Livingston County Tobacco Control Program

State: NY Type: Model Practice Year: 2004

The Livingston County Tobacco Control Program comprehensively addresses the need to reduce the use of tobacco and exposure to secondhand smoke in Livingston County through activities that encourage prevention and cessation. The program partners with agencies, organizations, and community members throughout the county to achieve its goal. Target population is the entire county of 64,328 residents, ranging from unborn babies to senior citizens. The total population is reached through a combination of approaches, including articles, paid ads, and public service announcements in local news publications that are delivered free-of-charge to every household in Livingston County. Activities emphasize: Developing, implementing, and enforcing policy. Collaborating with agencies, organizations, schools, and individual community members. Developing and then airing/printing media campaigns, paid ads, and public service announcements. Outcomes of the practice include:More signed pledges for smoke-free homes and cars.  More schools provided with tobacco-free policy signage.  A lower percentage of pregnant women who smoke.  A lower percentage of teens who smoke.  More healthcare providers identifying and counseling tobacco using patients/clients.  More Medicaid recipients who access pharmacotherapy for smoking cessation.  Greater access to cessation counseling services. Goals are to reduce exposure to secondhand smoke, decrease the social acceptability of tobacco use, and promote cessation of tobacco use.
The Livingston County Department of Health maintains the Livingston County Tobacco Control Program to respond to the local public health need to reduce the use of tobacco in the county. The department determined this was a relevant need after reviewing state and local surveys, local birth records, and available statistics, including New York State Behavioral Risk Factor Surveillance System (BRFSS) and the Centers for Disease Control and Prevention’s (CDC) New York State Youth Risk Behavior Survey. In collaboration with other agencies/organizations, the Livingston County Tobacco Control Program provides and promotes programs, resources, initiatives, and marketing to make policy changes that create environments that support tobacco-free living, thus encouraging behaviors to stop smoking and not to start. Efforts are constantly and consistently aimed toward the norm of tobacco-free choices for healthy lifestyles. The Livingston County Tobacco Control Program differs from other approaches used to address this need in that prevention and cessation are addressed under one unit of organization thereby avoiding duplication and reinvention of the wheel. Enforcement, community coalition, teen youth group, and elementary school youth group are coordinated to best serve the needs of Livingston County.
Agency Community RolesThe role of the Livingston County Department of Health is that of lead/fiscal agent. The stakeholders/partners in planning and conducting the program are co-planners, , facilitators, and spokespersons. The Livingston County Department of Health seeks community stakeholders by reaching out to community and business leaders, schools, and for-profit as well as not-for-profit organizations and agencies through meetings, community events, paid as well as earned media, regional initiatives, contests, and trainings. Community stakeholder collaboration has resulted in furthering the practice’s goals to reduce initiation of tobacco use, eliminate exposure to secondhand smoke, reduce the use of tobacco, and decrease social acceptability of tobacco use. Costs and ExpendituresThe costs for the Livingston County Tobacco Control Program have ranged from $40,000 to $200,000 per year over the past 10 years. Funding sources have included grants from National Cancer Institute (NCI) and Centers for Disease Control and Prevention (CDC) through the New York State Department of Health Tobacco Control Program, Livingston County budget funds, and fines collected from retail stores in violation of tobacco sales to minors. ImplementationThe objectives of the Livingston County Tobacco Control Program are: Increase the number of adults who live in a house and drive or ride in a vehicle where smoking is prohibited. Increase the number of educational institutions that implement effective tobacco-free policies to eliminate tobacco use from all facilities, property, vehicles, and events through the support and enhancement of the Student Support Services Center activities. Reduce the number of pregnant women who smoke during pregnancy. Increase the number of middle and high school students who indicate commitment to never use tobacco. Increase the number of healthcare provider organizations that have a system in place to implement the Prevent Services Task Force clinical guidelines for cessation. Increase the number of Medicaid recipients who access pharmacotherapy for smoking cessation. Increase access to cessation counseling and services. Continue to enforce tobacco related laws, i.e., sales to minors, self-serve, and clean indoor air. Expose and raise awareness of the tobacco industry’s marketing tactics to encourage youth to begin using tobacco. The timeline for carrying out the tasks for each objective is ongoing with consistent long-term improvement toward tobacco-free lifestyles for all residents of and visitors to Livingston County.  
