Tobacco Disparities Strategic Plan

November 2006

This Tobacco Disparities Strategic Plan reflects a process designed and funded by the Centers for Disease Control and Prevention, United States Department of Health and Human Services.
Colorado was one of 10 states funded to conduct a multi-month process that:  1) engaged stakeholders across various tobacco disparity groups and 2) defined strategic directions to eliminate tobacco disparities.

The Tobacco Disparities Initiative Strategic Planning Workgroup, whose members are listed on the following pages, served as the author of this document.  Workgroup members attended nine meetings, contributed population-specific working materials and created the overarching domains, goals and objectives included in this plan that are designed to reflect the needs of all populations disparately affected by tobacco.

The Core Team that supervised this effort included:

Judy McCree Carrington, Program Manager, Tobacco Disparities Initiative
Colorado Department of Public Health and Environment
State Tobacco Education and Prevention Partnership

Carsten Baumann, MA, Director of Evaluation
Colorado Department of Public Health and Environment
State Tobacco Education and Prevention Partnership

Arnold Levinson, PhD, Assistant Professor of Preventive Medicine and Biometrics, Associate Scientist in Behavioral and Community Studies
University of Colorado – Denver Health Sciences Center

The strategic planning process was facilitated by the Center for Research Strategies (CRS) (www.crsllc.org) whose team members included:

Suzanne White, MS, Director of Strategic Planning and Policy
Center for Research Strategies

