Moderator:

Susan Scrimshaw, PhD
Dean, School of Public Health, University of Illinois at Chicago

Bernard R. Malone, MPA
Director, Divisions of Chronic Disease Prevention, Missouri Department of Health

Discussed tobacco use prevention in Missouri and key results and signs of progress; highlighted the NCI-funded Americans Stop Smoking Intervention Study (ASSIST), MultiCounty Health Educators, Missouri Senate Bill 190 on Pregnancy and Drug Counseling, and FDA Contract--Check No Tobacco Sales to Minors.

Key Messages:

• Basic premise--tobacco prevention policy development at the state and local level will reduce youth access to tobacco, create clean indoor air environments, and limit tobacco advertising.
• Initiatives targets/uses media, worksites, schools, health care, and community groups (i.e., anti-tobacco advertising uses the media to frame public health policy that leads to individual decisions; media advocacy promotes tobacco-free environments through messages that encourage people to support prevention and services and to make healthy decisions. At worksites, smoke-free worksite policies increase productivity and reduce costs; worksite wellness programs include cessation and prevention goals);
• 1997 Youth Risk Behavior Survey (YRBS) showed 13% decline from 1995 to 1997 in the number of high school students who used spit tobacco;
• 1996 Current Population Survey on Tobacco Use in Missouri recorded a 19% increase in smoke free workplaces in 1993; a 9% decrease in those who felt smoking should be allowed anywhere in the home, and an 11% drop in the percent of students who were not asked to show proof of ID when purchasing tobacco.
• The cigarette tax report from the Missouri Department of revenue shows approximately a 3.5% decline in the number of packs sols during the last 18 months, or 1.8 million fewer packs per month. One disturbing finding was an increase between 1995 and 1996 in the percentage of Missouri 12th grade students who smoked two or more cigarettes per day on the days they smoked.

Jennie Tasheff, MPH
Healthy Kansans Coordinator, Kansas Department of Health and the Environment

Described Kansas LEAN coalitions as an example of use of community coalitions; to describe interrelationship of health risks and importance of environmental changes.

Key Messages:

• It is imperative that the community be invested.
• Multi layer and multiphasic approaches are needed. The nine-year old Kansas LEAN Coalition is organized around 5 task forces: pre-school age, school/school lunch, youth organization, older adults, and food professionals and developed and monitors an overall strategic plan.
• The Strategic Plan includes Healthy People 2000 objectives for nutrition and physical activity as goals for task force activities, i.e., the Kansas LEAN School Health Project explicitly contributes to meeting objective 8.10 and includes a community coalition to address nutrition and physical activity issues in the community and school.
• Environmental changes in the community are a critical aspect of efforts to achieve modification in behaviors.

Ann Mahony, MPH
Healthy People Workgroup Coordinator, Center for Substance Abuse Treatment, SAMHSA, HHS

Discussed Healthy Behaviors and Substance Abuse from a federal perspective. Overview of key definitions and issues, describes systems that help achieve healthy behaviors and posed questions need help answering.

Key Messages:

• Prevention is part of an interrelated continuum of service that as a public health approach emphasized preventing use of substances and is aimed at general populations groups with various levels of risk for alcohol, tobacco, and other drug-related problems.
• Systems of influence to prevent alcohol and drug abuse include educational approaches, environmental approaches, positive activities, and social norms which influence and reinforce no use: Systems to reinforce no use--family, schools, health care, community.
• Barriers to substance abuse prevention and treatment include stigma, need for broader scientific base, lack of optimum dissemination and application of what works, and treatment gap of an estimated 7.1 million for chronic illicit drug use and no estimate available for alcohol abuse.
• Comments are needed on the focus area, including on chapter placement in healthy behaviors versus reducing and preventing diseases and disorders; to identify gaps in science, objectives and data systems; and to help define priorities in the objectives.

Highlights of Comments/Questions from Open Discussion

• Need to get legislators and leaders involved in promoting healthy behaviors and take political message of Healthy People 2010 to Congress.
• Need to increase awareness (including among legislators) that there is an important interplay of Healthy People and community-level groups that spurs actions.
• Importance of environmental policy in achieving healthy behaviors shouldn’t be overlooked, i.e., walking trails; need to look at cost-benefit of these approaches.
• Need to make sure objectives are measurable (because what gets measured get done).
• Positive alternatives are important and still enable choice.
• Need to find a way to improve those data sources that really need improvement.
• Need to look at the interconnectedness of key risk factors.
• Concern about very little required physical education in schools; emphasizes point that schools are not utilized to full capacity, whether for comprehensive health education or school based health centers.
• Need to invest more in constituency building, (i.e., for comprehensive school healthy education).
• Sharing information about interventions is important.
• Need to start where the community is.
• Need broad campaign to help remove the stigma of mental health and disorders.

Key Summary Points:

• Partnerships are critical; community-based coalitions are especially critical.
• More emphasis is needed on environmental policy strategies for promoting healthy behaviors.
• Need great focus on opportunities offered by schools--comprehensive school health education and school health services/centers.
• Need a mechanism to share information about strategies.

Chicago Transcripts and Summaries