Tobacco Control Program

State: WI Type: Model Practice Year: 2003

The City of Milwaukee Health Department’s (MHD) Tobacco Control Program promotes collaborative community initiatives to reduce the morbidity and mortality associated with tobacco use. It is also committed to youth infusion in a traditional bureaucratic organization. Youth are a vital and creative partner in helping to bring positive change in the Milwaukee community. In a youth-led and adult-guided team created a proactive plan to set the tone for tobacco prevention throughout the city. This team focused on changing the social norm of tobacco use in government-owned buildings and vehicles. In June 2002, Milwaukee Common Council passed a 100% smoke-free government buildings and city-owned or leased vehicles ordinance and created a gradual forfeiture for willful violation of the smoking prohibition. This historical decision represents teamwork at its best.
In 1998, Wisconsin tobacco-related health care costs were estimated to exceed $1.6 billion annually. In addition, lost productivity due to cigarette smoking was estimated at $1.5 billion annually. Milwaukee County is Wisconsin’s most urban, most industrial, and densely populated region. It contains 30% of the state’s population in less than 10% of the state’s geographical area. According to the American Cancer Society’s April 2002 release of the “Burden of Tobacco in Wisconsin,” a total of 74,780,000 packs of cigarettes were sold in Milwaukee County in 2000. Direct health care costs for tobacco-related illnesses in this county were $277 million in 1998. In view of these statistics, the primary goal was to comply with the Center’s for Disease Control and Prevention’s 2010 objectives and reduce the morbidity and mortality associated with tobacco use. Since Milwaukee is the largest urban area in the region, it needed to focus on a critical first step and create an innovative response to help reduce this burden. Milwaukee Health Department (MHD) practices a systems approach to facilitate the prevention of disease, identify and eliminate disparities, and improve the health status of the community. It utilizes multiple resources to help effectively plan, deliver and promote health messages. Creative and resourceful youth advocates in Milwaukee are valued community partners in this approach. Thus, the idea to address the issue of smoke-free government buildings and vehicles as a first step was presented to a group of youth advocates by MHD’s Tobacco Control Coordinator. As a team, the goal was to create a proactive plan to set the tone for tobacco prevention throughout the city. This approach not only highlighted MHD’s commitment to building community leaders at every level but also helped to empower community youth through a real life civic lesson.
The City of Milwaukee Health Department served as not only the fiscal agent but also helped to coordinate the multiple resources to effectively deliver and promote tobacco use prevention education as a primary health care message and promote the development of core public policy. Strive Media Institute, Inc. (SMI), Milwaukee Commissioner of Health, American Cancer Society (ACS), American Lung Association (ALA), members of Milwaukee Community Tobacco Coalition, and members of Milwaukee’s Common Council supported this collaborative partnership. SMI, MHD, ACS, and ALA provided the advocacy training and role-playing for the young people prior to meeting with local legislators. In addition, partners provided various levels of expertise throughout the initiative. The collaboration was grounded in not only its commitment to youth in Milwaukee but also its commitment to fostering a positive environment for youth-led policy proposal. Specific program costs were included in a 2001-2002 timeframe for a larger initiative that focused on youth advocacy program development, youth training, and program implementation for a total cost of approximately $25,000. The total cost included subcontracts, training materials, youth stipends, lunches, transportation, mailing, ads, promotional materials, youth magazine ad development and ad placement in “GUMBO” magazine.MHD’s Tobacco Control Program funding supports the fiscal accountability for the program. Funding also includes, but not limited to, the State of Wisconsin’s Division of Public Health. In addition, MHD, SMI, MHD, ACS, and ALA provided in-kind services.  
The program was assessed and evaluated by the collaborative partnership throughout the initiative in the following ways: Interested young people were recruited and interviewed to assess their interest level and availability for the project. A timeline was created, edited and revised. Training materials were collated. Youth participants were pre- or post-tested relative to the interactive advocacy training. Role playing was initiated with participating youth advocates preparing for the legislative meetings. Young advocates reviewed and edited their legislative message wheels. Team meetings and updates were held on a regular basis to stay on track with the proposed plan. Everyone involved had an equally valuable voice in the process. The most outstanding impact of the program was the passage of the Milwaukee Ordinance 105-48 for Smoke-free Government Buildings and City-owned or Leased Vehicles by a 16-1 Common Council vote.
At the start of this initiative, smoking was prohibited in public places but still allowed in private office spaces and vehicles. The local legislators and many of their constituents had to be persuaded that the passage of this ordinance was a necessary and critical step needed to be taken by community leaders for the health of the community. Involving community young people in the planning, decision-making, and implementation of any public health initiative is not only a professionally rewarding experience for participating adults; but, it also contributes a unique perspective to the public health process. However, imperative to the success of any youth-led, adult-guided partnership is the importance of providing young advocates with the appropriate tools to guide them in the process. Youth should be a valuable and respected ally in the overall public health vision. A shared trust can only strengthen and promote coordinated services throughout the community. Therefore, there is a good argument to promote youth infusion as a positive and doable fit. Making a concerted effort to collaborate with other community partners that can create the same internal atmospheric response within their agencies further strengthens that argument. Everybody is a winner! Program sustainability is promoted through partnerships with local non-profit youth serving agencies and life-long skills developed in young people. Many public policy or public education and awareness initiatives can be adapted to have a youth-led, adult-guided focus. 1. An initial step is to have the skeleton of an idea and a core group of youth to present it to. Youth can be recruited through several avenues, many of which already mentor leadership building. A few examples would be youth-serving agencies such as the Girl Scouts or Boy Scouts, faith-based organizations and area high schools. Talk with the school principal and/or guidance counselor for their support and direction. Many high schools offer community service credit for students and this is a great way to help students build their resumes. In addition, approximately 60% of college scholarships request documentation of community service. 2. Draft a timeline. Everyone needs to know a start date and a projected completion date. 3. Make sure to have in some fun along the way.