Kaia Gallagher, PhD, President
Center for Research Strategies
 
TOBACCO DISPARITIES

STRATEGIC PLANNING WORKGROUP PARTICIPANTS

  • Catherine Benavidez Clayton, RN, MS, NP, President, National Association of Hispanic Nurses (Colorado Chapter)
  • Ellen Brown, MA, Grant and Publications Specialist, Colorado Social Research Associates
  • Priscilla Brown, AS, Executive Director and Faith-based Representative, Black United Fund of Colorado and Genesis Missionary Baptist Church
  • Juana Rosa Cavero, MA, Clean Indoor Air Policy Manager, Colorado Tobacco Education and Prevention Alliance (CTEPA)
  • Karl Chwe, JD, Program Coordinator, Asian Pacific Development Center (APDC)
  • Diane (Lee) Connelly, LPN, MIM, LGBTIQ Tobacco Specialist, Boulder County Public Health Department
  • Clint Cresawn, MA, LGBTIQ Health Promotion Specialist, Boulder County Public Health Department
  • Sarah Davis, MNM, Vice President of Tobacco Control Programs, American Lung Association of Colorado
  • Char Day, Tobacco Unit Director, San Juan Basin Health Department
  • Jean Denious, PhD, OMNI Research and Training, Inc.
  • Johnna Fandel, BA, Researcher, OMNI Research and Training, Inc.
  • Estevan Flores, PhD, Executive Director, Latino/a Research and Policy Center, University of Colorado – Denver
  • Belinda Garcia, MA, CACIII, Executive Director, Sisters of Color United for Education
  • Makaria Green, Tobacco Disparities Manager, American Lung Association
  • Felisa Gonzales, Research Assistant, OMNI Research and Training, Inc.
  • Mandy Graves, BA, Research Associate, MPH Candidate, University of Colorado – Denver, Health Sciences Center, Department of Psychiatry
  • Binh Hang, MA, Health Promotion, Denver Public Health
  • Lisa Harjo, BS, MA, Choctaw Nation of Oklahoma, Project Coordinator, Native American Cancer Research
  • Amy Houtchens, Tobacco Program Coordinator, American Lung Association of Colorado
  • Cerise Hunt, MSW, Health Disparities Specialist, Colorado Department of Public Health and Environment (CDPHE), Office of Health Disparities
  • Archie Jones, Director, Black Transplants Action Committee
  • Suzanne Kennedy-Leahy, PhD, OMNI Research and Training, Inc.
  • Christa Kriesel-Roth, Safe Zone Program Coordinator, Boulder County Public Health Department
  • Carla Ladd, President, Denver Black Pages.com
  • Rose Lee, BS, Navajo, Native American Cancer Research
  • Maggie McFarland, MEd, Director of Substance Abuse Services, Denver Area Youth Services
  • Tracy Mendoza, BS, Health Educator, Broomfield Tobacco Education and Prevention Partnership, Public Health and Environment Division
  • Francisco Miraval, News Journalist, web-based, Project Vision 21, LLC, Bilingual News and Information Services
  • Cesar Montoya, Community Outreach Coordinator, Sisters of Color United for Education
  • Robert Munoz, PhD, Research Associate, Latino/a Research and Policy Center, University of Colorado – Denver
  • Fernando Pineda-Reyes, BS, Executive Director, Groundwork Denver/CREA Results
  • Terri L. Rattler, BS, Lakota, Native American Cancer Research
  • Rosanna D. Reyes, MPA, BSN, Director of Programs & Initiatives, National Association of Hispanic Nurses (Colorado Chapter)
  • Donna Starck, Regional Health Disparities Specialist, Otero County Health Department
  • Ronald Jemal Stephens, PhD, Professor and Chair, Department of African and African American Studies, Metropolitan State College of Denver
  • Erik Stone, MS, CACIII, Director of Compliance and Quality Improvement, Signal Behavioral Health Network
  • Teresa Tellechea, PhD, formerly with Boulder County Public Health Department
  • Adam Vasquez, Prevention Specialist, San Luis Valley Mental Health Center
  • Harry T. Waters, Parliamentarian, Alpha Phi Alpha Fraternity, Inc.
  • Betty Waters, Retired Supervisor, Retired Dietician, Faith-based Representative, State of Colorado Department of Revenue and Mount Calvary Lutheran Church, Missouri
  • Synod Church
  • Jeannie Watts, Tribal Council Representative, Ute Mountain Ute Tribe
  • Jeanette Waxmonsky, PhD, Instructor, University of Colorado - Denver, Health Sciences Center, Department of Psychiatry
  • Hope Wisneski, MSW, Director of Youth Services, Gay, Lesbian, Bisexual and Transgendered (GLBT) Community Center of Colorado
  • Jennifer Woodard, MSW, Director of Healthy Living Programs, Gay, Lesbian, Bisexual and Transgendered (GLBT) Community Center of Colorado
  • Clarissa Woodworth, MA, CACIII, Director of Grant Management and Youth Programs, San Luis Valley Mental Health Center
  • Johnn Young, Health Education Specialist, Denver Health
  • Young-Sun Yun, Board Member, Colorado Developmental Disabilities Council
  • Michael Zinser, PhD, Associate Professor of Preventive Medicine and Biometrics, University of Colorado - Denver, Health Sciences Center

DEFINITION OF TOBACCO DISPARITIES

Colorado has used national and state data to identify groups experiencing tobacco-related disparities. Tobacco-related disparities are defined as higher- than-average rates of tobacco-related burdens affecting a population group, including:

  • Higher levels of tobacco use
  • Higher levels of exposure to secondhand smoke
  • Limited access to tobacco-related health care and
  • Targeted marketing by the tobacco industry.

State legislation has assigned priority for tobacco cessation treatment programs to people who have a mental illness or who abuse substances (Senate Bill 00-071). State legislation also requires that at least 15% of tobacco tax grant funds be awarded to eliminate health disparities among minority and other high-risk populations that have higher than average tobacco burdens (HB05-1262).

Ten groups are currently identified as Colorado populations experiencing tobacco-related disparities:

  • African Americans
  • American Indians
  • Asian Americans and Pacific Islanders
  • LGBTIQ
  • Latinos and Hispanics
  • People with low socioeconomic status
  • People with disabilities
  • People with mental illnesses
  • People with substance abuse disorders and
  • Spit tobacco users.

GUIDING PRINCIPLES

The presence of tobacco disparities is a social justice issue resulting from an inequitable distribution of resources and decision-making power, such that certain groups of people have unequal access to and unequal benefit from public goods and services.

