Comprehensive Tobacco Control Programs

Comprehensive tobacco control programs are wide-reaching, coordinated efforts to prevent and reduce the use of tobacco. The Centers for Disease Control and Prevention (CDC) describes key components of comprehensive tobacco control programs including state and community-level interventions, mass-reach health communications interventions, and cessation interventions.

Comprehensive tobacco control programs have been effective in increasing tobacco cessation and decreasing the prevalence of tobacco use and the incidence of tobacco-related diseases. This model is recommended by the Guide to Community Preventive Services.

The CDC developed Best Practices for Comprehensive Tobacco Control Programs, a resource for communities implementing this model. CDC lists the following goals for a comprehensive tobacco control program:

“Prevent initiation among youth and young adults.

Promote quitting among adults and youth.

Eliminate exposure to secondhand smoke.

Identify and eliminate tobacco-related disparities among population groups.”

Communities seeking to design a comprehensive tobacco control program may need to consider implementing the following components:

Community programs. While comprehensive tobacco control programs are often managed at the state level, they require strong support at the community level in order to reach individuals in rural settings. Community engagement is essential to supporting tobacco-free norms and making meaningful changes to the way that tobacco is marketed and sold in local jurisdictions.
Advocacy and policy changes. Program planners may need to advocate for policy changes in order to achieve the goals of a comprehensive tobacco control program. This could include smoke-free policies in schools, businesses, and other organizations or taxes on cigarette sales.
Cessation programs. In order to promote quitting among adults and youth, program planners should incorporate cessation activities into their comprehensive program. This could involve working with insurers to increase coverage of cessation services and nicotine replacement therapies, working with healthcare organizations to ensure that physicians are conducting screenings and providing counseling for tobacco use, and referring tobacco users to a quitline.
Mass-reach communications campaigns. Communications campaigns may focus on a wide-range of tobacco-related issues, including preventing initiation of tobacco products, promoting quitting among active users, and educating users about the importance of screening for tobacco-related diseases.
School-based programs. School-based programs ensure that children and young adults receive anti-tobacco messaging, education about the risks of tobacco use, and information about tobacco cessation.
Point of retail sale and enforcement programs. These programs may focus on stopping the sale of tobacco in certain businesses, such as pharmacies, and enforcing existing laws that prohibit the sale of tobacco to minors.
Surveillance and evaluation programs. The CDC states that surveillance and evaluation are critical components of a comprehensive tobacco control program. These activities will help program planners determine whether the program is achieving its goals.

Examples of Comprehensive Tobacco Control Programs

Baby & Me - Tobacco Free Program addresses the need to reduce smoking among pregnant women. The Chautauqua County Department of Health provided Baby & Me – Tobacco Free to pregnant women in Chautauqua County, New York and two other rural counties, Cattaraugus and Allegany. The Chautauqua County Coordinator partnered with the New York State Tobacco Control program in order to offer this program to 17 other New York State counties.
Tobacco Free Florida is a comprehensive tobacco education and prevention program that is administered by the Florida Department of Health's Bureau of Tobacco Free Florida. The state program provides funding to counties to implement evidence-based practices from the Guide to Community Preventive Services and the CDC's Best Practices for Comprehensive Tobacco Control Programs.

The health departments in rural Jefferson and Madison County in Florida elected to implement community mobilization interventions (which involved establishing community-wide advisory committees); developed policies to increase the price of tobacco products and require that retailers move tobacco products behind the counter; and developed mass anti-tobacco media campaigns directed at teens and adults.
Montana Tobacco Use Prevention Program (MTUPP) has implemented programs to reduce tobacco use in Montana. These include an American Indian Commercial Tobacco Quit Line where American Indian populations can connect with Native Coaches and receive cessation counseling, the Montana Tobacco Retail Mapper that provides information about point-of-sale strategies that retailers use to advertise tobacco and maps the distance between schools and tobacco retailers, and a partnership with the Montana High School Rodeo Association to promote tobacco-free rodeo events. MTUPP has a YouTube page with videos that describe its programs and anti-tobacco advertising.
California Tobacco Control Program has a long history of success utilizing several different types of initiatives to achieve their goals. These include the Tobacco Tax and Health Protection Act which allocated 20% of the tobacco tax to go towards funding tobacco control efforts. Other programs include a statewide media campaign bringing awareness to deceptive marketing strategies used by tobacco companies, local prevention programs targeting specific demographics, and a data-driven surveillance and evaluation component.

Considerations for Implementation

Comprehensive tobacco control programs require substantial funding to carry out program activities. The Community Guide states that “increases in program funding are associated with increases in program effectiveness.” The CDC describes the minimum and recommended funding levels for comprehensive tobacco control programs in Best Practices for Comprehensive Tobacco Control Programs. The minimum level describes the amount required to allow a state to fund and sustain a program ($2.3 billion across all states), while the recommended level also accounts for funds needed to attain resources that will have the greatest impact on reducing the use of tobacco ($3.3 billion across all states). For information about funding individual tobacco control and prevention programs, see Module 5.

Due to their wide-reaching and comprehensive scope, comprehensive tobacco control programs require extensive collaborations with partners at the state, community, and local level. Depending on the focus of the program, communities may need to form partnerships with national research organizations, business owners, schools, advocacy groups, local and state health departments, healthcare providers, and media organizations. Coalition building across sectors is particularly important when trying to create policy changes.

Program Clearinghouse Examples

Resources to Learn More

Texas Tobacco Prevention Pilot Initiative: Processes and Effects
Document
This article describes a study on the effects of an anti-smoking comprehensive community program and media campaign on teen tobacco use and attitudes toward smoking.
Author(s): Meshack, A.F., Hu, S., Pallonen U.E., McAlister, A.L., Gottlieb, N. & Huang, P.
Citation: Health Education Research, 19(6), 657-68
Date: 6/2004