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2003 Model Practice Application (Public)

Application Name: 2003 Model Practice Application (Public) : Suffolk County Department of Health Services : Learn To Be … Tobacco Free
Applicant Name: Dr. James Tomarken, MPH,MBA,MD,MSW,FACP,FRCPC
Practice Title
Learn To Be … Tobacco Free
Submitting LHD/Agency/Organization
Suffolk County Department of Health Services


The Suffolk County Department of Health Services has developed and is currently implementing a comprehensive tobacco control program called “Learn To Be … Tobacco Free (LTBTF).” It is based on CDC’s guidelines in “Best Practices for Comprehensive Tobacco Control Programs.” There are four main components of the program:
  • A school-based initiative includes prevention, adolescent cessation, and youth empowerment messages.

  • A counter-marketing/public education component targets adults with cessation and environmental tobacco smoke (ETS) messages, and youth with prevention and empowerment messages.

  • The adult community cessation program, which is in great demand, is available to residents throughout the county.

  • Programs are offered that deal with compliance with all clean indoor air laws, youth access laws, as well as a mandated vendor education program for merchants registered by the state to sell tobacco products in Suffolk County. All programs are offered free of charge to county residents.

Responsiveness and Innovation
Tobacco use is the number one cause of preventable death and disease in the nation. Nicotine is an extremely addictive substance. The goals are to prevent the next generation from becoming addicted to nicotine, to help those addicted to quit, and to reduce exposure to environmental tobacco smoke for all residents. The comprehensive nature of the program is what makes it unique and effective. Each of the components of the program works together and has a positive effect on the others. For example, what is learned in the school program is often brought home and encourages parents to modify their behaviors regarding ETS. The vendor education program provides participants with information about cessation classes. The public information component refers residents to cessation classes and also gives them information about how to make complaints.

Agency Community Roles
The Office of Health Education of Suffolk County Department of Health Services developed this program based on CDC recommendation and is implementing the program in cooperation with other contracted agencies. In the beginning, the office formed an advisory group comprising local voluntary agencies, school personnel, the Tobacco Action Coalition of Long Island, elected officials, and substance abuse prevention agencies. The office often reached out to those it wishes to serve, asking for advice and cooperation. For instance, the Commissioner of Health Services made several presentations to school superintendents to obtain their support for the program and to ensure it met their needs and would be convenient to adopt. The Tobacco Action Coalition provided a forum to enlist aid from all of their grassroots members. Eastern Suffolk BOCES responding to an RFP from the department, is helping schools develop effective tobacco control policies. Given their unique relationship with the schools, they were seen as experts in education and had easy entry into the schools.

Costs and Expenditures
The County Executive and legislature agreed to appropriate 20 percent of the Master Settlement dollars allocated to Suffolk for tobacco control in 2000. Specific allocations were made to each of the LTBTF components based on CDC’s recommendations of per capita spending for each activity. On average, the program has spent approximately $3 million each year since 2000.

Elected officials in Suffolk County have made a strong commitment to tobacco control. It is anticipated that commitment will continue throughout the life of the Master Settlement Agreement.

Outcome Process Evaluation
Each component of the program has conducted some type of follow-up for evaluation. For the cessation component, telephone and written follow-ups are conducted at regular intervals for up to one year after an individual completes a program. Retention and quit rates are available from returned evaluations. In the counter-marketing components, evaluation is based on the number of impressions of each ad, supplied by the contracted advertising agency, as well as the number of phone calls generated during media flights. The evaluation of enforcement is based on compliance rates for the Adolescent Tobacco Use Prevention Act. Currently, school evaluation has been limited to teacher satisfaction with the prevention and cessation programs and enrollment in the voluntary cessation programs. Two baseline surveys were conducted early in the program. A student survey in grades 6-12 was conducted in the 2000-2001 school year. An adult survey was also conducted in the spring of 2001. The department put out a Request for Proposals in the summer of 2003 for the purpose of developing and conducting an independent evaluation and surveillance component for the entire Learn To Be … Tobacco Free program. The health department anticipates having a contract in place by early 2004.

Lessons Learned
Almost from its inception, demand for the community cessation program has been very high. Waiting times to get into a class have been up to three months because it is very difficult to expand the county’s workforce. As an alternative, a contract with the American Lung Association of Nassau-Suffolk has helped to expand cessation services. They hired the staff to run the program. In addition, a Train the Trainer program was developed to help agencies that serve clients tailor the program for their population. When it was announced that the department was receiving funds for tobacco control, many companies claimed to have innovative programs that they wanted to sell to the Office of Health Education. The office relied on the expertise of the CDC distinguish promising programs from the rest.

Key Elements Replication
  • The key to replicating this program is support from local agencies interested in tobacco control. Grassroots support from groups such as Parent Teacher Associations, service organizations, and community-based agencies is critical. They need to help advocate the importance of this program and pledge their support in executing it.

  • It is important to clearly outline the enormous cost of tobacco use and how tobacco control saves money and lives.

  • It is also very important to have appropriate staff assigned to a tobacco control program, such as trained health educators, medical providers, and enforcement officers.

  • While staff need not possess an extensive background in tobacco control, they do need to have experience working with the public and interacting with groups. It is the personality and dedication of the staff that often brings in participants and keeps them in the cessation programs.

  • Resources, in terms of budget, cannot be minimized. It is important to provide products for cessation.

  • Paid advertising rather than public service time guarantees placement that reaches your target audience.

  • Providing schools with the curricula and training to run effective, evaluated programming greatly increases the chances that they will put those programs into use.

  • Evaluation will help health agencies modify the program if it is not meeting its intended goals and enable them to garner more support if it does. A thorough, independent evaluation usually accounts for 10 percent of the overall budget.