CDC-RFA-DP20-2001.pdf

Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion

National and State Tobacco Control Program

CDC-RFA-DP20-2001

Application Due Date: 04/03/2020

National and State Tobacco Control Program

CDC-RFA-DP20-2001

TABLE OF CONTENTS

Part I. Overview Information A. Federal Agency Name B. Funding Opportunity Title C. Announcement Type D. Agency Funding Opportunity Number E. Assistance Listings (CFDA) Number F. Dates G. Executive Summary

Part II. Full Text A. Funding Opportunity Description B. Award Information C. Eligibility Information D. Application and Submission Information E. Review and Selection Process F. Award Administration Information G. Agency Contacts H. Other Information I. Glossary

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA- DP20-2001. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

National and State Tobacco Control Program C. Announcement Type: New - Type 1 This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https ://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf.

Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP20-2001

E. Assistance Listings (CFDA) Number:

93.387 F. Dates:

1. Due Date for Letter of Intent (LOI): N/A

2. Due Date for Applications: 04/03/2020, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

3. Date for Informational Conference Call:

Information Conference Call #1: Wednesday, February 12, 2020, 3:00 – 4:00 U.S. Eastern Standard Time Information Call Number: 1-866-803-2146 Passcode: 19609609# Link: https://adobeconnect.cdc.gov/rr1ym55lt24e/

Information Conference Call #2 Thursday, February 13, 2020, 11:00 – 12:00 U.S. Eastern Standard Time Information Call Number: 1-866-803-2146 Passcode: 19609609# Link: https://adobeconnect.cdc.gov/rr1ym55lt24e/ https://www.grants.gov https://www.grants.gov https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.grants.gov https://adobeconnect.cdc.gov/rr1ym55lt24e/ https://adobeconnect.cdc.gov/rr1ym55lt24e/

A list of Frequently Asked Questions is available at https://www.cdc.gov/tobacco/about/foa/national-state-tobacco-control-program/index.html

G. Executive Summary:

1. Summary Paragraph:

CDC's Office on Smoking and Health (OSH) announces the availability of funds to implement DP20-2001, National and State Tobacco Control Program. This Notice of Funding Opportunity (NOFO) supports the achievement of four National Tobacco Control Program (NTCP) goals to

1) Prevent initiation of commercial tobacco use among youth and young adults; 2) Eliminate exposure to secondhand smoke (SHS); 3) Promote quitting among adults and youth; and 4) Identify and eliminate tobacco-related disparities. Achievement of these goals will reduce chronic disease morbidity, mortality, and disability related to commercial tobacco use and dependence and SHS exposure in the United States. These goals will be accomplished by funding two components:

1. National Tobacco Control Program (State Based): Approximately $67 million per year to fund 51 applicants.

2. Commercial Tobacco Use and Dependence Treatment Support System:

Approximately $16 million per year to fund 53 applicants to ensure quitline capacity during a national media campaign.

*When CDC references tobacco, the reference is for commercial tobacco and not the sacred and traditional use of tobacco by some American Indian communities.

a. Eligible Applicants: Limited

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 53

d. Total Period of Performance Funding: $403,000,000 Component 1: National Tobacco Control Program (State Based): $326,000,000 Component 2: Commercial Tobacco Use and Dependence Treatment Support System:

$77,000,000 Year 1 budget period is 10 months.

e. Average One Year Award Amount: $1,600,000 Component 1: National Tobacco Control Program (State Based): $1,300,000 Component 2: Commercial Tobacco Use and Dependence Treatment Support System: $300,000 Year 1 budget period is 10 months; therefore, the average award is lower than the anticipated amount for subsequent 12-month budget periods.

f. Total Period of Performance Length: 5

g. Estimated Award Date: 05/28/2020 https://wwwdev.cdc.gov/tobacco/about/foa/national-state-tobacco-control-program/index.html

h. Cost Sharing and / or Matching Requirements: N Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview CDC's Office on Smoking and Health seeks to build on the successes of previously funded work to expand evidence-based, culturally appropriate policy, systems, and environmental (PSE) strategies and activities to address the National Tobacco Control Program (NTCP) four national goals: 1) Prevent initiation of tobacco use (including emerging products and e-cigarettes) among youth and young adults; 2) Promote quitting among adults and youth; 3) Eliminate exposure to secondhand smoke (SHS); and 4) Identify and eliminate tobacco-related disparities among population groups. The most effective strategies for tobacco control are population-based PSE approaches that contribute to changes in social norms and behaviors related to tobacco use and dependence and SHS exposure. In order to have the greatest population impact, these evidence-based PSE strategies must be sustained for a sufficient amount of time at the appropriate intensity and have the greatest span (economic, regulatory, and comprehensive) and reach.

