Community-Wide Effort to Make Florida Tobacco Free

Florida public health practitioners, community advocates, and residents joined forces to change state policy in order to stem tobacco related health issues. Evidence-based interventions, like the ones found in The Community Guide, were applied across the state and led to substantial reductions in tobacco use and personal health care expenditures. (Released 2012)

• Making evidence-based interventions mandatory enables success. Florida has seen marked success in addressing tobacco use and prevention by requiring all programs to be evidence-based. Health departments are comfortable proposing and implementing interventions known to be effective.
• Identifying what works benefits the bottom line. Implementing programs that have shown success is the best use of limited funds and resources. For Florida, the use of evidence-based interventions led to a multi-billion dollar savings.
• Interpret the Community Guide at the level for which it will be used. Summarize information provided in the Community Guide for decision makers. Individuals who set policy are unlikely to search the website. Rather, provide them with a straightforward summary to inform decision making

Tobacco use placed a staggering burden on Florida’s economy and quality of life with annual health costs of more than $6 billion and tens of thousands of deaths per year.¹ More deaths are caused by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.² Tobacco is recognized as a cause of multiple cancers, heart disease, stroke, complications of pregnancy, and chronic obstructive pulmonary disease.² Florida public health practitioners, community advocates, and residents joined forces to change state policy to require counties to implement evidence-based tobacco control interventions including a number of recommendations made by the Community Preventive Services Task Force (Task Force) and found in the Guide to Community Preventive Services (Community Guide). This policy change laid the foundation for the use of effective public health interventions that dramatically reduced tobacco use in Florida.

Florida Strives to be Tobacco Free

The Jefferson and Madison County Health Departments observed substantial increases in teen tobacco use in the absence of anti-tobacco interventions and education programs. They also noticed that tobacco companies began giving minors new opportunities to start using tobacco. “There were no restrictions whatsoever on the tobacco companies,” recalls Kim Barnhill, Administrator in Jefferson and Madison County Health Departments in North Florida and a Liaison to the Community Preventive Services Task Force. “They were allowed to pass out free samples of their smokeless tobacco products at community events. We would see kids going through their lines multiple times to get these products. After two or three uses, the kids were hooked.”

In response to these dire circumstances, Florida residents passed a constitutional amendment in 2006 requiring the state legislature to set aside at least 15 percent of their tobacco settlement funds to reduce and prevent tobacco use. The Florida Department of Health dedicated these funds, upwards of $63 million, to implementing and maintaining Tobacco Free Florida, a comprehensive tobacco education and prevention campaign designed to reduce tobacco use.

Counties Mandated to Use Evidence-Based Interventions

Tobacco Free Florida mandates counties to implement evidence-based interventions identified as effective in the Centers for Disease Control and Prevention’s (CDC) Best Practices for Comprehensive Tobacco Control Programs, or in the Community Guide.

Ms. Barnhill and her team acted quickly to implement county-wide tobacco cessation and prevention campaigns Tobacco Free Jefferson and Tobacco Free Madison. The team turned to the Community Guide to identify and support the following recommended interventions:

• Increasing unit price of tobacco products,
• Mass media campaigns when combined with other interventions, and
• Community mobilization when used with other interventions.

Creating Policy and Mobilizing the Community

The local health departments knew that in order to promote anti-tobacco messages and make it harder for people, especially minors, to get tobacco products, it would be critical to educate local elected officials about evidence-based policy changes. The health departments did this and successfully created policies that limited minors’ access to tobacco products (e.g., by requiring tobacco products to be moved behind the counter; increasing the price of tobacco products). They then educated the community about the value of these new policies with local media campaigns.

Community mobilization was another key strategy in the local health departments’ approach. They engaged youth in program activities by creating S.W.A.T. (Students Working Against Tobacco) teams to start peer-to-peer education and support groups in local schools. In addition, they contributed grant funds to create community wide advisory committees to generate ideas and buy-in for county-wide anti-tobacco campaigns aimed at teens and adults. The committees, which continue to be active and include elected officials, school system representatives, health department staff, and health care professionals, leverage existing communication channels to advertise campaign messages, activities, and resources.

Smoking Rates Decrease Dramatically

Tobacco Free Florida has been extremely effective in reducing tobacco use in its communities. Within the first four years of the campaign, the smoking rate for adults in Florida decreased by 18.6 percent and fell well below the national average.³ This reduction saved an estimated $4.2 billion in personal health care expenditures. Additionally, the smoking rate among high school students decreased to 14.5 percent (approximately 3 points less than the national average), and the number of youth who promised to never smoke increased from 55 percent to 62.6 percent.

The statewide program and its county-level counterparts continue to make significant strides toward eliminating the economic burden of tobacco use on Florida’s economy and improving the quality of life for residents. In 2010, the Jefferson and Madison County Health Departments received additional funding to create a faith-based initiative that will engage churches and ministers in promoting smoking cessation programs and resources to their congregations. The outcome of these combined efforts demonstrates that when counties champion evidence-based interventions, including those identified in the Community Guide, success is possible.

¹ Florida Department of Health. www.doh.state.fl.us/Tobacco/tobacco_home.html. Changes in Smoking-Attributable Mortality and the Economic Burden of Smoking in Florida from 1999 to 2009. www.doh.state.fl.us/tobacco/PDF_Files/ChangesInFLSmokingAttributableMortality_EconomicBurden.pdf.
² Centers for Disease Control and Prevention. Health Effects of Cigarette Smoking Fact Sheet. www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking.
³ Florida Department of Health. www.doh.state.fl.us/Tobacco/tobacco_home.html.

Florida’s Department of Health Tobacco Free Florida

CDC’s Office on Smoking and Health

Community Preventive Services Task Force findings referred to in this story:

The Community Guide: Task Force Findings for Tobacco Use and Secondhand Smoke Exposure

• Tobacco Use and Secondhand Smoke Exposure: Community Mobilization with Additional Interventions to Restrict Minors’ Access to Tobacco Products
• Tobacco Use and Secondhand Smoke Exposure: Mass-Reach Health Communication Interventions
• Tobacco Use and Secondhand Smoke Exposure: Interventions to Increase the Unit Price for Tobacco Products