CHAPTER 26 Public Health Practice in Communities Box 26-1 Prevention Efforts: Tobacco use(Cigarette Smoking) The decrease in tobacco use has been called one of the 10 great public airlines and buses, and changes to FDA rules for more oversight health achievements in the 20th century. This success illustrates what tobacco production and marketing is required to change community health practices. Several historic 6. States action States used excise tax on tobacco to fund factors came together to enable significant improvements in this smoking control programs, which led to the development important public health problem. and evaluation of community-level approaches to tobacco A. Credible evidence and effective interventions led to medical control 7. New litigation strategies opened up even more monies and created willingness in industry to agree to changes 1. Changes in understanding of the genesis of tobacco addiction eframed the problem as not one of individual control and choice Because of this high level of attention at all levels and significant but of addiction. Evidence for harm to nonsmokers(secondary unding for community prevention programs, multiple tobacco exposure)strengthened the case for regulation interventions to reduce smoking were developed, evaluated, 2. Behavioral and pharmacologic treatments became available, seminated. The U.S. Community Preventive Services recor making it easier to support smokers desiring to quit. combining strategies to B. Trusted experts and grassroots groups provided effective a Reduce exposure to environmental tobacco smoke. a Reduce tobacco use initiation, especially among adolescents, Increase tobacco use cessation 3. The American Cancer Society, American Association, and American Heart Association were each ating against Recommended interventions include tobacco independent from each other. I they formed a Smoking bans and restrictions in public areas, workplaces, and alition on smoking, which was later by the American Medical Association. This broad coalition led legitimacy to the a Increasing the unit price for tobacco produ a Mass media campaigns of extended duration using brief, 4. Grassroots efforts in many communities and from many sources recurring messages to motivate children and adolescents to ang king. Examples include fligh emain tobacco free pendants advocating for their right for a smoke-free workplace Provider reminders to counsel patients about tobaco d the Reader's Digest series educating its readers. The grassroots groups framed their issues as part of the broader Provider education combined with such reminders environmental protection movement and increased consumer a Reducing out-of-pocket expenses for effective cessation health consciousness C. Political will on many levels and available funds led to effective Multicomponent patient telephone support through a state quit 5. On a federal level, Congress passed several laws addressing tobacco labeling, advertising on TV and radio, smoking bans on odified from Institute of Medicine: Ending the tobacco problem: a blueprint for the nation, 2007: Task Force on Community Preventive Services S): Recommendations regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke, Am/Prev Med 20(2 suppl): 10-15, 2001; and Tobacco. In Zaza S, Briss PA, Harris KW, editors: The guide to community preventive services: what works to promote health? Atlanta,2005,OxfordUniversityPress,http:/www.thecommunityguide.org/tobacco/tobacco.pd Box 26-2 Addressing Health Disparities Health in the U.S. population is characterized by pervasive and per- Empowering communities to a sense of increased ownership sistent health care disparities, sometimes also called health inequities. Despite the deeply rooted and intractable nature of many health care Ity participation parities,many states and communities have successfully imp a Addressing environmental factors such as safe walkabilit mented intervention to reduce them. Characteristics of successful bikeability of environment, and access to high-quality food programs include: n Making health equity a component of all policies, including a Strong data skills with geographic mapping of premature death clusters and other determinants of healtl Interventions against health inequities can be successful even on a a Strong coalitions among agencies, community leaders, and other ery small scale. Examples for such successful interventions include stakeholders librarians who visit schools to give each child a library card; public a Assessment of the community environment as a whole and housing directors who address lead and mold; and safe route to addressing the social determinants at the root of health school initiatives with "human school buses"(group of parents whe equities(e.g,, poverty, low rates for high school graduation take turns in walking children to school) ModifiedfromCentersforDiseaseControlandprEvention:hEalthdisparitiesandinequalitiesreport(chdir),2011.http://www.cdc minorityhealth/chdireport.html#execsummarY.IoMreportsonunequaltreatmentandreducinghealthcaredisparitieshttp://www.iom.edu/ Reports/201 1/State-and-Local-Policy-Initiatives-To-Reduce-Health-Disparities-Workshop-Summary asp