Tobacco Burden: Tobacco use and dependence remains the leading preventable cause of death and disease in the United States resulting in more deaths annually than HIV/AIDS, alcohol use, cocaine use, heroin use, homicides, suicides, motor vehicle crashes, and fires combined. Each year, approximately 480,000 people die from smoking, including more than 41,000 from SHS related deaths. Cigarette smoking and other tobacco use and dependence causes cardiovascular disease, multiple types of cancer, pulmonary disease, diabetes, eye disease, adverse reproductive outcomes, and the exacerbation of other chronic health conditions. Though progress has been made in reducing cigarette smoking among our nation's youth and young adults, the tobacco product landscape continues to evolve to include a variety of tobacco products, including e-cigarettes. In 2018, more than 3.6 million U.S. youth, that is 1 in 5 high school students and 1 in 20 middle school students, currently use e-cigarettes. E-cigarette use has become an epidemic among our nation's youth and young adults.

Health Disparities: Despite tobacco use and dependence reduction among the general population, tobacco use and dependence and SHS exposure is still higher among some population groups, including: African Americans; American Indians/Alaska Natives; Asian Americans, Pacific Islanders, and Native Hawaiians; Hispanic/Latinos; lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals; people of low socioeconomic status; people living with a disability; individuals with behavioral health conditions (including mental health conditions and substance use disorders); and by individuals living in different geographic regions.

Quit Support Services: Approximately 70 percent of adults who smoke cigarettes want to quit and more than 50 percent of people try to quit each year. One of the most accessible treatment resources that can efficiently reach people who smoke is a tobacco use and dependence quitline.

Quitlines increase quit rates among individuals who use tobacco and are trying to quit, reach a large number of people who smoke, and are effective among diverse and low-income populations. Advances in new digital-based quit support services (e.g., texting, web, chat, apps) show great promise in expanding the reach of tobacco use and dependence treatment systems.

Eligible applicants may apply for one or more components and may only submit a single application for this funding announcement. Each component must be labeled "Component 1" and "Component 2."

b. Statutory Authorities This program is authorized under section 317(k)(2)(e) of the Public Health Service Act, 42 U.S.C.

§247b(k)(2)(e), Comprehensive Smoking Education Act of 1984 15 U.S.C.§1341, and Comprehensive Smokeless Tobacco Health Education Act of 1986, 15 U.S.C. § 4401.

c. Healthy People 2030 This funding opportunity supports Healthy People 2030 objectives in the topic area of Tobacco Use (TU). For specific objectives within the topic areas, please visit www.HealthyPeople.gov.

d. Other National Public Health Priorities and Strategies This NOFO supports Government Performance Results Modernization Act (GPRA) Long-term Objective 4.6: Reduce Death and Disability Due to Tobacco, and the following measures:

4.6.2a Reduce the annual adult per-capita combustible tobacco consumption in the United States. (Intermediate Outcome)

4.6.3 Reduce the proportion of adults (aged 18 years and over) who are current cigarette smokers. (Intermediate Outcome)

4.6.4 Increase proportion of the U.S. population that is covered by comprehensive state and/or local laws making workplaces, restaurants, and bars 100% smoke-free (no smoking allowed, no exceptions)*. (Intermediate Outcome)

4.6.5a Reduce the proportion of adolescents grades 6 through 12 who are current users of any tobacco product. (Outcome measure)

4.6.8 Increase the proportion of every cigarette smokers aged 18 years or older who are former cigarette smokers. (quit ratio) (outcome)

In addition, this program supports the following national initiatives and strategic plans:

The National Prevention Council's National Prevention Strategy - America's Plan for Better Health (Tobacco-Free Living) http://www.ldh.la.gov/assets/docs/GovCouncil /MinHealth/NationalPreventionStrategyJune2011.pdf.

U.S. Department of Health & Human Services's (HHS) Strategic Plan (Objective 2.1:

Empower people to make informed choices for healthier living, and the following performance measure: Reduce the annual adult per capita combustible tobacco consumption in the United States). https://www.hhs.gov/about/strategic-plan/overview http://www.healthypeople.gov/ http://www.ldh.la.gov/assets/docs/GovCouncil/MinHealth/NationalPreventionStrategyJune2011.pdf http://www.ldh.la.gov/assets/docs/GovCouncil/MinHealth/NationalPreventionStrategyJune2011.pdf https://www.hhs.gov/about/strategic-plan/overview/index.html#strategic-plan

/index.html#strategic-plan.

*Note that all activities funded under this NOFO must be in compliance with applicable anti-lobbying provisions. See Section 17, Funding Restrictions for further detail and links to applicable guidance.

e. Relevant Work This NOFO continues to support ongoing efforts since 1999 to build state health department infrastructure and capacity to implement comprehensive tobacco control programs. The funding opportunity builds upon the following past NOFOs:

Tobacco Use Prevention: Public Health Approaches for Ensuring Quitline Capacity

(CDC-RFA-DP14-1410).

National State-Based Tobacco Control Programs (CDC-RFA-DP15-1509).

