Louisiana tobacco control: creating momentum with limited funds.

Abstract

The influx of tobacco settlement money has generated unprecedented potential to address the public health problem of tobacco use.1 In states such as California, Massachusetts, and Florida, where resources have been allocated to tobacco control efforts, much has been achieved.2 Yet a recent survey of state legislatures found that less than 10% of settlement funds are designated for smoking prevention.3 With this level of funding, existing blueprints for comprehensive tobacco control, such as the Centers for Disease Control and Prevention's (CDC's) “best practices,” are beyond the reach of most states.4 The CDC, through the Louisiana Office of Public Health, funds the Louisiana Tobacco Control Program's Research and Evaluation Center (LTCP-REC). LTCP-REC's purpose is to provide resources to the general public, health care providers, educators, and state-funded tobacco initiatives; identify and distribute educational materials; offer technical assistance in design, implementation, and evaluation of community-based tobacco control programs; provide tobacco use prevention and cessation information and referrals via telephone and community outreach; assist with media campaigns; and provide information on model policies and state legislation. LTCP-REC's operating budget for 1998–1999 was approximately $42 000 in direct costs, not including personnel. When resources are scarce and objectives are broad, opportunities are created through partnerships. For example, LTCP-REC initiated a pilot program in New Orleans public schools using the American Lung Association's “Teens Against Tobacco Use,” a school-based smoking prevention program led by teenagers. Twenty-one youths were trained to deliver 4 presentations to elementary school children assigned to in-school suspension for disciplinary reasons.5 This program was expanded, with American Lung Association sponsorship, in spring 2001. After a review of publications revealed a need for prevention materials for young adult African Americans, LTCP-REC conducted focus groups in collaboration with the Center for Substance Abuse Prevention to identify and develop anti-tobacco messages for African Americans aged 18 to 24 years.6 Strategic planning provides maximum flexibility and responsiveness. LTCP-REC began providing tobacco control education before all the resources were in place: The first educational presentation was held on August 29, 1998; 72 presentations had been made by July 2000. The experience provided immediate feedback about priorities, needs, and current challenges. LTCP-REC's newsletter, first published in May 1999, has grown from an initial distribution of 400 to 1277 (1000 posted, 277 e-mailed) by July 2000. It includes sections on local initiatives, national news, legislative updates, and statistical information. Surveys and focus groups of providers and smokers were conducted to assess cessation services in Louisiana.7 Expansion was achieved by implementing small projects on multiple fronts. Development of a tobacco control resource center requires networking, identification of communication channels, and management of educational materials (Table 1 ▶). Early progress indicators for LTCP-REC show positive feedback from clients, partners, and mailing list recipients; increasing recognition of LTCP-REC; growth in the number and extent of outreach and evaluation activities; and wider distribution of materials. TABLE 1 —Strategies to Develop a Tobacco Control Resource Center