Groups that are disparately affected by tobacco (“tobacco disparity groups?) face a variety of systemic social and economic challenges that have both direct and indirect effects.  Using tobacco is often a complex response influenced by poverty, oppression, stigma, discrimination and the stress created by the systematic de-valuing and exclusion of disparately affected populations.  Targeted media messages generated by the tobacco industry reinforce the use of tobacco among these groups. The ultimate goal of this plan is to empower individuals and reduce tobacco disparities, that is, the unequal burden of tobacco-related morbidity and mortality shouldered by tobacco disparity groups.

The following are guiding principles for program development, implementation and funding:
The development of programs for disparately affected populations should be participatory and community-based. 
Funding should support groups with proven proficiency in dealing with these populations.  Proficiency in dealing with disparately affected populations should be evidenced at all levels of project operation. 

Funds should become available to nurture the organizational and leadership capacity of grass-roots groups to enable them to deal most effectively with their targeted populations and to integrate them into the larger universe of funded agencies. 

Funding levels for tobacco prevention and control should be sufficient to enable agencies serving disparately affected populations to become sustainable over time.

The uniqueness and cultural diversity within and between groups must be specifically identified, recognized and respected as part of all funded project efforts.  Equal value must be given to all disparately affected populations.  Partnerships with local community organizations and leaders who represent these populations should be promoted and sustainable infrastructures created.   Any involved and funded organizations must ensure that cultural competence principles are embodied in all phases of project operations:  planning, program development, implementation, evaluation and sustainability.  Evaluation should be required to assure the presence and quality of cultural competence across program areas and project operations.

A continuum of tobacco prevention and cessation services should be available within disparately affected communities.  These services should be accessible, culturally appropriate and affordable.  Innovation in service delivery should be encouraged.  Quality assurance of service delivery shall be required.  Projects should address the social and economic barriers to care-seeking that are specific to individual communities, as well as those that are common to disparately affected populations. Innovative grant-making strategies to eliminate tobacco disparities should be considered, especially in areas where evidence-based practices do not currently exist, as identified through a systematic review of existing programs and funding approaches.  Rapid cycle, innovative pilot testing should be funded to promote interventions that meet the needs of disparately affected population groups.  Proposals should be solicited from non-traditional, community-based organizations with credentials in these communities that can develop and tailor program efforts to community needs. Review boards and planning groups should include representatives from tobacco disparity groups.

STRATEGIC PLAN DOMAINS

The strategic plan domains refer to the seven overarching goal areas of the Tobacco Disparities Strategic Plan. The domains listed below were decided upon by the disparities strategic plan workgroup members to address all areas of tobacco prevention and control for populations disparately affected by tobacco-related use and burdens from related morbidity and mortality. Objectives for each domain are listed in the following pages. Some of the objectives are outside of the scope of responsibility of state or federal government. Those particular objectives are therefore meant for consideration as opportunities for local communities.

GOALS AND OBJECTIVES

  • Policy
  • Media and Marketing
  • Research and Evaluation
  • Health Care
  • Education
  • Community Capacity-Building and Infrastructure
  • Community-Based Norms and Attitudes

POLICY

GOAL: Integrate representatives of disparately affected populations in key decision-making bodies and processes.

By December 2007, a Tobacco Disparities Subcommittee of the Tobacco Review Committee will guide the Review Committee in all matters involving disparately affected populations.

By June 2008, identify strategies to increase the membership and representation of disparately affected populations on public policy boards affecting the distribution of funding and policy making relevant to tobacco control and prevention including the Tobacco Grant Program Review Committee.

By June 2008, identify state and local regulations and policies governing health care providers and services that have potential to help address tobacco prevention, control and cessation services for disparately affected populations.

By December 2009, develop model reimbursement and service delivery policies and regulations intended to be incorporated into State regulations related to tobacco treatment services and programming.

By December 2009, and yearly thereafter, issue an annual report evaluating achievement of the goals and objectives in the Tobacco Disparities Strategic Plan.

MEDIA AND MARKETING

GOAL: Promote equity in tobacco counter-marketing penetration.

By December 2007, provide media message and communication training to agencies providing services to disparately affected populations.

