Transcript Document

San Francisco Department of
Public Health
Tobacco Free Project
Mini-Cessation Grant Project
2001-2007
National Conference on Tobacco or Health
October 24, 2007
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Provide it and they will
come….NOT
Providing community-based
cessation to underserved,
diverse populations
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Introduction
City and County of San Francisco and the Tobacco
Industry lawsuit
City to receive 25 million dollars in Master
Settlement Funds (MSF) annually for 25 years
City Attorney, Mayor and the Director of Public
Health recommended MSA funds be used to
reconstruct the City’s long-term residential care
hospital
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HISTORY
The SF Tobacco Free Project : Proposition 99 funded which
allowed up to 10% of the LLA funds be available for
cessation:
Served as a Local Lead Agency (LLA) for San Francisco
An LLA is responsible for developing a comprehensive tobacco control plan
LLA is required to establish a Coalition
Coalition comprised of voluntary organizations and stake holders
Provide guidance on the development of the comprehensive tobacco
control plan
Advocate for tobacco control policies
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The Coalition in Action
Advocated: 1 million of the 25 million MSA funds
be allocated to tobacco control programs
Successfully had that language inserted in the
ballot initiative, Proposition A
Proposition A passed by the voters in November
2000 election
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Allocating the funds
Defining The Problem

many communities not reached or minimally served
Coalition recommended:

SF expand cessation to previously underserved
communities
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Request for Proposals (RFA) Process
Criteria for cessation projects
Cessation & reduce exposure to
second hand smoke
Measure behavior change
Initially funded 6 special population
projects at $10,000 per project for 12
months
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Projects Funded
The Last Drag
UCSF Positive Health Program
( HIV+/AIDS community)
Chinatown Health Center Chinese Cooks Project
Kaiser Permanente SF: Prenatal Cessation
SUNSET Russian Tobacco Education Project
Not On Tobacco (NOT) - ALA teen cessation
Asian Perinatal Advocates - 2nd hand smoke
5 projects survived after the first year
4 projects survived after 18 months
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Lessons Learned
Building trust among a community, even for these
established agencies, takes time.
Are these agencies true representatives of the
community?
Has the anti-tobacco message been diffused to a
sufficient number of people in the target
community?
Does the community believe they are “at risk” or,
where is this community in relation to readiness to
quit?”
Is cessation the first stage of intervention, i.e. point
of entry ?
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What are the true prevalence rates?
Phase II: RFA 2003 - 2005
Released RFA to reach communities that had not been funded for
2001 – 2002
African American & Latino communities
Substance Abuse/ Mental Health/ Homeless Communities
Funded 3 new programs at $15,000 each annually
2 African American and 1 Latino/Spanish language
Phase III: RFA 2005 – 2007
Released 2 year funding cycle for $20,000 per year.
Added gender based interventions
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Individual Projects
The Last Drag ( LGBT/HIV+ & AIDS)
The SUNSET Russian Tobacco Education Project
The Tom Waddell Homeless Families
Tobacco Awareness Program (2004-05)
The African American Tobacco Free Project Faith Based
Project
Chinatown Public Health Center (accupuncture/1 to 1)
Asian Perinatal Advocates
Walden House (2005-07)
UCSF Latino Health Project: Dejar de Fumar (2005-07)
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THE LAST DRAG
Things to consider:
Prevalence of smoking among LGBT people was
higher than rate in the general public
Tobacco industry targets the community through
ads and marketing activities and sponsor events
Some LGBT consumers may not feel accepted in
general population cessation groups
HIV status
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The Tom Waddell Homeless Families
Tobacco Awareness Project
Originally designed as a provider based cessation
program
Families stayed 30 days\ policy changed to 60 days
Environmental readiness took time. Staff smoked,
clients smoked a few feet outside the entrance door
Child care concerns needed to be addressed
Project redesigned as a Tobacco Awareness
Project
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Hamilton Family Emergency Center
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SUNSET Russian Tobacco
Education Project
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Russian-speakers
Can’t make assumptions
about this community based
on Former Soviet Union (FSU)
Smoking prevalence may be
63-67% male and 14-35%
female
Male life expectancy in FSU:
57
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Modifications
“Russian Flavor”
Context and Scientific Evidence
Family Members involved
Discuss pervasiveness of smoking in
FSU and how to deal with unique social
situations
Alternative Medicine Interventions:
Acupuncture and Hypnotherapy
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Tobacco Free Project African
American Faith-Based Cessation
Project
Mission is to
change the
norms about
smoking and
tobacco usage in
the African
American
community
To alert and
educate the
community
about the
global
ramifications of
the predatory
tactics of the
Tobacco
Industry.
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THE STAFF
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Project Description
Free stop smoking classes with spiritual
component
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Non-denominational
Offered through religious institutions and
community based organizations
Client follow-up at 3 and 6 months post
intervention
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Challenges
Funding level
Community readiness to access services
Collaborating with other agencies
Clergy are BUSY people
Difficult to get clergy to write down the
spiritual component of curriculum
Labor-intensive outreach
Receiving referrals from providers
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Project Successes
Faith-based curriculum developed
Building cessation capacity in the
community
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Clergy trained as cessation facilitators
Institutionalization with collaborating religious
institutions
Strong follow up
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Where we go from
here?
Projects had an opportunity to develop
acceptable, relevant and culturally appropriate
cessation interventions
All staff had standardized cessation training
Chartered new territories:
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richer, more in depth understanding of target
communities
developed and tested new culturally appropriate
cessation methods
established base line cessation rates
made program modifications
revised curriculum
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Challenges Faced
Standardized curriculum incompatible with participant smokers who
enrolled in services
Agencies are in need of funding. They add a tobacco component
and may not be passionate about cessation/2nd hand smokers
Staff changes: Need for contingency plans at all times.
Data collection and evaluation: process vs. outcome-results not
always a high priority for agencies/ need quick turn-around
evaluation results for short term projects.
Need for relapse prevention /maintenance interventions or
opportunities
What defines success: Reduction / quit/ stage of change
movement?
Program design based on published research and not social contextual considerations: Evidence based research or practice
based evidence
Not enough provider referrals
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Continuing our work
Projects now have a grounded theory of what their community
wants and what they need.
For 2005-07 offered two year grants with opportunity for new
projects to use year 1 for planning.
Projects have a foundation of information and
can apply for larger grants. Program expansion possible.
Community trust and support improved.
Sound data collection tools.
Enhanced technical assistance to projects in analyzing their
data to improve their program and revise curriculum.
Host an tobacco summit in 2008 to identify gaps in services.
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Contact
Darlene I. Bahrs, MA, MPH, CTTS, CHES
San Francisco Department of Public Health
Tobacco Free Project
Program Director
Stop Smoking Program
San Francisco General Hospital
[email protected]
In appreciation to:
Alyonik Hrushow, MPH, Project Director: Tobacco Free Project
Mele Lau & Susanna Hennessey-Lavery, Health Educators
Daryl Kent, SFGH Stop Smoking Program
Melinda Moore, Program Evaluator
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Community Projects
Lei-Chun Fung, Ernestine Daniels, Lynette
Escobar, Bob Gordon, Ali Hall, Jill Jarvie,
Karen Lacavoli, Carol McGruder, Yelena
Moskov, Carlos Penilla, Delilah Raybee,
Gloria Soliz, and Amy Yu.
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