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

CDC-RFA-20-2001 Logic Model: National and State Tobacco Control Program

Inputs: CDC funding, training, technical assistance, and consultation on evidence-based strategies and activities, surveillance and epidemiology, and program evaluation

Evidence-Based Strategies and

Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

Component 1: National Tobacco Control Program (State Based) State and Community Interventions Engage communities, partners, and coalitions, and community-based organizations to strengthen capacity, and to coordinate and collaborate across programs, agencies, and stakeholder groups Inform and educate leaders, decision makers and the public Implement evidence-based, culturally

Increased public-private partnerships addressing tobacco control, tobacco-related disparities, and health equity

Increased public and decision-maker awareness and knowledge of the dangers of tobacco use, effective tobacco control interventions, and social norm change

Decreased exposure to tobacco marketing and access to tobacco products**

Decreased youth susceptibility to experimentation with tobacco products, including e-cigarettes and other emerging tobacco products

Increased implementation of tobacco control

Decreased initiation of tobacco use among youth and young adults

Decreased exposure to

SHS

Decreased tobacco use and dependence among adults and youth

Decreased tobacco-https://www.hhs.gov/about/strategic-plan/overview/index.html#strategic-plan appropriate state/ community interventions to prevent tobacco use, reduce SHS exposure, promote quitting, and reduce tobacco related disparities Mass-Reach Health Communications Interventions Plan, implement, and evaluate communications interventions, and support media engagement efforts Expand, leverage, and localize CDC media campaigns and resources Tobacco Use and Dependence Treatment Interventions Promote health systems change, including referrals to state quitlines Educate private and public insurers and employers on the benefits of barrier-free coverage and treatments Promote use of covered tobacco use dependence treatments to increase use

Increased evidence-based strategies and activities to decrease access to tobacco products, reduce exposure to SHS, promote quitting, and reduce tobacco-related disparities

Increased health communication interventions and messages to reach the general population and populations experiencing tobacco-related disparities**

Increased health care system changes to promote and support tobacco use and dependence treatment**

Increased access to and awareness of barrier-free coverage of evidence-based tobacco use and dependence treatments**

Increased capacity to collect, analyze, and disseminate data related to tobacco-related disparities and health equity policies, including comprehensive smokefree policies*

Increased price of tobacco products

Increased use of evidence-based quit support services

Increased quit attempts and attempts using evidence-based tobacco use and dependence treatment services

Increased successful cessation among people who use tobacco

Increased implementation and reach of evidence-based, culturally appropriate strategies and activities to reduce tobacco-related disparities*

Increased development of innovative and/or promising practices that contribute to the tobacco control evidence-base related disparities

Surveillance and Evaluation Maintain and enhance systems to collect, evaluate, analyze, and disseminate state and community-specific data Use surveillance and evaluation data to inform public health action, and evaluate progress in reducing tobacco use and tobacco-related disparities Infrastructure, Administration and Management Develop and maintain an infrastructure aligned with the five core components of the Component Model of Infrastructure Award and monitor sub recipient contracts and grants, and provide training and technical assistance Develop and maintain a fiscal management system

Increased or maintained infrastructure and capacity to support a state-based tobacco control program

Component 2: Commercial Tobacco Use and Dependence Treatment Support System Evidence-Based Strategies and

Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

Improve quitline infrastructure to streamline intake, enhance services, absorb increases in demand, and accept e-referrals Enhance quitline sustainability by increasing partnerships to diversify funding and working with private/public insurers and employers to provide or reimburse the cost of barrier-free quit support services Expand implementation and reach of evidence-based tobacco use dependence treatment services, including quitline services Conduct assessments of tobacco use and dependence disparities and develop an action plan to address identified disparities;

transfer calls to culturally appropriate quitlines (Asian Smokers' Quitline, 1-

855-DEJELO-YA, 1-

855-QUIT-VET)

Optimized quitline intake**

Increased public and private partnerships to ensure availability of high quality quit support services, including the quitline

Increased quitline funding from diverse sources for tobacco use and dependence treatment resources

Increased availability of culturally appropriate evidence-based quit support services, such as the quitline and the use of digital-based technologies, such as texting, apps, web, and chat

Increased awareness of quit support services among people who use tobacco **

Increased quitline referrals from health systems that serve populations experiencing tobacco

Increased number of insurers and employers that provide or reimburse for tobacco use and dependence treatment services, including the quitline**

Increase use and reach of evidence-based quit support services, including the quitline, and use of digital technologies, such as texting, apps, and chat.*

Increased quit attempts and attempts using evidence-based tobacco use and dependence treatment services

Increased successful cessation among people who use tobacco

Decreased disparities in the use of quit support services/treatments among populations experiencing tobacco-related disparities*

Decreased tobacco use and dependence among adults and youth

Decreased disparities in tobacco cessation and tobacco use and dependence

Conduct strategic efforts to increase awareness of quit support services to providers, tobacco users, and populations experiencing tobacco-related disparities (e.g., Medicaid) using culturally-appropriate protocols, channels, and messages to increase quitlines use and referrals Evaluate quit support services and monitor the reach of services delivered, including digital-based technologies, and submit data to the National Quitline Data Warehouse use and dependence disparities (i.e., Medicaid)

Increased intention to quit

*The recipient is required to report on all Tier 1 performance outcomes.

