Wednesday, April 27, 2011

Loneliness undermines health as well as mental well-being | UChicago News

Loneliness undermines health as well as mental well-being | UChicago News

Thursday, April 21, 2011

Confessions from an Ex-Smoker on Nicotine Addiction

I smoked for 25 years and was addicted to nicotine. As with any addict, the more my habit was accommodated, the more I indulged. And, I didn't care how it affected anyone else, even my own loved ones. When smoking stopped being allowed everywhere, I had to work harder at feeding my habit. One day, it was -3 below zero and I had to go outside to smoke. I loved smoking, but as I stood there shivering and puffing, with smoke billowing around me, it dawned on me how foolish this was and what a waste of time and I wondered was there any good to it. Even alcohol has medicinal purposes, but smoking, nada. I was enslaved by this addiction. I didn't like that so I made up my mind to quit smoking, and I did, though it took some effort. My thanks go to those who made it so hard for me to keep smoking. I was finally able to break free from nicotine addiction. As long as addicts are enabled, they will feed the addiction. Please keep passing laws and providing funding to help them break free and to protect others.

Saturday, March 19, 2011

What is Public Health Services?

The U.S. public health system is a network of federal, state, local, and territorial health departments, rather than a single agency. With the mandate to protect the population from disease and disaster, public health practitioners and professionals work in health agencies, hospitals, universities and private organizations, and all levels of government, including the military.

State and local public health agencies serve as the foundation of the nation’s public health efforts and now, more than ever, we understand which interventions work and those that have failed.

Ten Essential Public Health Services

  1. Monitor health status to identify and solve community health problems.
  1. Diagnose and investigate health problems and health in the community.
  1. Inform, educate, and empower people about health issues.
  1. Mobilize community partnerships and action to identify and solve health problems.
  1. Develop policies and plans that support individual and community health efforts.
  1. Enforce laws and regulations that protect health and ensure safety.
  1. Link people to needed personal health services and ensure the provision of health care when otherwise unavailable.
  1. Ensure competent public and personal health care workforce.
  1. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
  1. Research new insights and innovative solutions to health problems.     

Who Funds Public Health Programs?

Funding for public health programs comes from a combination of federal, state, and local dollars and private sector contributions. According to a study by the National Association of County and City Health Officials, local health departments receive 29 percent of their funding from local tax revenues, with another 23 percent coming from state revenue. Federal sources account for 20 percent, with Medicaid at 9 percent, Medicare at 2 percent, 6 percent in fees, and another 12 percent from other sources.

A recent report from the Alliance for Health Reform, an advocacy group, notes that nationally the U.S. spends more than 16 percent of the Gross Domestic Product (GDP), or about $2 trillion on treating preventable illness and injury. We spend only 3 percent, or $59 billion, on government public health services, long understood to be our first line of defense against disease and disaster.

Source: Core Public Health Functions Steering Committee. Available at
How Indiana Used Public Relations Counter-Marketing to Cut Smoking Rates 
Smoking-related disease is one of the leading causes of preventable death in the United States. In the 1990s, 46 states Attorneys General launched a civil lawsuit against the country’s largest cigarette manufacturers in an effort to recover the billions of dollars in state medical costs associated with treating smoking-related diseases covered under Medicaid. The suit also sought to recover costs for marketing illegally to minors. Philip Morris, R.J. Reynolds, Brown & Williamson, and Lorillard, the industry’s trade associations, and consulting public relations firms were all accused of violating state antitrust and consumer protection laws.  A settlement was reached In 1998, when the tobacco companies agreed to pay billions of dollars to the states in yearly installments.

Master Settlement Agreement Pays States $195.9 Billion to 2025
Referred to as the Master Settlement Agreement, or MSA, it requires the companies to pay the states $195.9 billion from 2000 through 2025 and imposes restrictions on tobacco advertising, promotion and marketing.

The restrictions include prohibiting advertisements targeting minors, cartoons in cigarette advertising, advertisements on public transit and billboards, and brand merchandising. Payments are allowed to be reduced as cigarette sales taxes decrease - indicating a reduction in tobacco use - or if the total cigarette market declines.

