and whether these known groups were being addressed by efforts already in place. Members established group process guidelines with input from every individual, which built trust and commitment from the participants, and completed a meeting assessment survey.
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Meeting 2 The workgroup reviewed Pennsylvania’s demo-
Meeting 6 Members gave individual SWOT analysis
graphic and chronic disease data for tobacco use prevalence and morbidity and mortality rates, generating critical issues relative to these data. The workgroup identified 20 issues from the data presentations during the first two meetings and subsequently prioritized 10 critical issues related to data, program, and policy needs for target populations. Members completed a meeting assessment survey.
reports, generated critical issues for SWOT analyses, and compiled 10 critical issues from the population survey results. Reviewed for consensus: 30 prioritized critical issues from the planning process—10 from the quantitative data assessment, 10 from the qualitative data assessment, and 10 from the SWOT analysis. Members completed a meeting assessment survey.
Meeting 3 The workgroup established six special popula-
Meeting 7 Workgroup members evaluated all critical
tion-focused subgroups—African American, Latino/Hispanic, Asian/Pacific Islander, rural and Amish, Native American/ American Indian, and LGBTQ (lesbian, gay, bisexual, transgender, and questioning)—and developed vision and mission statements for the strategic plan. Members also established the framework for conducting and presenting findings from population assessments and a SWOT (strengths, weaknesses, opportunities, threats) analysis and completed a meeting assessment survey.
issues and converted them into six planning priorities as the conceptual framework for the strategic plan. Members also reviewed and adopted final versions of the mission and vision statements and completed a meeting assessment survey.
Meeting 4 Subgroups reported on information gathered from population assessment surveys and generated 10 critical issues. Members were given an overview of the components of CDC’s Best Practices for Comprehensive Tobacco Control Programs and the four goal areas of the CDC National Tobacco Control Program (NTCP). Members completed a meeting assessment survey.
Meeting 5 The workgroup continued its discussion about critical issues gathered from population assessment information. This clearly demonstrated the level of engagement of workgroup members and resulted in rich qualitative data. PA DOH presented its completed SWOT analysis and instructed members on completing SWOT analyses for their organizations and service areas. Members completed a meeting assessment survey.
Meeting 8 Workgroup members developed goals, strategies, and objectives for each planning priority and began to develop first-year process actions. Members completed a meeting assessment survey.
Meeting 9 Pennsylvania Secretary of Health Calvin B. Johnson attended the morning portion of the meeting along with (via phone) Stephen B. Thomas, director of CMH, to thank the workgroup members and express their commitments to reducing health disparities. Members asked for additional time to continue their work so that they could expand the first-year process actions. (They completed them during a Webinar* conference provided by a workgroup member representing the National Cancer Institute’s Cancer Information Service.) Workgroup members voluntarily agreed to continue their work through participating in strategic planning subcommittees to ensure the completion and implementation of the strategic plan. Members completed a meeting assessment survey, and they and other participants were given the opportunity to share their impressions of the planning process.
*Webinar is an interactive online technology that uses the Internet, PowerPoint, and conference calling. It enables users to participate from the comfort of their personal computer anywhere in the country.
