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Best Practices for Comprehensive Tobacco Control Programs 2014 Suggested CitationCenters for disease Control and prevention . Best Practices for Comprehensive Tobacco Control Programs : Department of Health and Human Services, Centers for disease Control and prevention , National center for Chronic disease prevention and Health Promotion, Office on Smoking and Health, InformationTo download or order copies of this report, go to order single copies, call toll-free1 (800) CDC-INFO1 (800) 232-4636 Best Practices for Comprehensive Tobacco Control Programs 2014 The following individuals from the Centers for disease Control and prevention , National center for Chronic disease prevention and Health Promotion, Office on Smoking and Health (OSH), were primary contributors to the preparation of this publication.

Suggested Citation. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs — 2014. Atlanta: U.S. Department of Health and Human Services,

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1 Best Practices for Comprehensive Tobacco Control Programs 2014 Suggested CitationCenters for disease Control and prevention . Best Practices for Comprehensive Tobacco Control Programs : Department of Health and Human Services, Centers for disease Control and prevention , National center for Chronic disease prevention and Health Promotion, Office on Smoking and Health, InformationTo download or order copies of this report, go to order single copies, call toll-free1 (800) CDC-INFO1 (800) 232-4636 Best Practices for Comprehensive Tobacco Control Programs 2014 The following individuals from the Centers for disease Control and prevention , National center for Chronic disease prevention and Health Promotion, Office on Smoking and Health (OSH), were primary contributors to the preparation of this publication.

2 Brian King, PhD, MPHT erry Pechacek, PhDPeter Mariolis, PhDThe following OSH staff also contributed to the preparation of this publication:Judy Ahearn, BS; Stephen Babb, MPH; Diane Beistle, BA; Rebecca Bunnell, PhD; Ralph Caraballo, PhD;Shanta Dube, PhD, MPH; Monica Eischen, BS; Jami Fraze, PhD; Erika Fulmer, MHA; Bridgette Garrett, PhD, MS; Karen Gutierrez, BA; Carissa Holmes, MPH; David Homa, PhD, MPH; Brandon Kenemer, MPH; Rene Lavinghouze, MA; Allison MacNeil, MPH; Ann Malarcher, PhD, MSPH; Kristy Marynak, MPP; Timothy A. McAfee, MD, MPH; Sarah O Leary, MPH, MA; Gabbi Promoff, MA; Robert Rodes, MS, MBA, MEd; Patti Seikus, MPH; Shawna Shields, MPH; Kisha Smith, MPH; Karla S.

3 Sneegas, MPH; Xin Xu, PhD; and Lei Zhang, PhD. OSH also gratefully acknowledges the contributions provided by the following individuals:David Abrams, PhD, Legacy; Rob Adsit, MEd, University of Wisconsin; Linda Bailey, MHS, JD, North American Quitline Consortium; Cathy Callaway, BS, American Cancer Society Cancer Action Network; Jennifer Cantrell, DrPH, MPA, Legacy; Thomas Carr, BA, American Lung Association; Julia Cartwright, BA, Legacy; Frank Chaloupka, PhD, University of Illinois Chicago; K. Michael Cummings, PhD, MPH, Medical University of South Carolina; Marietta Dreher, BA, ClearWay Minnesota; Sherry Emery, PhD, MBA, University of Illinois Chicago; Matthew Farrelly, PhD, RTI International; John Francis, MPH, MBA, CDC s Division of Community Health; Karen Girard, MPA, Oregon Healthy Authority; Emma Goforth, MPH, Colorado Department of Public Health and Environment; Roy Hart, MPH, Mississippi State Department of Health; Sally Herndon, MPH, North Carolina Division of Public Health; Delmonte Jefferson, National African American Tobacco prevention Network; Harlan Juster, PhD, New York State Department of Health.

4 Pamela Ling, MD, MPH, University of California at San Francisco; Doug Luke, PhD, Washington University St. Louis; Marc Manley, MD, MPH, University of Pittsburg Medical center ; Danny McGoldrick, PhD, Campaign for Tobacco -Free Kids; Jeannette Noltenius, PhD, MA, National Latino Tobacco Control Network; Sjonna Paulson, APR, Oklahoma Tobacco Settlement Endowment; Meg Riordan, PhD, Campaign for Tobacco -Free Kids; Todd Rogers, PhD, RTI International; April Roeseler, MSPH, BSN, California Department of Public Health; Mary Kate Salley, BA, Alere Wellbeing; Scout, PhD, National LGBT Tobacco Control Network; Chris Sherwin, BA, American Heart Association; Jennifer Singleterry, MA, American Lung Association.