The American Legacy Foundation Gets $300 Million
The MSA also called for the participating companies to contribute $300 million a year for five years to a national foundation called the American Legacy Foundation, which was formed to conduct a public education program aimed at preventing and reducing smoking among youth and at educating the general public about the health hazards of tobacco use. Another $25 million went to the foundation to fund research in tobacco and other substance abuse.     

Master Settlement Shuts Down Tobacco Lobby Groups
Finally, the agreement called for the dissolution of the Tobacco Institute, the Council on Tobacco Research, and the Center for Indoor Air Research, organizations funded by the tobacco industry. Tobacco company lobbying activities are also restricted when it comes to tobacco-control legislation and administration. State Attorneys General are responsible for enforcing the restrictions. There are no restrictions on how the states spend the settlement funds.
In March of 2000, $35 million of the MSA funds paid to the State of Indiana was appropriated by the Indiana General Assembly and the sitting governor, Frank O’Bannon (now deceased) to establish the Indiana Tobacco Use Prevention and Cessation Trust Fund Executive Board for the development of a comprehensive tobacco control program. The board consists of five ex officio members: Executive Director, State Superintendent of Public Instruction, Attorney General, Commissioner of the Indiana Department of Health, Secretary of the Family and Social Services Administration, as well as eleven appointed members with experience in tobacco control or other areas of expertise, and six appointed members representing the American Cancer Society, the American Heart Association, Indiana Affiliate, the American Lung Association of Indiana, the Indiana Hospital and Health Association, the Indiana State Medical Association, and the Indiana Council of Community Mental Health Centers.

Five Year Strategic Plan to Decrease Tobacco Use
By 2001, based on the recommendations and guidelines by the National Centers for Disease Control (CDC), the Board had formulated a five-year strategic plan designed to decrease tobacco use in Indiana. Another $30 million was set aside to fund the program for the next biennium, and $32 million was budgeted for each of the following two years, stipulating that 57 percent of that amount be spent on community-based programs. An additional $7.5 million was allocated for grant-making to each of the 92 Indiana counties. Minority-based partnerships received $2.5 million for community cessation programs, as did the Indiana Alcohol and Tobacco Commission (State Excise Police) for use in enforcing laws prohibiting youth access to cigarettes.

The Centers for Disease Control’s Best Practices Model for Comprehensive Tobacco Control Programs recommends that states establish tobacco control programs that are “comprehensive, sustainable, and accountable and that they include the following components:

·     Community programs to reduce tobacco use
·     Programs to reduce the burden of tobacco-related chronic diseases
·     School programs
·     Enforcement
·     Statewide programs
·     Counter-Marketing
·     Cessation programs
·     Surveillance and Evaluation
·     Administration and Management

Hoosier Model for Comprehensive Tobacco Prevention and Cessation Program
Predicated on the CDC model, Indiana rolled out its Hoosier Model for Comprehensive Tobacco Prevention and Cessation program with funding for five major categories, including media campaigns and evaluation methods.

The Hoosier Model consists of community-based programs, a statewide media campaign, enforcement, evaluation and surveillance, and administration and management.  The agency’s overall stated goal, referred to as its vision, is to “improve the health of Hoosiers and to reduce the disease and economic burden that tobacco use places on Hoosiers of all ages.”

Its mission is to:

·     Change the cultural perception and social acceptability of tobacco use
   in Indiana
·     Prevent initiation of tobacco use by Indiana youth
·     Assist tobacco users in cessation
·     Assist in reduction and protection from environmental tobacco smoke
·     Support the enforcement of tobacco laws concerning the sale of tobacco to
   youth and the use of tobacco by youth
·     Eliminate minority health disparities related to tobacco use and emphasize
   prevention and reduction of tobacco use by minorities, pregnant women,
   children, youth and other at-risk populations

Agency Formed to Reduce Tobacco Use in Indiana
The ITPC Executive Board established a series of 19 objectives in 2001 that were to be accomplished by 2005. Based on extensive research, ITPC set specific, measurable goals designed to change and/or modify smoking behavior in Indiana among adult smokers and prevent smoking behavior among youth.

