Eliminating Tobacco Disparities through 4 Levels of Policy Change:

Examples from the Pacific Islander Communities

CERC 5th Annual Health Disparities InstituteRod Lew, M.P.H.

Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL)

October 19, 2012

Overview

Tobacco as a Social Justice IssueIntroduce 4-Prong Policy Change ModelExamples of Legislative Policy (state, federal

and local)Tobacco tax in GuamFDA regulation of tobacco (and menthol issue)Local CBPR project resulting in tobacco retail

licensingElements of Change

The APPEAL Network

APPEAL PrinciplesNational Network for diverse Asian American,

Native Hawaiian and Pacific Islander (AAPI)Includes focus on U.S. –associated Pacific

Islands (USAPIs)Addressing tobacco and other health issues as

social justice issuesCommunities have different readiness levels

requiring capacity building Move communities toward social norm change

Tobacco as a health disparities and social justice issue

Sacred Use of Tobacco

History of Tobacco’s Commercialization

Heavy Targeting by the Tobacco Industry

Disparities in Resources and Capacity

Tobacco as a Social Justice Issue

Tobacco Use among Native Hawaiians/Pacific Islanders

Nativ

e Haw

aiia

n

Amer

ican S

amoa

Chuukese

Palau

an0

20

40

60

80

MenWomen

Pre

vale

nce

Distribution of U.S. Population by Race/Ethnicity, 2010 and 2050

7.6%12.2%

11.8%

16.0%

30.2%

64.7%

46.3%

3.0%1.5% 0.8% 0.8%0.1% 0.2%

4.5%

White, Non-Hispanic

Hispanic

African-American, Non-HispanicAsian

Native Hawaiian andPacific IslanderAmericanIndian/ Alaska NativeTwo or More Races

NOTES: All racial groups non-Hispanic. Data do not include residents of Puerto Rico, Guam, the U.S. Virgin Islands, or the Northern Marina Islands. Totals may not add to 100%.SOURCE: Kaiser Family Foundation, based on http://www.census.gov/population/www/projections/downloadablefiles.html U.S. Census Bureau, 2008, Projected Population by Single Year of Age, Sex, Race, and Hispanic Origin for the United States: July 1, 2000 to July 1, 2050.

Total = 310.2 million

Total = 439.0 million

2010

2050

Per Capita Cigarette Consumption United States 1900 to 1999

Source: Tobacco Use - United States, 1900-1999. MMWR November 5, 1999; 986-993

Impact of Tobacco Control Policiesand Tobacco Tax

Youth are most sensitive to tobacco price change- every 10% price increase decreases youth smoking by 6.5% and adult smoking by 2% (CTFK)

Tobacco tax has impact on tobacco prevention and treatment (Chaloupka 1999) but needs to be paired with tobacco control spending (Rice 1999)

Scenario : tax increase by $1, tc spending increase by 20 cents= smoking prevalence decrease from 12.2% to 11.2% in 5 years. (Max 2011). This results in $2.3 billion less in health care expenditures, 2367 lives saved and 46,000 years of life gained.

4- Prong Policy Change Model

1. Need to work within our racial/ethnic communities where tobacco may not be a high priority

2. …within the mainstream tobacco control movement where racial/ethnic communities are not a high priority

3. …with legislators where neither tobacco nor racial/ethnic communities are a priority

4. …against the tobacco industry where racial/ethnic communities are one of the highest priorities

Legislative Policy Change

State or Territorial LevelFederal LevelLocal Level

Tobacco use in Guam• Indigenous Chamorro represent 37% of the

159,358 population• Second highest prevalence of tobacco use

of any U.S. state or territory• Many tobacco distributors and tobacco influence• Other factors including highsuicide rate among youth

Guam’s Legislative PolicyBill 150 to raise tobacco tax by $2.00 per

pack of cigarettesCollaborative process of key public health,

policymakers and broad-based coalitionLegislative policy focused on relationships

and building on years of previous successesKey components of capacity building and

leadership development

Posted: Tuesday, January 26th, 2010 4:49 AM HST

Guam lawmakers OK bill to triple tobacco tax By Associated Press HAGATNA, Guam (AP) — Smokers on Guam are waiting to see if they will be paying the second highest tobacco tax in the United States.

The Legislature of the U.S. territory on Friday approved a bill to increase the $1 tax on a pack of cigarettes to $3.

If signed into law by Gov. Felix Camacho, Guam would tie Connecticut for second place behind Rhode Island's tax of $3.46 a pack.

Lawmakers say the intent of the increase is to stem the tide of smoking-related illnesses on the island.

American Medical Center family physician Dr. Vincent Taijeron Akimoto says tobacco abuse has led to hospitals being filled with people suffering from heart and lung disease.

If Akimoto had his way, Guam's tobacco tax would increase by $10 a pack.

Guam passes tobacco tax

Federal Legislative Policy

Tobacco industry has been targeting racial/ethnic communities and have successfully adapted their strategies to changing markets and policies

June 22, 2009 President Obama signed the Family Smoking Prevention and Tobacco Control Act

Unintended consequences of Master Settlement Agreement and FDA Legislation

CAPAC advocacy to encourage FDA to ban mentholated cigarettes

Increase of little cigars and cigarillos

Local Legislative Policy:Study on Environmental Influences of Tobacco

CBPR study among Pacific Islander and Asian American communities in 3 cities (Long Beach, Richmond and Seattle)

Aim was to study the relationship between environmental characteristics (both pro- and anti-tobacco influences) and tobacco use among youth using GIS mapping and Photovoice

Describe Your Community Exercise

“Here you can see part of Richmond stores trying to make money by selling smokes and having ads to influence people to smoke. By selling smokes that slowly kill us while they make money we should reduce smoke shops and ads.”

Long Beach City Council passes Tobacco Licensing Ordinance

·Advocates

·Communities

·Coalitions

·Leaders

·Partnerships

·Resources

·Time

·Community Participation

·Community Competence

·Community Empowerment

Prioritization and Goal-

Setting

LeadershipDevelopment

Infrastructure

Development

Community Mobilization

and Organizing

Inputs GuidingPrinciples

StrategicPlanning

Community CapacityBuilding

Short Term and

Intermediate Outcomes

Long TermOutcomes

Programs

·Cessation·Prevention

4-Prong Policy Change Model

·Community Policy·Mainstream Institution Policy·Legislative Policy·Corporate Policy

ReducedTobacco Use

Health Parity and

Health Justice

Strategic Framework for Tobacco Control among Asian Americans, Native Hawaiians and Pacific Islanders

Community Readiness

Environment Assessment

and Data

Elements of Effective Policy Change

4-Prong policy change approachDifferent pathways to policy changeBuild capacity through advocacy trainings and

leadership developmentPolicy change builds upon years of work Building alliances between all racial/ethnic

communities

Implications for Other issues in the Pacific

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www.appealforcommunities.org

www.tobaccopreventionnetworks.org

Thank you !!