By July 2008, create a mechanism for the Tobacco Disparities Subcommittee to partner in media activities targeting disparately affected populations.  Work with STEPP* media contractors to ensure that they demonstrate cultural proficiency and involve disparately affected populations.

By December 2008, develop effective tobacco-free and health promotion messages that target, reach and involve specific disparately affected populations, including high-risk groups and local communities within these populations.

On an ongoing basis, use and test alternative communication strategies to more effectively reach and involve disparately affected populations.

On an ongoing basis, monitor tobacco industry media and marketing targeting of disparately affected populations in Colorado and local communities and disseminate this information to disparately affected populations.

*State Tobacco Education and Prevention Partnership

RESEARCH AND EVALUATION

GOAL: Increase knowledge of and within disparity groups regarding tobacco use and unequal tobacco burden.

By December 2008 and on an ongoing basis, evaluate and report the effectiveness and reach of current tobacco prevention and control policies, strategies and practices that relate to and involve disparately affected populations.  Distribute the findings.

On an ongoing basis, starting no later than July 2007, develop research and data collection methods appropriate to disparately affected populations by a variety of strategies including involvement of these populations in research design and implementation.

Annually, develop, pilot and evaluate at least one innovative tobacco prevention and control strategy for disparately affected populations.

By December 2007, establish actionable baselines of tobacco use attitudes, behaviors, and risk factors among disparately affected populations, using research methods appropriate to the populations and involving relevant disparately affected populations.

By June 2008, establish a state clearinghouse of research instruments, methods, and results relevant to disparately affected populations.

HEALTH CARE

GOAL: Provide access to standards-based, culturally proficient health care for tobacco prevention, cessation and control.

By December 2007, determine feasible and meaningful amounts of change for each of the following objectives, consistent with baselines identified through the Research and Evaluation goal.

By June 2010, increase the proportion of people in disparately affected populations who receive tobacco prevention and cessation services from health care providers.

By June 2010, increase the proportion of providers and community-based programs that educate consumers from disparately affected populations in tobacco prevention and control.

By June 2010, increase health care coverage and establish provider reimbursement for culturally proficient tobacco prevention and cessation services to disparately affected populations.

By June 2010, increase the proportion of health care providers who receive regular training in, and deliver, culturally proficient tobacco prevention and cessation services, including services addressing spit tobacco use.

EDUCATION

GOAL: Educate leaders and individuals in disparately affected populations to reduce initiation, use and exposure to tobacco.

By December 2007, create community-appropriate, cultural strengths-based strategies to educate disparately affected populations to increase awareness and reduce the elevated risk and exposure to tobacco use.

By July 2008, identify or develop efficacious, culturally proficient tobacco education interventions for youth in disparately affected populations.

By June 2010, increase the proportion of leadership in each disparately affected population that is educated on tobacco prevention and cessation

COMMUNITY CAPACITY-BUILDING AND INFRASTRUCTURE

GOAL: Mobilize and enhance community networks, leadership and infrastructure to address tobacco prevention and control.

By June 2007, designate funding to be used for assessing and building community capacity for tobacco disparity initiatives.

By July 2007, establish a Technical Assistance Resource Center (TARC) that will provide technical assistance to organizations addressing tobacco disparities.

On an ongoing basis, promote collaboration between disparately affected populations and statewide tobacco partners and grantees using the TARC to facilitate sharing expertise across agencies through a variety of forums, including cultural proficiency and tobacco-control practices.

By July 2007, support leadership development within disparately affected populations for tobacco prevention and control.

On an ongoing basis, include as an application review criterion a population's tobacco burden, in order to reduce tobacco disparities.

COMMUNITY-BASED NORMS AND ATTITUDES

GOAL: Use community-based approaches to respond to cultural norms concerning tobacco prevention and control to develop a climate of healthy change within communities

On an ongoing basis, identify and engage additional partners in disparately affected populations to help promote healthy norms around tobacco use.

On an ongoing basis, support the use of community communication channels and networks to address attitudes and behaviors toward tobacco.

Every other year, starting by June 2009, hold a statewide conference, jointly developed by representatives of disparately affected populations and state agencies to explore:  1) tobacco as a social justice issue and 2) community-based, culturally appropriate tobacco control strategies.

