Philippe Boucher's Rendez Vous: Clay Parton
Rendez-vous with Clay Parton
Manager of the Tobacco control program for the state of Oregon, Portland, Oregon, USA
By Philippe Boucher
RENDEZ-VOUS 63
Friday, April 21 2000
Thank you Clay for accepting our rendez-vous.
May I ask you to introduce yourself?
I'm relatively new in tobacco control (3 years), compared to many of the seasoned professionals who are leading the movement worldwide. However, tobacco elimination (not control) has become my passion. Prior to this, I managed public health organizations and health care delivery systems in several states. In health care delivery, I saw firsthand that our health care system is burdened by the health effects of tobacco. Because health care is about 1/7th of America's GNP, tobacco causes tragedy both in terms of human lives, and of the effect upon all of our lifestyles.
First question : When one thinks about the most successful states in the US in terms of tobacco control, one usually refers to California, Massachusetts or Florida and one tends to forget Oregon. But since the vote of the initiative ballot 44 in november 1996, Oregon has a comprehensive tobacco control program. Can you tell us what has been achieved and how ?
Oregon's dramatic results are measurable with hard data. These results may have the effect of saving $300 million annually (in health care and productivity) and 1,200 lives. Since the program began in mid-1997 (about 2.5 years ago):
How has Oregon's program accomplished this? Keyword: "comprehensive." Our main focus has been on population-wide strategies. The tobacco-control movement in Oregon is a broad movement that includes very active involvement by the voluntaries, by government, by virtually all multicultural communities, by health care, and by schools. Oregon's Measure 44 program builds upon this broad involvement through a comprehensive "best practices" program that emphasizes specific strategies:
1. First, we began a strategic effort to reduce adult tobacco use and thus create a statewide tobacco-free environment through local workplace smoking bans, an aggressive media campaign, and through a statewide tobacco Quitline. 2. Second, we have focused significant efforts upon protection against secondhand smoke. This has brought the non-smokers as our allies, and has accelerated the movement to a tobacco-free environment. Key to this strategy have been community tobacco coalitions, voluntary organizations, and an effective media campaign. 3. Finally, we have tried to reduce youth initiation by reducing youth access, reducing advertising and promotion, active in-school programming based upon best practices, and smokefree workplaces.
Each of these strategies is implemented in a variety of ways through coalitions in communities, tribes, and multicultural groups; school-based programming; a statewide and local media campaign; and a statewide QuitLine.
2. Since your funding is biennial, you published in 1999 a very interesting brochure. Can you tell us about your objectives for the next two years ? was your funding renewed ? increased ? are there new directions, new priorities ? is a website coming ?
Energy is still running high. Almost 100 community coalitions, tribes, and schools are actively engaged in the fight to stop the killing. With these groups, and with active involvement of the voluntary organizations, more work has gone toward local policy initiatives, particularly smokefree workplaces. Additionally, we have increased resources to the Quitline, focused our media messaging even more toward secondhand smoke and cessation messages, added projects in multicultural communities, come on-line with a statewide clearinghouse, and begun work toward a tobacco prevention website aimed toward prevention advocates.
3. When Jane Moore of the Oregon Tobacco Control Program visited Seattle at the invitation of the Washington State DOH she mentioned ups and downs. How do you assess the situation now, for Oregon and more generally for the US ? After all a former Senator of Oregon, Maureen Neuberger was a fervent tobacco-control advocate in the early sixties (didn't she hire Mike Pertshuk ?) and what happens or does not happen at the federal level can have an impact?
I tend to think mostly in terms of "highs and mid-ranges" in today's tobacco control climate. Here in Oregon, we're almost daily enjoying the glow of some pretty dramatic success after everyone's hard work (beginning with the passage of Measure 44). Nationally, we are still (I believe) reaping the benefits of successfully blocking Congress from granting immunity to the industry during the MSA negotiations. Lawsuits still have the industry on the run. The recent Supreme Court ruling, while a major disappointment, might have the benefit of once again raising to the national spotlight the issue of tobacco, its addictiveness, and its death toll. So in the end some good may come from it. Time will tell.
Really, though, there are some "low" points right now. For example, our nation's recent involvement in lowering China's tobacco tariffs upon US tobacco was a disappointment. Our failure on a state-by-state basis to allocate significant settlement funds toward tobacco prevention demonstrates clearly the influence that the industry has at statehouses.
But overall, I still feel that as a national movement, we're taking many more steps forward than backward.