** For Tier 2 performance outcomes, the recipient will report only on the performance outcomes for strategies and activities implemented by the recipient that are intended to achieve the related outcome.

i. Purpose Recipients will be funded to implement evidence-based PSE strategies and activities to 1) Prevent initiation of tobacco use (including emerging products and e-cigarettes) among youth and young adults; 2) Promote quitting among adults and youth; 3) Eliminate exposure to SHS; and 4) Identify and eliminate tobacco-related disparities among population groups.

ii. Outcomes Recipients are expected to implement activities that will impact relevant short-term, intermediate, and long-term outcomes within five years or earlier. The specific short-, intermediate-, and long-term outcomes should be tailored to the work plan priorities and strategies. Data for long-term outcomes are measured by CDC.

Component 1: National Tobacco Control Program (State Based) Short Term

Increased health communication interventions and messages to reach the general population and populations experiencing tobacco-related disparities**

Increased health care system changes to promote and support tobacco use and dependence treatment services**

Increased access to and awareness of barrier-free coverage of evidence-based tobacco use and dependence treatment**

Intermediate

Decreased exposure to tobacco marketing and access to tobacco products, including e-cigarettes and other emerging tobacco products**

Increased implementation of tobacco control policies, including comprehensive smokefree policies*

Increased implementation and reach of evidence-based, culturally appropriate strategies and activities to reduce tobacco-related disparities*

Long Term

Decreased initiation of tobacco use among youth and young adults Decreased exposure to secondhand smoke Decreased tobacco use and dependence among adults and youth Decreased tobacco-related disparities

Short Term

Optimized quitline intake** Increased awareness and use of quit support services among people who use tobacco**

Intermediate

Increased number of insurers and employers that provide or reimburse for evidence-based tobacco use and dependence treatment services, including quitline services**

Increased use and reach of evidence-based quit support services, including the quitline, and use of digital technologies, such as texting, apps, and chat*

Decreased disparities in the use of quit support services/treatments, including the quitline, among populations experiencing tobacco-related disparities*

Long Term

Decreased tobacco use and dependence prevalence and consumption Decreased disparities in tobacco cessation and tobacco use and dependence

*The recipient is required to report on all Tier 1 performance outcomes.

** For Tier 2 performance outcomes, the recipient will report only on the performance outcomes for strategies and activities implemented by the recipient that are intended to achieve the related outcome.

iii. Strategies and Activities Evidence-based, state tobacco control programs that are comprehensive, sustained, and accountable have been shown to reduce smoking prevalence as well as tobacco-related diseases and deaths. According to CDC's Best Practice - 2014, a comprehensive statewide tobacco control program is a coordinated effort that includes:

Eliminating exposure to secondhand smoke.

Promoting cessation and assist tobacco users to quit.

Preventing initiation of tobacco use.

CDC funding is designed to support and leverage statewide tobacco control funding for evidence-based strategies and activities. CDC recognizes the funding in this NOFO is not adequate for a fully comprehensive tobacco control program to meet CDC's Best Practices - 2014 . Therefore, recipients should plan strategically to prioritize strategies and activities based on the total funding available for tobacco control. For Component 1, recipients are required to implement activities across all five components of a comprehensive tobacco control program as outlined in Best Practices - 2014, but have flexibility in prioritizing evidence-based strategies and activities based on available funding. CDC expects recipients to focus on the State and Community Interventions component in Component 1 and implement policy, systems, and environmental (PSE) strategies and activities that provide an opportunity for all people to live a healthy, tobacco-free life. Applications are expected to ensure that the selected evidence-based strategies and activities are equitable in order to eliminate tobacco-related disparities.

Component 1: National Tobacco Control Program (State Based) https://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm https://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm

State and Community Interventions: Recipients will select evidence-based strategies and activities that support a comprehensive statewide tobacco control program that coordinates community-level interventions.

Establish a statewide program that supports and/or facilitates tobacco prevention and control partnerships and coalition development, as well as links to other related partnerships and coalitions (e.g., cancer control, cardiovascular disease, diabetes, asthma, oral health).

Establish a strategic plan for comprehensive tobacco control with appropriate partners at the state and community levels.

Collaborate with state and community coalitions for program planning and identification of populations most affected by tobacco use and dependence and secondhand smoke exposure.

Collaborate with partners to implement and evaluate culturally-appropriate, evidence-based strategies and activities to reduce tobacco-related disparities in the state and communities.

Identify benchmarks for closing gaps for disparate populations and improving health equity.

Collaborate with CDC's funded national networks, Networking2Save, to enhance training and implementation of evidence-based strategies among specific populations affected by tobacco-related disparities.

Educate state leaders, decision makers, and the public about the burden of tobacco use and dependence and evidence-based strategies to equitably reduce this burden.

Engage stakeholders and partners on approaches, such as message development and messengers, to reach populations most impacted by tobacco use and dependence and secondhand smoke exposure.

Collect, disseminate, and analyze state and community-specific data.

Sponsor community, regional, and statewide trainings, conferences, and technical assistance on best practices for effective tobacco use and dependence prevention and treatment programs.

Monitor and share tobacco marketing information to inform discussion among partners, decision makers, and other stakeholders at the state and community level.

