The Network

for LGBT Tobacco Control

Institute 2010: Tobacco Policy & Health Systems Change

by Scout

While some of this workshop was deep talk from state viewpoint about changing systems, they did do a great review of best strategies for how to get a health care agency to integrate routine cessation interventions. Considering I bet every community has a few LGBT friendly docs with large natural LGBT patient populations, focusing on getting these community-friendly offices to change can probably have a big impact on LGBT smoking status community-wide.

Background: Multi-state Collaborative for Health Systems Change

Who is this? It’s a group of 20 states that have partnered with national groups to pioneer better integration of cessation services into routine health care. See lots of great case studies and tools about this on their website.

How do we integrate better cessation into health care systems? Most current leading edge work is still focused on the basics: getting medical providers to do the AAR, or Ask, Advise, Refer model from the Public Health Guidelines. Referrals these days are often through fax forms to quitline, which allow nice followup contact between quitline & doc.

Entree: Best tips and tricks for getting health care providers to integrate cessation?

Note: This is a real time of change for providers, healthcare reform is going to usher in conversion to electronic health records for all soon, so it’s a great time to address tobacco use well. See some bullets on this at end.

  • Assess current tobacco intervention process (multi state collab has assessment tools on their website)
  • ID clinical and administrative champion (make sure clinical champion is high enough up ladder)
  • See if they have electronic health records for at least 2 yrs (so they’ve worked out bugs) (you can change systems without this but much harder to track change)
  • The newer AAR (Ask, Assist, Refer) intervention is good & takes less time than the old intervention (aka “5As” from the old guidelines).
  • Try to advocate for smoking assessment to be part of vital signs (taken at each visit) versus other medical info (not looked at too often). And it should be required vital sign, not optional.
  • Might not be doc taking vital signs, could be nurses, make sure you have champion there!
  • American Acad of Family Physicians and Amer Acad of Pediatrics have full Ask and Act toolkit for providers to integrate this work into their routine. Lots of templates and resources there, esp for elec health record integration.
  • Have info technology (IT) person at table from start, esp to plan to routinely circulate performance info reports (# smokers identified, # brief interventions, # referrals, by provider). Docs are competitive & like to do well!
  • Train staff, test changes (revise if needed), implement the feedback reports (see sample reports on web)
  • There is new money under healthcare reform to assist many medical practices to convert to electronic health records, I hear $44k per doc.
  • Eventually, healthcare reform changes means docs will get lower medicare and medicaid payments if they don’t have electronic health records that collect key info, like tobacco use.
  • See Federal Health IT website for details on how new electronic records need to meet “meaningful use” guidelines and for local tech support for conversions.

Bonus Tidbit: Best Tobacco Healthcare Reform Briefing Sheet

University of Wisconsin has boiled down the several thousand page Affordable Healthcare Act to 7 pages of what changes for tobacco and when those changes roll out. These folk say it’s the best summary they’ve seen, download it here.

October 5, 2010 Posted by | Uncategorized | , , , | 1 Comment

Institute 2010: Legal Workshop & Marketing Tidbits

by Scout

My morning workshop for the 3 days of this institute is on legal strategies, particularly Using Public Health Law to Seize Opportunities in Tobacco Control Policy.

Now that we’re almost done with day 2, let me shoot off a few highlights of the great info that’s been bandied around. We’ve got reps from about 25 states in the room, all swapping strategies that they’re using on the homefront.

Legal Strategies

Here are just a few of the legal strategies being pursued at the state level, I knew about some, but some were brand new to me.

  • excise tax increases (Tip: base on price, not weight. Add caveats to avoid ‘2 for 1’ offers to get around this.)
  • clean air laws
  • clean air park or playground laws
  • lots of buzz on clean air in public housing projects
  • mandating state insurers provide comprehensive coverage for cessation services
  • mandated tobacco retailer education classes
  • restrictions on local marketing (<- apparently FDA regulation gives lots of room for this. Think cigs should be out of sight.)
  • sales bans in particular venues
  • mandated increased insurance premiums for smokers
  • prosecutions/penalties for sales violations


Anyone know what a ‘powerwall’ is? It’s the solid wall of tobacco ads and cigarettes at retailers. We’re even hearing that at some retailers where they’ve banned ads, the boxes are being arranged to convey a message. Sneaky, eh?