4. You used a fair number of TV and radio clips from California. Is this collaboration still going on for new clips ? Are you using materials from other states as well ? what about the clips produced by the American Legacy Foundation ? Are you already working in coordination with the ALF?
One of our decisions early on was driven by the fact that we simply don't have as much funding as do California and Massachusetts. Because of this, we decided not to devote resources to the development of new television creative, since really good creative already existed from those states. We focus-tested those and other ads, and have been using those pieces in our ETS and cessation messaging. We did focus test the Florida ads here in Oregon, and they didn't test as well with either youth or adults. Our focus groups responded much better to personal stories of loss or to the effect of their smoking upon others. For that reason, we haven't been using either the Florida or the ALF creative in our airtime. We are still trying to get information from ALF regarding the specifics of their media buy. We would really like to be able to coordinate our purchases with theirs. So far, we have not been given that information.
5. I just read that in Ireland they have decided to create an office of smoking and health to take care of tobacco control. Can you tell us how you are organized? Were new people hired to handle the program when it was created? how much staff is there now, with what tasks and what is your operating budget? and last but not least how much do tobacco taxes bring into the state's budget ?
The agency with responsibility for stewarding the Measure 44 funds is Oregon's Health Division (a division of the Department of Human Services). Although I wasn't here at the time, I know that the Health Division and Voluntary Agency leadership had some essential "guiding principles" when they designed our program.
We are housed in the Division within the Chronic Disease Prevention section (under Jane Moore, PhD). The Chronic Disease Section is directly under the State Epidemiologist (Dr. David Fleming), who is focused upon population-based measures. The commitment of these individuals has been invaluable.
One of those principles was to target maximum funds to active programming. (Only 4% of Measure 44's annual $8.5 million funding is dedicated to Program Coordination, and 4% to an independent evaluation. In the program coordination branch, there are a total of 7 staff. The independent evaluation unit has 3.5 FTEs plus surveillance contracts.) ·
Thus, about $7.8 million is available annually for actual statewide and local programming (about $2.25 per capita). Although this is only about 43% of the CDC recommended minimum funding of $21 million annually, it is a good start. We have had to spend these funds very carefully, using principles described below.
We have relied heavily upon an independent evaluation unit to provide us with constant regular feedback regarding what's working and what isn't. That relationship has been invaluable. The evaluation unit utilizes sales data generated by the Department of Revenue from tax collection information, and surveillance data from BRFSS and YRBSS, together with other surveillance information from birth/death certificates and numerous other sources.These Measure 44 funds are contracted directly to community coalitions, tribes, multicultural groups, schools, the Quitline, clearinghouse, and to the media campaign to carry out specific programming using best practices.
Second, leadership made the specific decision that all interventions would be population-based, and based upon nationally-proven best practices. · The result of these principles is that we require best practices in all projects funded, and all of our funded activities focus upon community change, as opposed to individual behavior change.
Our focus has been upon designing best practices, training groups toward effective strategies, assisting with problems, coordinating the media component with each and every strategy, assisting with cessation efforts, and effectively managing contracts.Local Coalitions ($3.25 million annually) focus their efforts upon Clean Indoor Air, Youth Access, Reducing Promotion, and Increasing Linkages to Cessation Services. Schools projects ($1 million annually) focus primarily upon Tobacco-Free Policies, curriculum integration, parent-youth involvement, and youth involvement in anti-tobacco activities. Tribes and Multicultural Communities ($.5 million annually) build capacity internally and work toward Clean Indoor Air, Youth Access, Reducing Promotion, and Increasing Linkages to Cessation Services. · Statewide Projects ($1.5 million annually) specifically support local initiatives. Examples include the tobacco clearinghouse, training contracts, and innovative projects. Oregon's Quitline ($1.3 million annually including media promotion) is a statewide, toll-free telephone-based cessation support service, and is available to all. In addition, NRT and intensive counseling is available to the uninsured and to Oregon Health Plan members, and to many private HMOs who have contracted with the Quitline. Media ($1.75 million annually no including cessation promotion) messaging is targeted to broadcast and outdoor. Print advertising is undertaken through local coalition budgets, and is specific to their local initiatives. Statewide messaging is primarily Secondhand Smoke (this does not include Quitline promotion).
6. Do you have anything else you would like to add ?
I know that in its inception, Oregon received lots of help from other states' programs, and especially from the CDC. Those groups have helped provide the strategic and "best practice" framework that has been the underpinning of our success so far. Our success might not have happened without them.
Thank you Clay for taking the time to be with us today.
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