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Strategic Planning Workgroup Reena Antony Tobacco Control Program Analyst Philadelphia Department of Public Health Yolanda Atencio Smoking Cessation Specialist Council of Spanish Speaking Organizations (Concilio) Judith A. Bannon Executive Director Sudden Infant Death Services (SIDS) of Pennsylvania Lora Ann Bray Partnership Program Coordinator for Western Pennsylvania National Cancer Institute’s Cancer Information Service University of Pittsburgh Center for Minority Health Norman Bristol-Colon Executive Director Pennsylvania Governor’s Advisory Commission on Latino Affairs Adana Burke-Hooten Rural AIDS Service Director UPMC Lee Regional Elizabeth Byrne LGBT Smoking Cessation Program Director Mazzoni Center Rafael J. Canizares Tobacco Coordinator Latinos for Healthy Communities Catherine deRicci Horwatt Program Director Gateway VISION Lorraine Ettaro Visiting Assistant Professor of Public Health and Lead Researcher University of Pittsburgh Center for Rural Health Practice Maria Garcia Director of Social Services Hispanic Center of Reading and Berks County
Robert M. Goodman Professor and Chair Department of Behavioral and Community Health Sciences University of Pittsburgh Graduate School of Public Health Marcie Grello Partnership Program Coordinator National Cancer Institute’s Cancer Information Service Melissa Hagan Hughes Postdoctoral Fellow University of Pittsburgh Tine Hansen-Turton Executive Director National Nursing Centers Consortium (NNCC) Miriam Lavandier Director of Community Health I-Lead Inc. Matty Lehman LGBTQ Youth Smoking Cessation Counselor The Attic Youth Center Olive M. Mckeithan Executive Director Minority Health Center Zoe Meleo-Erwin LGBT Tobacco Control Coordinator The SafeGuards Project Jason Moffitt Tobacco Prevention Specialist Dauphin County Executive Commission on Drugs, Alcohol, and Tobacco Derietra L. Neal-Ferguson Tobacco Cessation Director Centers for Healthy Hearts and Souls Laurie Nicholl Principal Nicholl Brandt Communications Jeannine Peterson CEO Hamilton Health Center
Sonya Reynolds Tobacco Cessation Project Manager NNCC Martin Raniowski Senior Director of Public Advocacy American Heart Association Pennsylvania/Delaware Affiliate Larry Robinson Deputy Health Commissioner, Health Promotion Philadelphia Department of Public Health Bonnie L. Sowers Tobacco Control Nurse Consultant Pennsylvania Department of Health Southcentral District Angela D. Simons Program Facilitator Project ANSWER Maribeth Tarpley-Garrett Sexuality Educator and BUSTED! Coordinator The Washington Hospital Teen Outreach Program Alison Tartaglia Tobacco Program Supervisor Planned Parenthood Association of Bucks County Charles J. Vukotich Jr. Assistant Deputy Director Allegheny County Health Department Sandy Walker Program Coordinator York’s Helping Hand for the Homeless Marlin Williams Project Director Bucks County Tobacco Control Project Mikell Worley State Health Improvement Plan (SHIP) Project Director Dauphin County Community Health Improvement Partnership
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Participating Agencies Strategic Planning Implementation Team
Allegheny County Health Department
Laurie H. Mettam Workgroup Facilitator Tobacco Technical Assistance Consortium (TTAC)
The Attic Youth Center
Serina R. Gaston Project Manager Prevention Program Manager Pennsylvania Department of Health Division of Tobacco Prevention and Control
Council of Spanish Speaking Organizations (Concilio)
Raymond A. Howard Planning Consultant Project Director University of Pittsburgh Center for Minority Health
Hispanic Center of Reading and Berks County
American Heart Association Pennsylvania/Delaware Affiliate Bucks County Tobacco Control Project Centers for Healthy Hearts and Souls Dauphin County Community Health Improvement Partnership Dauphin County Executive Commission on Drugs, Alcohol, and Tobacco Gateway VISION Hamilton Health Center I-Lead Inc. Latinos for Healthy Communities Mazzoni Center Minority Health Center National Cancer Institute’s Cancer Information Service National Nursing Centers Consortium (NNCC) Nicholl Brandt Communications Pennsylvania Department of Health Division of Tobacco Prevention and Control Pennsylvania Department of Health Southcentral District Pennsylvania Governor’s Advisory Commission on Latino Affairs Philadelphia Department of Public Health Planned Parenthood Association of Bucks County Project ANSWER The SafeGuards Project Tobacco Technical Assistance Consortium Sudden Infant Death Services (SIDS) of Pennsylvania University of Pittsburgh Center for Minority Health University of Pittsburgh Center for Rural Health Practice University of Pittsburgh Graduate School of Public Health University of Pittsburgh Medical Center (UPMC) Lee Regional The Washington Hospital Teen Outreach Program York’s Helping Hand for the Homeless
For information about the Strategic Plan to Eliminate Tobacco-Related Health Disparities in Pennsylvania, or to obtain a copy, please contact Division of Tobacco Prevention and Control Pennsylvania Department of Health 717-783-6600 or visit the following Web sites: Pennsylvania Department of Health www.health.state.pa.us Pennsylvania Tobacco Prevention Clearinghouse
UMC 4962-0506
www.patobaccoprevention.org