Support new ways of implementing evidence-based PSE strategies and activities that address unique characteristics of the communities.

Provide support to community-based organizations to strengthen the capacity of these groups to positively influence social norms regarding tobacco use and dependence.

Build relationships among multiple sectors of the community, such as housing, education, business, and planning.

Empower community agencies to build coalitions and partnerships that facilitate sociodemographic and multi-disciplinary diversity among local governments, voluntary and civic organizations, and community-based organizations.

Collaborate with partners and other programs to implement evidence-based strategies and activities; build and sustain capacity through technical assistance and training.

Support community strategies and activities to educate the public and media, not only about the health effects of tobacco use and dependence and exposure to secondhand smoke, but also about available quit support services.

Promote public discussion among partners, decision makers, and other stakeholders about tobacco-related health issues and pro-tobacco influences.

Establish community strategic plans of action that are consistent with developed comprehensive state tobacco control plans.

Ensure that funded local lead agency measures and evaluates social norm change outcomes (e.g., policy implementation, increased compliance) resulting from their strategies and activities.

Ensure that funded partners from various entities work together collaboratively.

Collaborate with behavioral health systems to create tobacco-free campuses, increase tobacco use and dependence screening, and provide tobacco use and dependence treatment assistance to clients.

Engage and educate parents, teachers, administrators, professionals and others who influence youth and young adults about the rapidly evolving tobacco product landscape, the harms of tobacco use and dependence, and the benefits of prevention interventions.

Collaborate with partners to develop a coordinated response to the rapidly increasing use and dependence of emerging tobacco products by youth and young adults.

The recipient must address the three (3) population-specific requirements outlined below. In the work plan, the recipient is required to include objectives, strategies, and activities for each population-specific requirement.

1. Statewide Disparities Requirement Required: Recipients will develop strategies and activities to address populations with behavioral health conditions or low socioeconomic status (SES).

Approximately 1 in 4 (or 25%) of United States adults have some form of behavioral health condition, and these adults consume almost 40% of all cigarettes smoked by adults. To encourage tobacco use cessation among individuals with behavioral health conditions, recipients should work with the behavioral health systems, providers, hospitals, outpatient facilities, residential facilities, and recovery residences, to create tobacco-free campuses, increase tobacco use and dependence screening, and provide tobacco use and dependence treatment assistance to clients.

According to Morbidity and Mortality Weekly Report, Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities ;- United States, 2016 (MMWR 2018), full integration of tobacco use and dependence treatment interventions, coupled with implementation of tobacco-free campus policies in behavioral health treatment settings, could decrease tobacco use and dependence and tobacco-related disease and improve health outcomes among individuals with behavioral health conditions.

Recipients are required to work with behavioral health systems unless the state's data meets or exceeds the following national average as reported in the MMWR 2018

National Average

Mental Health

Facilities

Substance Use

Facilities Percent 49% 64% http://dx.doi.org/10.15585/mmwr.mm6718a3 http://dx.doi.org/10.15585/mmwr.mm6718a3 http://dx.doi.org/10.15585/mmwr.mm6718a3 screening for tobacco use Percent of smokefree campuses

49% 35%

If a state's mental health and substance use facilities meets or exceeds the national average above,** then the recipient can choose to continue working with the behavioral health population or work with the low SES population and the state Medicaid program to decrease tobacco use and dependence and exposure to secondhand smoke.

Proxy measures for low SES include: level of educational attainment, employment status, and United States federal poverty level. Individuals experiencing low SES have a much higher prevalence of cigarette smoking and other tobacco products use and are less likely to successfully quit and more likely not to have access to affordable cessation support. Recipients who choose to work with the low SES population should consider the following:

Improve understanding of comprehensive tobacco use and dependence treatment coverage with Medicaid recipients and health care providers.

Promote health systems changes in Federally Qualified Health Centers and other state-funded and non-profit health centers.

Collaborate with low-income multi-unit housing to implement smokefree policies and promote quit support resources.

Work with social service agencies to increase access to quit support services.

**NOTE: The following states meet or exceed the national average: Alaska, Connecticut, Indiana, Maine, New Hampshire, New York, Oklahoma, Oregon, Utah, and Wyoming.

2. Community-Based Disparities Requirement Community-based PSE strategies and activities use a community-led approach to address populations that are disparately affected by tobacco use and dependence and secondhand smoke (SHS) exposure in a specific community within the state. A community within the state could be defined as a city, county, parish, or jurisdiction/sub-jurisdiction. The recipient is required to work with a selected population within a community.

Best Practices - 2014 recommends that funds be awarded directly to local lead agencies (e.g., community-based organizations, local health departments, federally-recognized American Indian Tribe/Alaska Native Villages) that serve specific populations, in order to implement evidence-based programs and activities targeted to that population. All recipients must direct funds from their Component 1 award or state dollars to fund one local lead agency to implement tobacco control strategies and activities in a community. The local lead agency must have a demonstrated track record of successfully working with the selected population affected by tobacco-related disparities and demonstrate impact/improvement in at least one social determinants of health.

Examples include the following:

Access to health care services.

