Friday, June 18, 1999
Thank you Mele for accepting our " rendez-vous ". May I ask you to introduce yourself?
My name is Mele Smith with the San Francisco Tobacco Free Project. I am responding to this "rendez-vous" on behalf of my colleagues Susana Hennessey-Touré and Alyonik Hrushow, the Tobacco Free Project Director.
1. If I understood correctly, the San Francisco Tobacco Free Project is part of the Health Promotion and Prevention Branch of the San Francisco Department of Public Health.
When was the project created, how many staff people work there, how is it funded and what is your annual budget? I mean, we want to know everything!
Since 1989 the project has been funded through California's Proposition 99, which was passed by the voters in 1988. The proposition raised the tobacco tax by 25cents and earmarked 20% of the money to health education. Each county health department receives an annual allocation to develop and implement the Comprehensive Tobacco Control Plan for the county. We are fortunate that San Francisco is both a City and a County so that we only have one jurisdiction to focus on.
Susana, Alyonik, and myself staff the project collaboratively. Together we develop and implement the comprehensive plan for San Francisco with input from the SF Tobacco Free Coalition. We provide staffing and coordination to the Coalition. The Coalition is completely autonomous from the Department of Public Health and can advocate for tobacco control policies as it sees fit. The three of us have been working together for eight years and have developed three - comprehensive tobacco control plans for San Francisco. The collaborative relationship at the project is excellent and I feel most fortunate to work with two very creative people.
Our annual allocations have fluctuated a great deal in the past eight years. Because our funding is tied to tobacco tax revenues, we are, in a sense, working ourselves out of a job. In addition to fluctuations caused by decreased tax revenues (which is good), there have also been a number of political situations which led to decreases (which is bad). Over the past eight years, we have gone from $1.5 million dollars one year to $300,000 the next year and back again. Currently we are in the midst of a three year plan where we have an average allocation of $700,000 per year. In addition to the three of us, the budget funds a health educator who coordinates the Stop Smoking Program as SF General Hospital and an Environmental Health Inspector who is responsible for providing education related to the State law prohibiting smoking in worksites, including restaurants and bars.
In addition, we fund community based agencies (a.k.a. NGOs) to
implement our Capacity Building Process (CCB). This is a process
whereby the agencies recruit and train health advocates (generally
youth advocates) to diagnose and research a tobacco control issue in
their community and design an action that addresses the issue by
changing the environment (e.g.:
policies). Tobacco Free Project staff provides extensive technical
assistance and training to the CCB projects. The CCB process has led to
actions that the three of us would never have come up with on our own
and has also resulted in a cadre of health advocates on the Tobacco
Free Coalition. Examples include:
- a group of youth went to the SF School Board and successfully advocated for a ban on tobacco promotional items in schools;
- a group of youth successfully advocated for the SF Recreation and
Park Commission to prohibit smoking in outdoor playground areas;
- another group of youth filed a complaint with the Federal Trade
Commission about the lack of warning labels on beedies, Indian
cigarettes that have been popular among youth;
- a group of youth advocated for the SF School Board not to purchase
tobacco subsidiary products. The School Board is still considering this
action.
In addition, the CCB advocates along with other Coalition members have been successful in advocating for:
- ban on smoking in worksites, including restaurants;
- a ban on self-service displays;
- a ban on publicly visible tobacco advertising including billboards, storefront, banners and sidewalk signs;
- a ban on tobacco advertising on taxi cabs;
- earmarking part of the Attorneys General Settlement monies for tobacco prevention.
As you can see all of these actions have a policy focus and meet the three criteria that we have defined as an action - achievable, sustainable, and changes the environment for the well being of all.
But that's not all - we also fund a media contractor and an evaluation contractor. Both of these contractors provided technical assistance and training to the CCB projects.
2. One of your mandated priorities is reducing ETS exposure.
I read you have a program towards households with children.
Can you give us more details about it and about your other ETS projects?
The California Department of Health Services issues the funding guidelines for Prop. 99 funds. These guidelines mandate three priority areas: Reducing exposure to ETS, reducing youth access to tobacco products, and countering pro-tobacco influences.
Over the past few years, we have been focusing on reducing children's exposure to ETS in the home. Comparison of two random phone surveys conducted in 1996 and 1998 indicated that smoke-free households with children had increased among African Americans and Caucasians, but decreased among Asians. In Latino households, over 97% were smoke free in 1998. In order to identify barriers to adopting smoke free home policies, smokers who did not protect their children from ETS at home who were included in the random phone survey were re-contacted. A standard set of questions was asked and responses were recorded in writing by the interviewer. Interviews identified two major obstacles: (1) smoking outside was uncomfortable when it was cold or raining, since smoking was associated with relaxing; (2) messages about the dangers of second hand smoke were not believed by many.