During this same time, the board formed the state office of the Indiana Tobacco Prevention and Cessation agency and named Karla Sneegas, M.P.H., as executive director to lead the agency in carrying out the mission. It also authorized $7 million to go toward a statewide counter-marketing campaign. 

Advertising and Public Relations Counter-Marketing Campaign Launches  

Seeking to win behavioral change among tobacco use publics, the counter-marketing campaign would aim at making it no longer socially acceptable to smoke. In July 2001, ITPC awarded the account to a major, full-service Indianapolis advertising and public relations agency, MZD Advertising, LLC, along with a team of partner agencies and consultants with experience in tobacco control programs. Chuck Wolfe, former executive director of the American Legacy Foundation and the originator of the nationally praised truth® campaign that focused on deterring youth smoking was one of the consulting partners, along with Golin Harris (formerly the Nixon Group), the agency that had successfully launched Florida’s highly effective tobacco control program.

Step 1: Research Shows Indiana in Top 5 for Highest Smoking Rates in U.S. 
Several research studies were conducted in 2001-2002 that were to be used for the planning of the campaign and to establish a baseline measure to be “used to evaluate the effectiveness of the media campaign.”
The State of Indiana had one the highest smoking rates in the country entering into the 21st century, with research showing that Indiana’s overall tobacco use was almost 27 percent in 2000 compared to the 23 percent national average. With over one in four adults being smokers, Indiana ranked in the top five states for tobacco use. The cost for medical treatment for diseases related to smoking was estimated at $1.6 billion annually. 

Survey Shows High Tobacco Use Among Indiana Youth
In addition, according to the Indiana Youth Tobacco Survey, the cigarette smoking rate for 9th to 12th grade youth was 31.6 percent compared to 28 percent nationally. It was 9.8 percent for 6th to 8th grade adolescents, compared to the national rate of 11 percent. Higher percentages were attributed to pregnant women. Based on Indiana Birth Certificate Data and the Indiana Natality Report, 20 percent of pregnant women smoked versus the 12 percent national average.

ITPC conducted pre-campaign research before the launch of the media campaign that sought to assess the beliefs and attitudes people in Indiana have about tobacco use. They found people’s attitudes to be “strongly pro-tobacco” when it comes to the right of the tobacco industry to sell tobacco products.

They found that Hoosiers also did not object to being exposed to secondhand smoke. These results indicated a gap in knowledge regarding the deceptive manufacturing practices of the industry in producing cigarettes that had been exposed by the states Attorneys General, the industry’s exploitive marketing practices, and the health hazards of secondhand smoke, factors that  contributed in ITPC deciding to campaign to change cultural norms.

Research into smoker behavior and the onset of smoking behavior revealed that changing smoking behavior among smokers would require overcoming both ignorance and apathy, and understanding nicotine addiction. It established that more education is needed to reduce smoking behavior, not only among the smoking population, but also among the general population. ITPC publics include the healthcare industry, smokers, nonsmokers, youth, and ethnic minorities.

Step 2: Analysis and Planning for Media Advocacy
Bain J. Farris, chairman of the Indiana Tobacco Use Prevention and Cessation Trust Fund Executive Board, wrote in the agency’s annual report for 2001-2002 that “changing tobacco use behavior has to happen at the community level.”  In the same report, Karla Sneegas, the executive director of the Indiana Tobacco Prevention and Cessation agency, wrote, “to change Indiana’s extremely high tobacco use rates, we must work community-by-community.”

Community Relations Focus Used to Change Attitudes on Smoking
ITPC relied on the use of media advocacy, defined as “advancing toward public policy goals through the use of earned media coverage,” ethnic marketing, youth activism and grassroots channels of communication to increase awareness about the tobacco issue and reduce the tobacco industry’s “share of voice” in communities: homes, work sites, schools, places of worship, civic organizations, entertainment venues, and other public places.

Step 3: Action – Implementation of the Public Relations Plan
Indiana launched the media campaign in the fall of 2001 using commercials from Massachusetts and California that ITPC tested in Indiana focus groups before airing. The commercials had been effective in changing attitudes in other state counter-marketing campaigns. In another adopted approach, ITPC produced new materials for radio, outdoor advertising and print to raise awareness and supplement the television commercials.