Process evaluation:Challenges included lack of available time for people involved as well as scheduling to accommodate the maximum number of people. To address these challenges condensed trainings have educated professionals and volunteers to efficiently utilize resources; brief, frequent tracking methods have been developed; and monthly face-to-face meetings are conducted with follow-up minutes for thirty core people representing twenty different agencies/organizations. Timelines have been met. Outcome evaluation: Methodology/data collection methods for evaluation have included surveys, tracking systems, questionnaires, and pre/post surveys. Positive changes in outcomes can be attributed to the practice in that outcomes are most notable where emphasis of the practice was greatest at any particular time period. It is always possible that outside factors influence outcome (i.e. New York State Department of Health tobacco-related advertising). The practice is definitely worth the resources invested in it. Outcomes demonstrate positive progress toward tobacco use reduction in Livingston County. The practice serves as a coordinating unit of all tobacco-free related activities in the county allowing for efficient use of paid as well as volunteer people power to achieve tobacco use reduction in Livingston County. Unintended consequences have been very positive. Youth who have been involved in the practice have had the edge in gaining scholarships. Participation in the practice helped at least one youth decide on a college major in political science. Another youth helped spearhead anti-tobacco activity during her freshman year at college. Tobacco Busters have received unsolicited invitations outside the county to present activities. This practice, the Livingston County Tobacco Control Program, does in fact achieve the goals and objectives outlined earlier as evidenced by outcomes that are reported in this application.
SustainabilityStakeholder commitment to perpetuate the Livingston County Tobacco Control Program is strong. The Livingston County Center for Environmental Health has conducted and will continue to conduct compliance checks at retail stores as well as respond to violation of laws complaints. The Center will also continue to provide up-to-date information through its regularly scheduled training classes and special mailings. Community volunteers have conducted and will continue to conduct cessation classes using materials that to date have been free-of-charge. For three years, PTA parents have taught—and they will continue to teach—the Comprehensive Health Education Foundation’s curriculum Get Real About Tobacco to elementary school children. The curriculum is reproducible; therefore, materials in the curriculum are sustainable. The youth groups, both the teen group and the elementary youth group, have established school adult liaison personnel. Schools are committed to the tobacco-free promotional activities of these groups. The American Cancer Society’s “FreshStart Families” program has been incorporated into the services of WIC, the Women’s Health, and Prevent Team at the Livingston County Department of Health, and the services of health care providers affiliated with the local hospital. Behavior Modification training specific to tobacco use has been conducted for health care providers at the Livingston County Department of Health, the local hospital, and the local Council on Alcohol and Substance Abuse. Health Care providers at all these locations now routinely identify tobacco users and counsel according to each client’s/patient’s stage of behavior change. There are plans to sustain the practice over time and to leverage resources. It is anticipated that the above mentioned activities will continue, given the firmly established practices by the various community groups. Resources available will include the New York State Smokers’ Quitline, New York State’s soon-to-be-established Area Cessation Center, Coalition grant funding, retail store fine collections, and available county budget funds. Lessons Learned People often need to be invited to participate, and they often need to be instructed or trained in specific tasks to be effective and feel successful. People seem to be more willing to assist with short-term projects. The simpler the task, the more people become involved. When given choices, people feel more in control, thereby accomplishing more activities toward goals and objectives. Using the services of professionals is often most efficient. Other lessons helpful to agencies seeking to adapt or replicate this practice are that first, comprehensive projects that include the best practices of community programs, school programs, counter marketing, cessation, enforcement, and administration and management, and surveillance and evaluation really do work in gaining a steady progression toward behavior and policy changes. Second, matching people’s interests with needed tasks results in long-term commitment from paid as well as volunteer community members. Key Elements Replication A county health department or similar government agency. Some funding sources. Partnerships with community and county agencies and schools. Access to youth. Access to health care providers. Rapport with local media. Capable volunteers. Of vital importance is the community’s support and involvement in the planning and execution of activities as well as the community’s commitment to internalize activities that prove effective in reaching the goals of the practice.