For the design of effective media messages to address these barriers, three (3) focus groups were conducted with African Americans, European Americans, and Cantonese speaking Chinese smokers with children. Based on information from the focus groups, specific media messages were developed for three (3) TV ads in English, targeting African Americans, European Americans and Asians, and one (1) TV ad in Cantonese. Funding was not available for another large-scale phone survey to evaluate the impact of the media campaign. As an alternative, at the end of the TV ad, an incentive (a combination of key chain/alarm clock/flashlight) was shown and viewers told they could call the Tobacco Free Project for a free incentive.
Callers were sent educational material and a postage pre-paid survey. If callers returned the survey, they were sent the incentive, which was, tagged "It's Time To Go Outside." The survey asked about smoking status, whether smoking was done inside, outside or both and whether the ad had influenced them to make a change. Similar questions were asked of those who planned to ask someone else in their household to smoke outside. The responses to surveys will be summarized with respect to the impact of the ad.
In addition, we have an ETS educational program through English as a Second Language classes where class participants will (hopefully) choose to adopt a smoke free home policy. This program has only just begun.
3. You also care about the international aspects of tobacco control.
Is it because there are so many immigrants in San Francisco?
Can you also tell us about the "buddy" program you developed with David Simpson?
The SF Tobacco Free Project and the SF Tobacco Free Coalition recognized that while many regulations to control tobacco have been enacted on the local, state and national level, the tobacco industry has shifted its focus to the international community to ensure its growth and profits. In a city as international as San Francisco, we have observed a direct impact on our residents, particularly immigrants from Asia. Therefore any success the United States has in reducing tobacco use will be mitigated by the relentless march of the U.S. tobacco companies for ever greater profits even if it means bringing death and disability to the rest of the world.
With only 4% of the world's smokers and, until recently, two of the three largest tobacco companies in the world at home, it must imperative to think globally and act locally in our tobacco control efforts. The U.S. tobacco companies are not bound by any borders - nationally or internationally - in their insatiable drive for new customers. Neither can we be bound by borders in our tobacco control efforts.
The SF Tobacco Free Project and SF Tobacco Free Coalition have been working for the past few years on operationalizing the concept of thinking globally while acting locally. This has resulted in successful local actions including divestment of the public monies from tobacco stock, passing of Board of Supervisor resolutions in support of national tobacco control legislation with international components as well as press conferences to call attention to the global impact of tobacco.
We have been fortunate to have met up with David Simpson who heads the International Agency on Tobacco and Health. Since last fall, we have been working with David to implement the Buddy Program. The Buddy Program is a joint project between IATH and health groups in the US which are concerned about tobacco control in countries where there are fewer tobacco control resources. The IATH Buddy Program aims to promote grassroots exchange and solidarity by matching tobacco control advocates in countries with less resources with groups in the US and to promote the exchange of tobacco control ideas, techniques, and resources between communities. The Tobacco Free Project has been facilitating the matching of groups. To date matches have been made between California tobacco control groups and groups in Slovakia, the Czech Republic, Pakistan, Russia, Ghana, Barbados, and Thailand.
4. Ross Hammond and Mary Purcell wrote with your support (and Essential Action) a series of booklets about tobacco in 10 various countries and there are more to come. Can you tell us about them? Are they going to be available on line? On your site on Globalink?
Ross Hammond and Mary Purcell have done an excellent job researching and writing our country specific booklets. To date we have completed booklets on China, South Africa, Mexico, Central America, Vietnam, Russia, India, Brazil, Senegal and Thailand. Each of the booklets gives an overview of the health status with respect to tobacco related disease, an overview of tobacco control laws, and an overview of the tobacco industry's presence in the country.
We hope to have six more booklets completed this summer on Turkey, Germany, Zimbabwe, Japan, Sri Lank, Ukraine, Jordan and Egypt, and Venezuela.
The booklets are not on line yet, but we do have hopes of putting them up on Globalink and our website (www.globalink.org/gtm/sftfc).
The Addicted to Profit report written in collaboration with Essential Action is on-line on our website. The report looks at the global expansion of the transnational tobacco companies to increase their profit.
5. A new program is starting in Europe that tries to involve cities in tobacco control. From your 10 years experience in San Francisco, what advice would you give them?
I don't know if we are in the position to give advice per say since each location is different. However the following areas have been very crucial for any success we have had:
1. Stable funding is essential. We are very fortunate to have dedicated funding for our project.
2. An autonomous coalition that receives staffing and coordination by tobacco control staff is also very important. Any success we have had has been directly due to the members of coalition, which includes the capacity building projects that we fund.
3. Funding a capacity building process whereby community members identify the tobacco control issues they want to address. A key to this process is focusing on the assets and strengths of the community and working towards environmental change (e.g.: policy focused) 4. A comprehensive approach that includes community capacity building, media, evaluation, enforcement, and an international focus.
5. Building and gaining public support for policies to lay the groundwork for environmental change through education and media advocacy
Do you have anything else you would like to add?
Thank you very much for this opportunity to share our experiences with the members of Globalink. If anyone would like copies of the booklets we have developed or more information, please contact myself at [email protected] or Susana at [email protected]
We all admire the hard work and dedication of the many tobacco control advocates worldwide. The work they do with so little support or funding is truly commendable.
Thank you Mele for taking the time to be with us today.
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