Indiana’s campaign consists of paid advertising at the state and local levels to support the public relations and media advocacy efforts that make up a large portion of the initiative. Its aim is to reach key publics at the community level and effect measurable change in smoking behavior.                 
Focus on Greed of Tobacco Industry Used to Increase Awareness 
Advertisements produced in 2002 focused on the greed of the tobacco industry and its manipulation of an unknowing consumer market. For this, ITPC used advertisements that had been developed and used in Massachusetts and that focused on the toxins found in secondhand smoke. Other specially produced advertisements and communications material were circulated within ethnic markets to support public relations activities that included promotions and events taking place in communities across the state.

The Public Relations Role in Public Education 
A major part of the Indiana tobacco control program’s success was the public involvement of key business, government and community leaders and healthcare experts and professionals. This support for the program is more critical now that the budget is only 31 percent of what it had been initially. 

To promote smoking cessation and discourage the onset of smoking behavior, especially among youth, ITPC used public relations campaigns, combined with counter-marketing efforts in its public education initiatives to cut through the tobacco industry’s advertising, and to bolster the key messages about the harmful effects of tobacco use and the industry’s use of deceptive marketing practices. Indiana’s public education campaign, using paid and earned media messages, is designed to “counter pro-tobacco influences” and to promote pro-health messages statewide and combines a wide range of media outlets, including counter-advertising in television, radio, billboard and print. 

How Anti-Smoking Campaign Reached Minorities
The campaign aggressively uses ethnic marketing — reaching out to minority media outlets and collaborating with minority-based partners — media advocacy and public relations techniques and tactics such as media outreach, media tours, news releases and news conferences, op-ed pieces and feature stories.

ITPC also engaged its key publics at frequent community events and health promotions and made efforts to replace or reduce tobacco industry sponsorship and promotional dollars at popular events. In 2002, the Indiana Black Expo (IBE) was able to replace tobacco industry funding, after having received sponsorship for its programs and events for over twenty years. Based in Indianapolis, IBE is the largest nonprofit organization in the state serving the African American community. Its annual summer exhibition, by the same name, draws a national audience of approximately 300,000 primarily African American attendees and its Coca-Cola Circle City Classic, a football game between two historically black colleges held annually in October, draws another 50,000 thousand each year.

In 2004, ITPC and its 1,600 local coalitions organized over 7,200 activities statewide to raise awareness about tobacco prevention and cessations.  The figure grew to 10,200 in 2005.  The agency launched two branded websites: and, the site for the agency’s youth-led group VOICE. The website (referring to cigarettes and the tobacco industry cover-up of the harmful effects of smoking) was set up to educate the general population about the deception by the tobacco industry that led to the countrywide lawsuit brought against it. By 2005, had received over 2 million hits representing 70,000 visitors. Key areas of interest to the site had 261,000 visitors accounting for 6 million hits. The youth website,, encouraged anti-tobacco teen activism and posts downloadable material on the effective strategies and tactics to use. It received over 500,000 hits by 2005.

Communications Outcomes
  • By 2002, the media relations initiative had “increased earned print media coverage of tobacco issues over baselines established in 2000” by almost 400 percent, and reached out across the state with its “Live Without Tobacco” message.
  • The media campaign reaches every county in the state and tracking surveys show that 75 percent of youth and adults are aware of the advertisements.
  • Youth are 45 percent more likely to be cognizant of the dangers of tobacco use and its addictive properties if they are aware of at least one ITPC advertisement, compared to those who are not aware. Fifty-one percent of adults understood the issue.
  • Youth aware of at least one television commercial were 55 percent more likely to agree with anti-tobacco industry attitudes as opposed to youth who were not aware of the television commercial in 2003.  The figure was 59 percent for 2004.  
  • The media gave more newsprint and airtime to local coalition activities regarding smoke free policies in public spaces. Compared to newspaper coverage of tobacco issues from 1999-2000, 2000-2003 saw an increase by over 900 articles. By 2005, nearly 4,800 tobacco control stories had been placed.
  • By 2005, seven out of ten youth and adults reported having seen an ITPC television commercial.
  • ·Articles about secondhand smoke doubled between 2004 and 2005
  • Newsprint coverage on tobacco issues doubled or tripled in 2005 from the  year before and four counties had over 100 items in 2005.

