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Tobacco Logic Model

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by

Alice McCaffrey

on 20 August 2013

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Transcript of Tobacco Logic Model

Youth tobacco initiation needs to be reduced
Measure
Past 30-day tobacco use rate for HS students is 21%
(TN School Climate Survey 2011-12)
Measure
24% of adults smoke
(County Health Rankings)
Measure
90% of adult smokers began before they were 18 years old
Social Access
Measure
Measure
Promotion
Measure
Measure
Measure
Measure
Families condone or defend use of tobacco products
Measure
If 14.5 % of HS students usually obtain them by purchase in retail environment
(2009 TN HS YRBS)
the rest of them are getting them from family or friends
Measure
Key informant interviews with juvenile courts report parents resist court ordered interventions, they just pay the fines
Measure
Key informant interviews (Juvenile Courts, HS principals, Coordinated School Health)
Measure
The tobacco industry expose youth to promotional and new product advertising because they need replacement smokers for the 1200 customers who die each day
Measure
Tobacco companies spend as much as 75% of their marketing money in tobacco retail stores (Federal Trade Commission)
Measure
21 retailers were found non-compliant in 2011
(TN Dept. of Agriculture)
21 of 153 retailers were non-compliant in 2011
(TN Dept. of Agriculture)
31.4% of MS students had ever tried a cigarette
(2009-10 MS YRBS)
7.6% of MS students who had ever tried a cigarette had tried them before age 11
(2009-10 MS YRBS)
Measure
9.9% MS students smoked at least one cigarette/day
(2009-10 MS YRBS)
Almost 90% of replacement smokers smoke their first cigarette by age 18. (Surgeon General's Preventing Tobacco Use Among Youth and Young Adults Fact Sheet)
Cigarettes can be obtained from friends or family
6 of 15 randomly selected retailers had advertising at child's level (3 feet) (Store Alert Report Card)
Some retailers are not compliant
17 retailers were found non-compliant in 2010
(TN Dept. of Agriculture)
Policy
City and County governments will pass ordinances asking the Legislature to repeal state preemption against local options
Policy
Store Alert Surveys will be conducted and results reported
Provide information
Information to students about promotional activities that manipulate their behavior
(84% of advertising spent at point of purchase)
Build skills
Provide support
Provide Store Alert surveys to retailers
Help share best practices between retailers
Change access
Use TN Dept. of Health Complaint system to report violations
Consequences Incentives
Physical Environment
Provide information
Build skills
Provide support
Change access
Consequences Incentives
Physical Environment
Policy
Information to non-compliant retailers about the history of youth protection in TN and how to be compliant
Teach coalition members to perform Store Alert surveys
Provide Coalition yard sticks to non-compliant retailers
Use technology to make store alert surveys easier to conduct
Provide feedback to retailer about survey results
Provide survey results to media
Provide information
Build skills
Change access
Consequences Incentives
Physical Environment
Provide support
Provide information
Build skills
Provide support
Consequences Incentives
Policy
Physical Environment
Change access
Juvenile Courts will start assigning community service hours with the Coalition to youth with tobacco violations
Have courts require offender and parent to attend anti-tobacco presentation
Educate youth about the dangers of smoking
Use poster contest to engage students in creating prevention messages for the community
Train youth leaders to help build ongoing strategy and participate in evaluation
Increase Tobacco Free signage where families play
Conduct media campaign about secondhand smoke outdoors
Provide information on website, newsletter, social media
Winning contest poster is displayed on three billboards
Teach coalition how to advocate for new ordinances
Other data needed:
Age of onset
Perception of risk
Perception of parent disapproval
Prepare community for tobacco cessation provisions of ACA
Change state compliance check rules
Provide anti-smoking poster contest - 6th grade
Increase no smoking signage where needed in community
Provide signage about second-hand smoke at outdoor facilities and city owned property
Courts require offender and parents to attend anti-tobacco presentation
Both the Tennessee Department of Health and the Tennessee Department of Labor and Workforce Development have authority to enforce the law. The Department of Health will enforce the law for the establishments it inspects. Among them are:
Restaurants
Public and private educational dining facilities
Health care facilities
Hotels, motels and bed and breakfast facilities
Organized camps
Tattoo and body piercing parlors
Sports arenas, including enclosed public areas in outdoor arenas
Child care and adult day care facilities

The Department of Labor and Workforce Development will enforce the law for establishments they inspect including:
Manufacturing facilities
Construction sites
Convenience and grocery stores
Retail stores and shopping malls
Sports arenas, including enclosed public areas in outdoor arenas
Who is responsible for enforcing the law? (Which Law?)
Draft of a past Resolution -https://docs.google.com/document/d/1xZfkusnMPUyqb7Sm1V5CHLDb-3Coe6khvL7tQXVX2x0/edit?usp=sharing
Fines can only be $10 - 50, court costs are $87
Increase number of after school program campuses who have policies that state they are tobacco free.
http://www.cadca.org/files/Tobacco_Free_Recreation_Areas_Ordinance.pdf
Tobacco free parking lots
Pass ordinances for smoke free outdoor recreation facilities on city/county owned properties
Random sampling of tobacco retailers found 11 of 15 received an F on the Store Alert Report Card (March 2013)
In 2012 non-compliance rate decreased to 6.35% when minor was no longer allowed to show ID during compliance check (Dept. of Agriculture training requirement)
Policy Resource:
www.publichealthlawcenter.org