Access to social support services.

Safe housing.

Access to healthy food options.

Access to transportation.

Job opportunities.

Active living opportunities.

Public safety.

The applicant is required to use data to select one of the following populations that is disparately affected by tobacco use and dependence and SHS exposure.

African Americans.

American Indians/Alaska Natives.

Asian Americans, Native Hawaiians, or Pacific Islanders.

Geographic regions.

Hispanic/Latinos.

Lesbian, Gay, Bisexual, Transgender, and Queer.

Individuals with low socioeconomic status.

Individuals with behavioral health conditions.

Individuals living with a disability.

Individuals with military/veteran status.

The applicant is required to complete the following:

Identify the population that is disparately affected by tobacco use and dependence and SHS exposure and provide the following:

o Provide justification for selecting the population group for targeted evidence-based programs and activities.

o Adult smoking prevalence for the selected population group.

Include in the application a draft request for proposal (RFP) or cooperative agreement to fund at least one local lead agency to implement tobacco control strategies and activities.

Discuss how the recipient will recruit and select individuals that understand the unique cultural differences of the selected population for an advising group within the first three months to assist with selecting the community.

In the Year 1 work plan, the applicant will develop strategies and activities to address activities listed in the Required Activities table below.

Required Activities

Year Activities Year 1 During the first three (3) months of the award, the recipient will recruit and select individuals that understand the unique cultural differences of the selected population to assist with selecting the community. The recipient should budget for one staff member to implement Year 1 activities.

Recipient and two individuals that understand the unique cultural differences of the selected population will attend one training.

Budget for three staff and two individuals that understand the unique cultural differences of the selected population to travel to Atlanta for training.

During the first six (6) months of the award, the recipient will complete the following activities:

Select the community.

Award a local lead agency with a cooperative agreement or grant.

Recruit community stakeholders.

Develop a memorandum of understanding (MOU) or memorandum of agreement (MOA) to be signed by the coalition.

During Year 1, the recipient will collaborate with the local lead agency to develop and implement culturally appropriate policy, systems, and environmental (PSE) strategies and activities and will complete the following:

Develop a coalition or engage a current coalition. The coalition must include representatives from the following groups:

o Community stakeholders.

o Community leaders.

o Local public health.

o Multi-disciplinary and diverse community partners - e.g., health care systems, housing, businesses, faith-based organizations, and education.

Provide results from a community health needs assessment that provides specific information about the community and selected population. The needs assessment should have been completed within the last five (5) years and should include demographic characteristics, health status, community profile, existing tobacco control policies, and available health care systems. Data sources used to define and describe the selected population must be cited. Examples of data sources include:

o County Health Rankings https://www.countyhealthrankings.org/.

o City Health Dashboard https://www.cityhealthdashboard.com/.

o Census https://www.census.gov/.

o Census Factfinder https://factfinder.census.gov/faces/nav/jsf/pages

/index.xhtml#.

o Community Commons https://www.communitycommons.org/.

Collaborate with the local lead agency, coalition, and community stakeholders to develop the following:

o A five-year strategic plan.

o Detailed work plans and culturally appropriate policy, systems, and environmental (PSE) strategies and activities which seek to https://www.countyhealthrankings.org/ https://www.cityhealthdashboard.com/ https://www.census.gov/ https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml improve health equity.

Establish a baseline for the selected population.

Collaborate with CDC to determine the minimum number of people within the selected population that will be reached by the PSE strategies and activities.

Obtain one (1) letter of support from the local lead agency that includes a description of their role in support of the proposed project and submit to

CDC.

In collaboration with the local lead agency, coalition, and community stakeholders, the recipient will complete the following activities:

Build new relationships and strengthen current relationships.

Engage the community leaders, stakeholders, organizations.

Provide training opportunities.

Conduct data collection.

Conduct a joint readiness assessment.*

Years 2 - 4 The recipient and local lead agency will complete the following activities:

Establish objectives.

Implement strategies and activities and adjust action plans as appropriate.

Conduct an additional readiness assessment to identify barriers to success.

Year 5 The recipient and local lead agency will complete the following activities:

Conduct data collection.

Evaluate and develop a best practices document/publication based on lessons learned.

*CDC will provide technical assistance for conducting a readiness assessment.

3. Statewide Prevention of Initiation to Emerging Tobacco Products, Including E-cigarettes, for Youth and Young Adults Requirement Recipients are expected to support and implement programs and policies and collaborate with organizations, health care systems, and networks that encourage and support youth and young adults to make behavior choices consistent with tobacco-free norms. CDC expects recipients to focus on the State and Community Interventions component and implement PSE strategies and activities that provide the opportunity for all people to live a healthy, tobacco-free life. Recipients are expected to ensure that the selected evidence-based strategies and activities are equitable in order to eliminate tobacco-related disparities.

Required Activities

Comprehensive Tobacco Control Program

Activities

Components State and Community Interventions

The available funding level is appropriate for statewide interventions that include the strategies/activities listed below.

Even though community-based work is important in tobacco control and prevention, there is not sufficient funding to require funding to the local communities.