Step 4: Evaluation 
Indiana’s tobacco control program seeks to educate the public about the dangers of tobacco use and motivate it to take action to correct the negative impact of tobacco use on both the smoker and the nonsmoker (possible tobacco-related disease and death). The communications strategies and tactics used by the program are based on the philosophy that to “achieve behavior change that supports non-use of tobacco, communities must change the way tobacco is promoted, sold, and used while changing the knowledge, attitudes, and practices of young people, tobacco users, and nonusers.”
In the first three years of the Indiana Tobacco Prevention and Cessation agency, Indiana received “national attention as a model state” for having funded tobacco control efforts at almost the full amount recommended by the Centers for Disease Control Best Practices and ITPC was able to make a significant impact on smoking reduction in the state.    

In the 2004-2005 Annual Report, Looking Forward, ITPC’s Executive Director, Karla Sneegas, wrote that the state’s “public awareness and media campaign provides critical support for all components of the Hoosier Model” and noted that ITPC and its advertising and public relations team (MZD, Promotus Advertising, Bingle Marketing, Golin Harris, and Chuck Wolfe) had “produced effective, award-winning campaigns that have high recall by Hoosiers.”

Now funded by payments from the MSA, state tobacco control programs often use persuasion in an effort to alter “the way society acts and thinks in order to achieve the level of change to satisfy the organizational goals” and those are the changed behavior goals set forth by the Indiana tobacco control program.

The first step in societal change is to affect mores – the "informal rules by which we all agree to live.” Mores help to determine what society will or will not accept, such as smoking behavior anywhere before the Master Settlement Agreement and state tobacco control programs. Society not only once tolerated, but also accommodated, smoking behavior. 

According to “changing mores (smoking is no longer cool in some parts of society) and creating new laws (public smoking is now against the law many public places) help to move an organization’s agendas well past what it could do with communication alone.”

The final step is the engineered solution when persuasion, mores and laws are ineffective. A way to physically prevent the behavior may follow, i.e., nicotine patches that release controlled amounts of nicotine don’t affect others with second hand smoke, and bans on smoking in public places.

By 2003, the adult smoking rate had gone from almost 27.7 percent in 2002 to 26.1 percent. It had fallen to 24.9 percent in 2004. Smoking behavior for high school age youth had seen a 32.5 percent decrease from 2000 to 2004, going from 31.6 percent to 21.3 percent. During the same time, middle school youth smoking rates went from 9.8 percent to 7.8 percent; showing a 20 percent decline rates dropped below the national average for the first time.

The Indiana tobacco board recognized the need for an evaluation component to measure program achievement and demonstrate accountability. The process was conducted using surveillance and evaluation research. The two complementary methods of measurements provide the means for program assessment: a) Surveillance monitors tobacco-related behaviors and attitudes, as well as data routinely collected by the Indiana State Department of Health on health outcomes. The Indiana Youth Tobacco Survey (YTS) monitored tobacco use prevalence among youth;  b) Evaluation research uses survey or data collection methods specifically designed to measure specified program activities. An independent evaluation center performs evaluations.

Originally, in 2001, Indiana’s budget for evaluating the effectiveness of its efforts at tobacco control amounted to 10 percent of the total $32.5 million tobacco program fund, or $3.25 million. By the end of 2003, however, ITPC had lost two-thirds of its state funding. When the original funding was reduced to only $10.8 million, budgets were cut for community grants, the counter-marketing campaign and program evaluation. ITPC’s reach dwindled when almost a year went by with no advertisements running and community programs restricted. Data released by the Indiana Behavior Risk Factor Surveillance System survey showed that Indiana’s adult smoking rates, down to 24.9 in 2004, were back up to 27.3 percent in 2005.