Promotion
Tobacco advertising cannot target youth; cannot be placed at child level (3 feet).
Second hand smoke harmful unless 13 - 25 feet away from smoker (defeats purpose of healthy recreational area
Litter - it takes the filter 15 years to decompose
Model healthy behaviors to youth
Alternative ordinances:
Not within 25 feet of:
children's playground
picnic areas
where food is sold
Legal Authority is the "police power" to protect the health, welfare and safety of residents (like speed limits, seat belts, litter laws
Components:
Smoke free or Tobacco free
Where - parks, playgrounds, swimming areas, bike paths, ball fields
Adjacent areas - parking lots, sidewalks, pathways
Designated smoke area? Criteria
Signage
Ashcans: none vs at entrance
Enforcement:
Somewhat self-enforcing / public will participate
Who?
Law enforcement
Park staff
Protocol
Warning
Citation
Arrest
Penalties
How is alcohol enforced?
Do we need a central reporting form?
Reducing smoking does not help with health risks
All smoke causes harm (laws protecting chimney sweeps - 1867)
Coalition will use FDA reporting form to report potential violations directly
What about Dept. of Agriculture inspectors?
Police Officers
Principals
SROs
How can we get data about use of:
dip
snus
Hookahs
Not safer, typical use:
30 minutes vs 5 minutes
100 puffs
More harm:
2.96 mg nicotine vs 1.74 mg
800mg tar vs 22.3 (36 times more)
145 mg CO2 vs 17.3 (8 times more)
(Physicians need to ask about all forms of tobacco (be specific - there is no safe tobacco)
Monitoring the Future now asking about SNUS and dissolvables
To make this case, we're going to have to copy page of Synar Report where TN chooses minor does not show ID
Other legislative issue - individual court orders for minors to work
Future Considerations
Smoke-free public housing - http://www.cadca.org/resources/detail/smoke-free-public-housing-would-reduce-healthcare-costs
Meet with Student Health Councils
Letter writing campaign before governmental presentations
Susan LaGuardia recommended talking to Drs. Robert Lee and Joe Ley (ped)
Provide information where families receive medical care
Conduct Store Alert Surveys
Letter writing campaign to council members and commissioners
Check new YMCA
E-cigarettes bring smokers back inside for now - http://www.npr.org/2013/04/27/179490799/e-cigarettes-bring-smokers-back-inside-for-now
The law: A person engaged in the sale or distribution of tobacco products shall demand proof of age from a prospective purchaser or recipient if an ordinary person would conclude on the basis of appearance that the prospective purchaser or recipient may be under twenty-seven (27) years of age.
Minors working lawfully in Tennessee's retail tobacco prevention program are not allowed to carry or show their legal ID when attempting to purchase tobacco. The minor must simply state, "I have no ID" when he or she attempts a purchase. (This requirement is Dept. of Agriculture policy, not law.)
Non-compliance rates have been reduced dramatically since this change
There are several advantages for allowing/requiring the minor to show their legal ID:Youth tobacco purchases are enforced more adequately providing fewer illegal sales of tobacco to minors and fewer young people becoming addicted to tobacco.
Tobacco outlet owners and managers learn to adequately train their clerks to require ID, and deny sales to minors.
Store clerks learn to require ID and determine the young persons age to make sure tobacco is not sold to minors.
The minor's I have worked with are more enthusiastic and motivated to work in the program when they are able to present their legal ID upon request of the clerk.
More revenue is provided (due to fines for illegal sales) to the state.
§ 39-17-1509 (2012) - The owner or manager of a store that sells tobacco products at retail shall provide training to the store's employees concerning the provisions of this part. As a part of this training, each employee shall, prior to selling tobacco products at retail, sign a statement containing substantially the following words:
"I understand that state law prohibits the sale of tobacco products to persons under eighteen (18) years of age and that state law requires me to obtain proof of age from a prospective purchaser of tobacco products who, based on appearance, might be as old as twenty-six (26) years of age. I promise to obey this law, and I understand that monetary or criminal penalties may be imposed on me if I violate this law."
(f) The department shall prepare annually for submission by the governor to the secretary of the United States department of health and human services the report required by Section 1926 of subpart I of Part B of Title XIX of the Public Health Service Act, codified as 42 U.S.C. § 300x-26. The department shall prepare for submission to the general assembly and the public an annual report describing in detail the department's enforcement efforts under this part.
The following notice shall be prominently posted, including at each ticket booth, for elementary or secondary school sporting events:
"Smoking is prohibited by law in seating areas and in restrooms."
More retailers selling - Family Dollar / Dollar General
Finding information about what to report
TN Fuel & Convenience Store Association has better info than TN.gov website
Hookah bars - is there regulation?
Full transcript