 

WORKGROUP ROLE AND PROCESS

A key goal of the tobacco disparities strategic plan has been to build Colorado’s capacity for the identification and elimination of tobacco-related disparities by engaging a diverse and inclusive workgroup in a strategic planning process.  It is this goal that inspired the composition and size of the Colorado Tobacco Disparities Strategic Planning Workgroup.  The populations that would be included in the process were identified through data analysis previously conducted by staff within Colorado’s State Tobacco Education and Prevention Partnership (STEPP).

Workgroup Composition

The Workgroup was composed of 47 members representing eight of the disparate communities identified in the previous data section.  The communities represented are: African-Americans, American Indians, Asian Americans, Latinos, persons who are Lesbian, Gay, Bisexual, Transgendered, Intersexed and/or Questioning (LGBTIQ), substance abusers, persons with mental illnesses, and spit tobacco users. The two groups not represented in this round of strategic planning were: People living with disabilities and individuals experiencing low socio-economic status (SES), though the condition of low SES was cross-cutting for all the represented groups. Approximately half of the workgroup members were also recipients of grants provided by the STEPP Tobacco Disparities Initiative program.  Other members were identified and asked to participate by the STEPP health disparities program director based on their knowledge, expertise, and role in their respective communities.   All the participants were compensated for their work during the course of the process.

Workgroup Process

The tobacco disparities strategic planning process was initiated by the Colorado Department of Public Health and Environment through the STEPP program.  STEPP received money from the Centers for Disease Control and Prevention (CDC) to conduct the strategic planning process with disparately affected populations.  The populations were identified through an analysis of Colorado Tobacco Attitudes and Behavior survey data and were included in the 2001 Colorado Tobacco Strategic Plan.

Members of the STEPP strategic planning team facilitated the workgroup process.  The team included:  Judy McCree Carrington, project manager - CDPHE; Carsten Baumann, project evaluator - CDPHE; Arnold Levinson, data analysis for the University of Colorado at Denver Health Sciences Center and; Kaia Gallagher and Suzanne White, project facilitators from the Center for Research Strategies.  The team participated in training sessions conducted by the Centers for Disease Control and Prevention (CDC) and structured the process in Colorado based on the recommendations and experience provided by the CDC.

The workgroup process consisted of nine monthly meetings.  At each meeting, the workgroup focused on discussions and activities that would contribute to components of the plan and the final product.  Between meetings, participants were frequently asked to work within groups, representative of their populations disparately affected by tobacco, to prepare materials that would be discussed at the meetings.  This work was critical to the process and required a great deal of commitment from the workgroup participants.  Key components of the plan that were developed at the workgroup meetings were:  1) definition of disparities 2) population assessments 3) SWOT analysis 4) critical issue identification 5) identification of domain/goal areas 6) development of goals and objectives and 7) development of action strategies.  The schedule of meetings with the broad agenda topics covered is included below.

MONTH

 DEADLINE ACTIVITY

December

11/29/05-12/2/05

CDC Training #1

January

1/1/06

Complete Data and Information Analysis for CDC

1/27/06

First Colorado Workgroup Meeting

February

2/1/06

Workgroup is Operational

2/15/06

SWOT Analysis and Population Assessment and Critical Issues Identified

2/24/06

 Second Colorado Workgroup Meeting

2/28/06

First Process Evaluation Report due to CDC

March

3/8/06-3/10/06

CDC Training #2

3/8/06

Five to six Critical Goal Areas due to CDC

3/28/06

Third Colorado Workgroup Meeting

April

4/30/06

Second Process Evaluation Report Due to CDC

4/28/06

Fourth Colorado Workgroup Meeting

May

5/31/06-6/2/06

CDC Training #3

5/26/06

Fifth Colorado Workgroup Meeting

June

6/16/06

Development of Domains, Goals and Objectives

July

7/19/06

Finalization of Goals and Objectives

August

8/24/06

Completion of Goals and Objectives and Finalization of Population Assessments

September

9/29/06

Final Meeting and Finalization of Guiding Principles and Critical Issue Identification