The recipients is required to complete the following statewide activities:

Implement the minimum age of purchase of any tobacco products, including e-cigarettes, to 21 years old.

Educate stakeholders and decision makers on evidence-based, population-level strategies to reduce emerging tobacco products use, including e-cigarettes, among youth and young adults, for example:

o Add e-cigarettes to smokefree indoor air policies in school/college/university policies as well as community and state policies.

o Restrict access to emerging tobacco products in retail settings.

o License tobacco retailers.

o Add e-cigarettes to tobacco product price policies.

o Develop state and community-based educational initiatives targeting youth and young adults.

o Decrease exposure to marketing that appeals to youth and young adults.

o Reduce access to menthol and other flavored tobacco products.

o Decrease access to online sales of e-cigarettes and emerging tobacco products.

Engage parents, teachers, education professionals, coaches, and other stakeholders who influence youth and young adults about the rapidly evolving tobacco product landscape, the harms of use, and the benefits of prevention interventions.

Partner with community-based programs or organizations to:

o Conduct education outreach to prevent initiation of e-cigarettes and other emerging products among youth and young adults, for example:

Community-based youth organizations.

Youth sports organizations.

School clubs and organizations.

Youth military organizations (e.g., ROTC).

Organizations that reach at-risk youth and young adults particularly in low SES populations.

Engage youth to educate other youth and communities on the dangers of tobacco use and dependence, including e-cigarettes.

Recruit and engage partners to reach at-risk youth and young adults impacted by tobacco-related disparities in communities, schools, worksites, and colleges and universities.

Conduct surveillance activities that focus on emerging tobacco products among youth and young adults.

Engage pediatricians, OB/GYNs, school nurses, social workers, and other health care providers in strengthening their own health care systems through the integration of child and family centered tobacco control initiatives to address the initiation of emerging tobacco products, including e-cigarettes.

Collaborate with pediatricians and other health professionals to create culturally safe medical practices including integrating child and family communication strategies and evidence-based screening tools for tobacco use and dependence among child and family.

Collaborate with school nurses to screen for tobacco use and dependence when interacting with students and provide age-appropriate educational information.

Collaborate with dentists, dental hygienists, and orthodontists to screen for tobacco use and dependence, including e-cigarettes, and educate when interacting with youth and young adults.

Collaborate with behavioral health professionals to screen for tobacco use and dependence, including e-cigarettes, and educate when interacting with youth and young adults.

Mass-Reach Health Communication Interventions

An effective statewide, mass-reach health communication intervention delivers strategic, culturally appropriate, and high-impact messages through sustained and adequately funded education campaigns that are integrated into the state's comprehensive tobacco control program. For an effective paid education campaign, adequate funding is needed to ensure that advertisements reach 75% to 85% of the target audience each quarter of the year, with a minimum average per quarter of 1,200 gross rating points (GRPs) during the introduction of a campaign and a minimum average of 800 GRPs per quarter thereafter. To effectively develop and implement paid media, earned media, social media, please review Best Practices User Guide: Health Communications at https://www.cdc.gov/tobacco/stateandco mmunity/bp-health-communications/index.htm.

The funding level is not sufficient to fully fund a comprehensive youth and young adult media intervention. Therefore, recipients should focus on earned media efforts to reach youth and young adult stakeholders, expand upon and/or complement existing paid media efforts at the national level focusing on emerging tobacco products, including e-cigarettes, and should consider existing creative materials to reduce paid media cost. Examples include:

Earned media includes news stories, letters to the editor, editorials, media interviews, and public service announcement (PSA) distribution and outreach to encourage broadcast/publication.

Social media includes YouTube, Instagram, Facebook, and Twitter. Examples include:

o CDC's Media Campaign Resource Center.

o Truth Initiative social media posts, gifs and still images.

Paid media includes ads on television, radio, in print, posters, and digital advertising. Examples include:

o Truth Initiative ads:

"Sweet Clouds" "Burn Through" "Making Menthol Black" "Power in Numbers" o CDC's Media Campaign Resource Center.

Recipients should leverage existing educational resources and effective messages, in lieu of a new education media campaign, to reach youth and young adults directly or indirectly. Existing evidence-based resources and messaging include:

CDC Office on Smoking and Health (CDC/OSH) E- Cigarettes Resources:

o Facts, fact sheets, and youth specific information at https://www.cdc.gov/tobacco/basic_informati on/e-cigarettes/about-e-cigarettes.html.

o Know the Risks: A Youth Guide to E-cigarettes Presentation.

o E-Cigarettes and Youth Toolkit for Partners: How You can Help End the Epidemic.

o Youth communication materials:

https://www.cdc.gov/tobacco/stateandcommunity/bp-health-communications/index.htm https://www.cdc.gov/tobacco/stateandcommunity/bp-health-communications/index.htm https://foa.grantsolutions.gov/%20?https:/www.cdc.gov/tobacco/multimedia/media-campaigns/index.htm https://www.youtube.com/watch?v=ZLZMntxyBCY https://www.youtube.com/watch?v=0SMnc8EA5LM https://www.youtube.com/watch?v=2LBMriiWiZ8 https://www.youtube.com/watch?v=U-iQnbsuZnQ https://foa.grantsolutions.gov/%20?https:/www.cdc.gov/tobacco/multimedia/media-campaigns/index.htm https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html https://www.cdc.gov/tobacco/basic_information/e-cigarettes/youth-guide-to-e-cigarettes-presentation.html https://www.cdc.gov/tobacco/basic_information/e-cigarettes/youth-guide-to-e-cigarettes-presentation.html https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/e-cigarettes-youth-partners-toolkit-508.pdf https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/e-cigarettes-youth-partners-toolkit-508.pdf

One Brain radio PSA.