5 Madeline Solomon, MPH, Tobacco Technical Assistance Consortium; Jeff Soukup, BS, Nebraska Department of Health and Human Services; Colleen Stevens, MS, California Department of Public Health; Bob Vollinger, MSPH, National Cancer Institute; Donna Warner, MBA, MA, Multi-State Collaborative for Health Systems Change to Address Tobacco Use; Jeff Willett, PhD, Kansas Health Foundation; and David Willoughby, MA, ClearWay Minnesota. 5 Table of ContentsExecutive Summary ..6 Introduction ..9 Section A: Components of a Comprehensive Tobacco Control Program ..17I. State and Community Interventions ..18II. Mass-Reach Health Communication Interventions ..30 III.

6 Cessation Interventions ..40IV. Surveillance and Evaluation ..56V. Infrastructure, Administration, and Management ..64 Section B: Recommended Funding Levels for All 50 States and the District Of Columbia ..71 Annual Total Funding Levels for State Programs ..72 Annual Per Capita Funding Levels for State Programs ..74 Section C: Recommended Funding Levels, by State ..77 Appendices ..129 Appendix A: Funding Recommendation Formulations ..130 Appendix B: Program and Policy Recommendations for Comprehensive Tobacco Control Programs ..133 Appendix C: National prevention Strategy Recommendations ..136 Appendix D: Guidelines for Comprehensive Local Tobacco Control Programs .

7 138 Appendix E: Data Sources ..1396 Executive Summary Tobacco use is the single most preventable cause of disease , disability, and death in the United States. Nearly one-half million Americans still die prematurely from Tobacco use each year, and more than 16 million Americans suffer from a disease caused by smoking. Despite these risks, approximately million adults currently smoke cigarettes. And the harmful effects of smoking do not end with the smoker. Secondhand smoke exposure causes serious disease and death, and even brief exposure can be harmful to health. Each year, primarily because of exposure to secondhand smoke, an estimated 7,330 nonsmoking Americans die of lung cancer and more than 33,900 die of heart disease .

8 Coupled with this enormous health toll is the significant economic burden. Economic costs attributable to smoking and exposure to secondhand smoke now approach $300 billion annually. Fifty years have passed since the 1964 Sur-geon General s report on smoking and health concluded: Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action. There now is a robust evidence base for effective Tobacco Control interventions. Yet, despite this progress, the United States is not currently on track to achieve the Healthy People 2020 objec-tive to reduce cigarette smoking among adults to 12% or less by the year 2020.

9 A 2007 Institute of Medicine (IOM) report presented a blueprint for action to reduce smoking so substantially that it is no longer a public health problem for our nation. The two-pronged strategy for achieving this goal includes: 1) strengthening and fully implement-ing currently proven Tobacco Control measures; and 2) changing the regulatory landscape to per-mit policy innovations. Foremost among the IOM recommendations is that each state should fund a Comprehensive Tobacco Control program at the level that the Centers for disease Control and Pre-vention (CDC) , statewide Tobacco Control Programs that are Comprehensive , sustained, and accountable have been shown to reduce smoking rates, as well as Tobacco -related diseases and deaths.

10 A Comprehensive statewide Tobacco Control program is a coordinated effort to establish smokefree policies and social norms, to promote and assist Tobacco users to quit, and to prevent initiation of Tobacco use. This Comprehensive approach combines educational, clinical, regulatory, economic, and social strategies. Research has documented the effectiveness of laws and policies in a Comprehensive Tobacco Control effort to protect the public from secondhand smoke exposure, promote cessation, and prevent initiation, including: increasing the unit price of Tobacco products; implementing Comprehensive smokefree laws that prohibit smoking in all indoor areas of worksites, restaurants, and bars, and encouraging smokefree private settings such as multiunit housing; providing insurance coverage of evidence-based Tobacco cessation treatments; and limiting minors access to Tobacco products.