Some folks were talking about how policymakers at their state level were former tobacco industry staff, which pretty much um, trumps their best efforts. Makes me think of a strategy being used in California by LGBT advocates, of focusing on getting the LGBT-connected legislators to agree they will stop taking tobacco funding…. sounds like if other states encouraged all their community groups to do this, we might be able to neutralize the tobacco industry influence at more of the policy level! I know Naphtali Offen, Bob Gordon and others in CA have been doing this work, maybe we can ask them to do a short guest post on how it’s worked for them.


I got to sit down with reps from WA, WY, and MS and talk about marketing, heard some really interesting stuff that they’re doing locally.

Mississippi has some interesting youth prevention campaigns, Reject All Tobacco aims at younger schoolkids, but is also running another for middle and high schoolers called GenerationFree that includes games and merch you can earn by building up points by participating. Reminds me how Legacy said their mini games were used lots on the web, sometimes on their site, sometimes by placing them on other sites. I want some LGBT-focused mini games we can pass around, anyone know a game designer?

Wyoming showed some savvy, after coming FDA bans on promotion at family events pushed the tobacco industry to bail from the big local rodeos, Wyoming tobacco control moved in to replace their sponsorship with cessation/prevention ads instead! (lesson learned: make sure you negotiate to be only tobacco related advertiser, or you might find yourself next to snuff ads too). They’ve developed the We Draw The Line campaign, which nicely, is integrating several health issues. Word is Wyoming is already starting to bundle lots of health issues, like at the school level, they’re just starting to combine tobacco prevention and youth suicide and other prevention behaviors into one bundle, which means there’s broader opportunity for us to just get one combined campaign to include LGBT outreach, not bunches of different ones.

And Washington state was happy to announce their “Dear Me” campaign has just won a National Award for Excellence in Ads, a very rare phenom for a public service announcement. Looks like 11 states are using this campaign so far. Sad reality is, Washington state had their own media campaign cut, so it’s hardly running on the homefront. Nicely for us, Washington State is one of the ones that runs a statewide LGBT network, along with other associated disparity networks. I know they’ve generated some great lessons learned from years of that work.
Washington State Department of Health – “Dear Me – Vance” – :60 – USA

And that’s my report for now! More as I learn it!

Network Director

Bookmark and Share

October 5, 2010 Posted by | Uncategorized | Leave a comment

Institute Keynote – Author of “Switch: How to Change Things”

Gustavo Torrez

I am currently at The Institute 2010 – Shifting to a Higher Gear tobacco skills conference hosted by CDC and TTAC.

The opening Keynote Speaker was Dan Heath, Author of the Book Switch – How to change things when change is hard.

Dan’s charismatic nature sweep the room, and all of a sudden 8:30am did not feel so early!

He begins talking about how Psychologists have discovered that our minds are ruled by two different systems – the rational mind and the emotional mind, both compete for control.

The Rational conscious deliberative mind wants a great beach body the Emotional unconscious automatic mind wants that the ice cream… Sound familiar? I see it as the good gender-neutral individual in white on one shoulder and the bad gender neutral individual in red on the other shoulder. How may times do we have these types of discussions with ourselves?

What happens if they agree… CHANGE can be made with very little resistance!

It is not always that easy, and sometimes you need to address how to really create change.

Dan shows us the picture below, a man on an elephant. The man thinks he is in control but in reality who is in control? Of course the elephant!

Dan’s 3-part framework for behavior change he addresses in the follow ways

Direct the rider (man on the elephant), direction for the rider

Motivate the Elephant, we have to have the desire to change

Shape the path, make it simply easier to make the change, clear your path

When we talks about “Directing the rider”, he says the rider focuses on problems. The elephant is doing what it wants…

So what can you do to create change?

Find bright spots, identify what’s working today and do more of it…

People remember the negative longer than they remember the positive, he referenced a study which showed that individuals pay more attention to the negative things, an not enough of the positive.

This is so true though right? When we watch the evening news the top story is something negative, throughout the evening they focus on the negative things happening in our communities more that the positives.

Dan believes “we need to identify the bright spots” When you look at your kids report card don’t highlight the F in math, but highlight the A in English and the B in History, then identify ways it take to assist them in bringing the F grade up.

How often do we look for the bright spots, and build on them? Got you thinking… I know it has me thinking….

