THE PROGRAM’S BACKGROUND
From 1991-1999, South Carolina participated with 16 other states in Project ASSIST (American Stop Smoking Intervention Study), funded by the National Cancer Institute. On September 30, 1999, the ASSIST states joined all other states, the District of Columbia, and U.S. territories in carrying out the goals of the National Tobacco Control Program (NTCP) funded by the Centers for Disease Control and Prevention (CDC). The NTCP utilizes the effective components of ASSIST; however, emphasis is also placed on the development of state health department infrastructure, as the shift has been made from a time-limited, contractual study to a national partnership for a durable, comprehensive tobacco-use prevention and control program. The CDC also provides for and highlights the need for cessation as a component within an effective tobacco prevention program.
Knowing the Health Risks
Exactly how bad is smoking for your health? Analyze the facts and then you be the judge.
According to the World Health Organization, smoking is the greatest preventable cause of death and disability - more than any other single factor. It is a known or probable cause of at least 25 diseases. However, its total impact on one's quality of life, loss of productivity, and the financial burden that it produces will probably never be completely assessed.
Currently, the Centers for Disease Control and Prevention estimate that 47 million adults in the United States smoke. This figure represents about 23.2 percent of all adults in the U.S. today. Right here in South Carolina the percentage of people who currently smoke is 25.5, well above the national average.
Each year, cigarette smoking causes an estimated 430,700 deaths in the United States - nearly 1 in every 5 deaths! Oftentimes people ask how can something as small as a cigarette have such a deadly effect? The answer is simple. Scientists have discovered that every "puff "that comes from a cigarette contains more than 4,000 different chemicals; namely ammonia, lead, benzene, arsenic, formaldehyde, and hydrogen cyanide. More than 45 of these chemicals are known to increase the risk of cancer and hundreds of the other ones are both lethal and toxic.
Using the Program Model
CDC's National Tobacco Control Program uses a multi-pronged systems change model that strives to affect policy and create change within populations at the social and environmental levels. The SC Division of Tobacco Prevention & Control is housed in DHEC's Bureau of Community Health and Chronic Disease Prevention and receives approximately $1.2 million per year from CDC to conduct outcome-based activities statewide directed at the following four program goals:
- Eliminate Exposure to Environmental Tobacco Smoke (ETS): Secondhand smoke is directly linked to chronic diseases, sudden infant death syndrome (SIDS) and poor birth outcome, and triggers asthma in children and adults. The division assists public establishments and private businesses, including schools, restaurants and recreational facilities with policy adoption and enforcement. In addition, the program conducts ETS awareness programs and collaborates with organizations or groups that serve pregnant women, children, and families to promote ETS risk awareness and/or cessation referral services.
- Promote Quitting Among Adults and Youth: The division works with regional offices, care providers, and insurers to expand and promote cessation services across the state. The division also works with schools and youth programs to help young people who use tobacco products choose to quit and provide them with the support to do so.
- Prevent Youth Initiation: The division works with schools and youth programs to build awareness regarding the risks of tobacco use and manipulative marketing practices of the industry, and will continue to encourage young people, their parents, and their communities to view tobacco use as socially unacceptable. The division also supports local efforts that build youth self-efficacy and aspirations toward a hopeful and healthy future.
- Identify and Eliminate Disparities Among Populations: The Tobacco Division supports the South Carolina African American Tobacco Control Network (SCAATCN), which works with minority communities and organizations across the state to engage in tobacco-use prevention and control objectives. The division also works with DHEC's Chronic Disease Epidemiology Division to identify and target disparate populations and with the Office of Minority Health to ensure inclusiveness and the use of appropriate materials and practices.
Creating Program Strategies
The Tobacco Division works through existing community organizations and networks to influence individuals to make behavior changes consistent with tobacco-free norms. The division works to counter pro-tobacco messages with pro-health messages through the use of media advocacy, counter advertising, and exposing tobacco industry tactics. It tracks and analyzes policies related to tobacco use, marketing, and regulation, and uses the information to educate policy makers and others about public health concerns.
Building Program Partnerships
The division funds 12 local tobacco-use prevention coalitions and SCAATCN to carry out program goals at the community level. The division also continues to collaborate with the South Carolina Tobacco Collaborative, the American Cancer Society, the American Lung Association, and the American Heart Association on statewide tobacco-use prevention and control efforts. In addition, the division has increased its involvement with other state agencies including the Department of Education and the Department of Alcohol and Other Drug Abuse Services. The University of South Carolina’s School of Public Health also frequently collaborates with the Division of Tobacco Prevention and Control. More partnerships are continually being developed as the Tobacco Division works to reach every South Carolinian with its message about the dangers of tobacco.
Adopting Surveillance and Evaluation
With CDC funding, surveillance and evaluation of the tobacco-use prevention division has been expanded at the state level, and results will be used to adjust and drive multi-level program efforts. The division works closely with the Chronic Disease Epidemiology Branch to determine indicators to be measured and data sources and will produce an annual Burden of Tobacco Use report and summary that will be used to educate policy makers and others on issues concerning tobacco and health. Ongoing evaluation of program efforts is conducted under the supervision of the division director and an evaluation committee.
Using Master Settlement Funding
In 2000, the SC Legislature appropriated $1.75 million to DHEC for youth tobacco-use prevention and control. DHEC contracted with the SC Department of Alcohol and Other Drug Abuse Services (DAODAS) for an American Legacy Foundation planning grant match, merchant education, and youth access enforcement ($700,000). The remaining funds were allocated to DHEC's Division of Tobacco Prevention & Control for youth tobacco-use prevention and cessation activities. In 2001, the SC Legislature allocated $1.6 million to DHEC for youth tobacco-use prevention and control.