It's Not Like You Can Buy A New Brain

(Vending Machine) print ad.

Protecting Young People from E-cigar ettes digital and social media images.

FDA e-cigarette prevention posters, available for download at FDA Exchange Lab.

Office of the Surgeon General youth materials:

o It's a Fact radio PSA.

o Any Volunteers' video PSA.

o E-Cigarettes Risky for Youth digital and social media images.

o E-Cigarettes, Nicotine, and Brain Development social media image.

Tobacco Use and Dependence Treatment Interventions

The funding level is not sufficient to fully fund a comprehensive youth and young adult tobacco use and dependence treatment intervention. Therefore, recipients should focus on the following:

Identify and develop cessation strategies that are appropriate for youth and young adults.

Surveillance and Evaluation The level of available funding is not sufficient for a fully comprehensive evaluation or surveillance activities, including measuring local youth behavior. The following activities are required for the current level of funding available:

Conduct state youth tobacco survey or state youth risk behavior survey.

Conduct surveillance activities that focus on emerging tobacco products among youth and young adults, including those that are at greatest risk for tobacco-related disparities based on sociodemographic factors and social determinants of health.

Develop and implement a plan for sharing data with community members, stakeholders, and decision makers.

Monitor changes in the tobacco product use and market environment, including emerging products and e-cigarettes.

Communicate evaluation findings and lessons learned using data visualization to stakeholders.

Submit a minimum of one impact statement during each project year.

Infrastructure, The recipient is required to staff a full-time person to manage the https://nccd.cdc.gov/MCRC/apps/AdDetails.aspx?CatalogID=3180&IFS=0#writeAReviewJump https://nccd.cdc.gov/MCRC/apps/AdDetails.aspx?CatalogID=3074&IFS=108#writeAReviewJump https://nccd.cdc.gov/MCRC/apps/ExploreCampaignDetails.aspx?CampaignID=248 https://nccd.cdc.gov/MCRC/apps/ExploreCampaignDetails.aspx?CampaignID=248 https://secure-web.cisco.com/17uoU1SNZyj_TQSgVZnPgIFWcyd6-C3y7freeFXi-WIwzu0ftA8i0s5c_lOM9oTL4TrLeuwaT7A5BnrWfON4ZfvgJbvVTFDvdavmG8hgflxbbLKKHGVy_ohV3GKehlrDusZqohM6CopsFe4xdvg9n6RfAR_H5Dp8UyPAaX8L7yl9LGHO6pGSioZApdvQnQmVcPO285M1TSJyRnmECybeXNWnWv8o1HvosJsxNUE3RNkDIulSoQHtB-dauw5toijcLgx32sMnqx7Z8s2JVvHY13IFmBk6UD74kt25FCSl2h8wclPTNennbe0xqkkBKPI8oZTbctnyvOwZCo3KrJgkvBXLpnF4E5IQQt_mTUEcZj_9sn9_opZL-Z69cZWwnpBDBaZzI3hLFEArBKKbzPiNUj0NXouoqEBi40NyKCmTRgfPVogCaUSuoh2rdzrJjn8gPE1Dstpmpsr7RtAjJ1Ix4NQ/https%3A%2F%2Fdigitalmedia.hhs.gov%2Ftobacco%2F https://nccd.cdc.gov/MCRC/apps/AdDetails.aspx?CatalogID=3181&IFS=0#writeAReviewJump https://nccd.cdc.gov/MCRC/apps/AdDetails.aspx?CatalogID=3037&IFS=108333#writeAReviewJump https://nccd.cdc.gov/MCRC/apps/AdDetails.aspx?CatalogID=3141&IFS=19722 https://nccd.cdc.gov/MCRC/apps/AdDetails.aspx?CatalogID=3150&IFS=246018 https://nccd.cdc.gov/MCRC/apps/AdDetails.aspx?CatalogID=3152&IFS=52079

Administration, and Management youth and young adult activities. Additionally, the recipient must ensure a program evaluator is available. The recipient should complete the following:

Leverage existing, expand, and establish new partnerships with the state education system, health care organizations, military bases, and other youth organizations to prevent initiation of e-cigarettes and other emerging products among youth and young adults.

Demonstrate staff capacity and expertise to manage and implement proposed youth and young adult activities to prevent initiation of emerging tobacco products.

Mass-Reach Health Communication Interventions: Mass-reach health communication refers to the various means by which public health information reaches large numbers of people.