Part two if his framework is to “Motivate the Elephant”

The elephant speaks feeling, speak to the feeling to insight action. Knowledge is not enough, have to speak to the emotions. Change comes from emotion and if you motivate the elephant, you will create change.

Shrink the change, our elephants are easily spooked, he addressed phrasing the issue without making it look more daunting than it actually is! Take it one step at the time, and you will see it is easier than you think.

Ambiguity is the enemy of change.

Our role is to get people moving in the right direction, and if we shrink the change and take it one step at a time we will take the path of less resistance. Which transitions into part three of his framework.

“Shaping the path”

We have to make it easier, give people the map, be more direct he says…

Don’t just tell someone that there is a food drive on Friday at the town center, give them a map to the town center, tell them what you need, and the times to come by.

What can you do to make it easier for people, I believe we are a society of convenience… bottled water, sliced bread, it’s all convenient! So if we shape the path we will create the road of less resistance!

All in all, think about Dan’s 3-part framework, and spend a little extra time focusing on the bright spots, from talking with your child about grades, to embarking on your next social cause see how these strategies can assist you!

And if his great presentation wasn’t enough to get me reading the book, right after it Bronson Frick from Americans for Nonsmokers’ Rights stood up and said it’s one of the best books he’s ever read on behavior change. OK, this book now becomes a must read!

Bookmark and Share

October 5, 2010 Posted by | Uncategorized | 1 Comment

The Tobacco & Diabetes Training Institute Reports

by Scout, Network Director

This week the whole Network staff team and reps from each state are all down in Atlanta, attending The Institute 2010, a training event for people in tobacco and diabetes. We’ve been to one of these a few years ago, but this is the first time it’s combined with diabetes folk too, so this time it’s a joint production of the Tobacco Technical Assistance Consortium (TTAC) and the Diabetes Training and Technical Assistance Center (DTTAC).

So, since we’re all about linking people and information, watch this week as we keep posting info about what we’ve learned in our courses down here.

Just to start us off, we had an introduction by Dr. Ursula Bauer, the head of CDC’s Chronic Disease Center. As we know from some prior meetings, Dr. Friedan, the new head of CDC, is really taking a strong hand in shaping CDC direction now. Dr. Bauer reviewed the 6 “winnable battles” Dr. Friedan has identified as agency priorities:

  1. tobacco use
  2. nutrition/physical activity
  3. teen pregnancy
  4. iatragenic infections (caused by healthcare)
  5. motorvehicle injury
  6. HIV

Dr. Bauer says, chronic diseases account for nearly 3/4 of the $2 trillion dollars we spend on health care every year. Plus we know nearly every chronic disease is influenced by the 3 pillars of what’s now known informally as “wellness”, that’s tobacco, physical activity, and nutrition. So, right now there’s an increasing emphasis on changing these upstream factors to save some of that cash downstream. That’s right, run that balance sheet and show everyone how doing tobacco control work offers a great return on the healthcare dollar.

As I know we’ve reported before, Dr. Bauer continued to echo the new big emphasis on environmental policy change as a smart strategy for changing the arena. As she aptly noted, an investment in policy change lasts long after the original money is gone. Some of the ones she brought up as smart continue to echo some of the strategies we saw before at the big wellness conference, namely: banning transfats, taxing sugar sweetened beverages, increasing tobacco taxes, bolstering clean air laws, building better walking/biking options. She talked a lot about building structures that support health. As Dr. Bauer says, “Right now our communities are designed for disease. It’s unreasonable to expect people will change behaviors when so many social and cultural factors conspire against them.” (I believe part of that was a quote of B. Smedley).

I know I’m not alone in loving this larger persepective on structures to support health. Every time I’m at a conference on health, I struggle as a vegetarian to even get reasonable food to eat. And last time I was down here at the CDC wellness conference, I was biking on some of the overcongested streets to the local health store and a driver leaned out their window and yelled, “See you in the emergency room!”. Which, considering the 18″ rut that was my bike lane, I thought wasn’t terribly far fetched. So, again, loving this bigger perspective on real health and I for one can’t wait until we all do enough work to see more of those ground level changes. Just even 12 more inches of them!

Watch for more reports from the team about other things we learn at the Institute in the next few days.

Director, Network for LGBT Tobacco Control

Bookmark and Share

October 5, 2010 Posted by | Uncategorized | , , , | Leave a comment


%d bloggers like this: