Tobacco Action Group Meeting 1 Discussion Board
Meeting 1 Notes
October 27, 2005
Welcome to Comprehensive Tobacco Control Action Group!

[NOTE: Comments listed here are based on notes taken during the meeting and may not accurately capture or summarize comments made by participants. Corrections and clarifications are welcomed and should be emailed to Connie Satzler,]

Members Present: Lisa Benlon (phone), Carol Cramer, Ken Davis (phone), Julia Francisco, Carolyn Gaughn (phone), Sandy Griffith, Sarah Gronberg, John Hauxwell (phone), Harlen Hays, Mary Jayne Hellebust, Jennifer Kelly (phone), Paula Marmet, Karry Moore, Ghazala Perveen, Terri Roberts, John Rule, Brandon Skidmore

* Welcome & Introductions *

* Overview by Paula of HK2010 Planning Process *
- Steering Committee of 20 people with vested interest in public health issues
- Identified cross-cutting issues to become agenda for HK2010 process
- Series of 3 meetings, identified 3 cross-cutting issues, developed HK2010 plan
(1) Reducing/Eliminating Health/Disease Disparities
(2) System Interventions to Address Social Determinants of Health
(3) Early Intervention, Risk Reduction for Women, Children & Adolescents
- Bottom line - with recommendations of workgroups, steering committee took into consideration action items that had most votes from workgroups, identified slate of 25 or so top priority actions.
- From that Steering Committee organizations signed up for action steps most interested in.
- At this point, convening action groups around each:
(1) Disparities Data action group
(2) Cultural Competency action group
(3) Comprehensive Tobacco Control action group
- Action groups should...
(1) develop specific recommendations for policy agenda
(2) specific recommendations for integration into program
...that will impact 10 Leading Health Indicators

* Terri Roberts, Director of Kansas Nurses Association, Tobacco Free Kansas Coalition (TFKC) Board member *
Overview of policy platform

Where we came from:
Tobacco control movement has been successful because people moving in the same direction.
1992-93, Robert Wood Johnson Foundation (RWJF) identified tobacco as issue, asked for states to respond to request for proposal to become smokeless state.
Goal: reduce consumption of tobacco
Kansas was one of the first states to be funded.
Money to strengthen coalitions, grassroots efforts, education about industry & counter-measures…what has become comprehensive tobacco control?
Brought together researchers to discuss elements (youth access, cessation, etc.)
Kansas ran with, in addition to that, lawsuit filed. All except a couple attorney generals joined in, legislation on a national level. In addition to getting settlement, also changes agreed upon by industry that attorney general is instrumental in obtaining for us. Kansas had Carla Stovall sign on. In own state, year master settlement agreement (MSA) signed and released, able to earmark half the money or settlement for cessation & other children's issues. After settlement announced 97-98, legislature changed, broadened, and became children's cabinet.
Emphasis and basic funding came from RWJF. Don't think we would be where we are today if not for those states. Snowball effort.
Other thing that RWJF gave us, was money to train cadre of people who really understand industry & tobacco control. Have had good consistency of staffing in our own state. TFKC, Kansas Health Foundation (KHF) (e.g., media campaign - take it outside).
Has not been done in isolation, other states have done, been brought together.
Quantum leaps in tobacco.

Where we are now:
Have been fortunate in TFKC, to have strong participation from multiple partners, Kansas Public Health Association (KPHA), Kansas State Nurses Association (KSNA), American Lung Association (ALA), American Caner Society (ACS), and Kansas Academy of Family Physicians

Decided needed strategic plan
-Try policy initiatives
-Community projects
-Always stay at community level
Major policy initiatives (past through now)
* Earmarking fund for tobacco control
* Strengthening youth access laws (eliminated vending machines children had access to, graduated penalties)
* Able to defeat a preemption attempt on floor of Senate
* Non-negotiable to discuss with us a preemption state law

9 components to comprehensive tobacco control (CTC) plan
ALL 9 are essential
1. Community programs
- engaging the community to work on tobacco control (e.g., smoke free school, other enforcement, clean air)
2. Chronic disease programs to reduce burden of tobacco on chronic disease
- Heart disease, cancer, stroke
3. Cessation
- focused on individuals who want to quit
- Quitline in Kansas, more campaigning with health professions to recommend Quitline
4. Counter marketing/media
- Progressive counter-marketing by some of task groups as well as nationwide
5. School programs
- Trying to teach children skills to resist or delay
6. Surveillance & evaluation
- So we know we're making a difference
7. Enforcement
- Have had a little slide back, but still doing pretty well with enforcement
- Have a 20% youth rate, so youth are getting access
8. Statewide program
- Helps increase capacity of local program, synergize with statewide program, particularly true in our state w/ 105 counties, can't have an expert on tobacco cessation, usage - control in every local health department
9. Administration
- Committed staff at KDHE, partnered exceptionally well with other health professionals and organizations and other state agencies
- Great commitment by Julia & Paula, longevity
- Able to be focused and progressive

Priorities that TFKC have come up with:
1. Clean indoor air (communities, statewide initiative)
2. Promotion of tobacco cessation among adults and youth.
- We know a lot more about what works than we did 10 years ago. Make interventions available
3. Prevention of initiation of tobacco use among youth. (currently 21%; want to drop further; mimics adult rate; children of smokers much more likely to smoke)
4. Identification/elimination of disparities among different populations. Disparate use
Example: Medicaid pregnant women have higher incidence than overall 21%. It was at 26%.

Even though we haven't gotten enough funding. Need $18.1 million to fund. Have been given small pittance of money. Have received $500,000.
Movement to fund comprehensive plan. Salina was pilot community selected. On the 4th year of comprehensive tobacco control plan.
Failed on referendum to repeal no smoking law for restaurants.
Had strong advocates with local health department in Salina.
Had university there, other strong partners, residency program, could support initiatives.

* Overview of HK2010 Workgroup Results, Comprehensive Tobacco Control & 10 Leading Health Indicators (See Meeting 1 documents #3 and #4) *

There was a common thread of tobacco being a root cause in multiple presentations (e.g., MCH, Cancer, etc.) that the steering committee heard. Had people looking at data presented, was data-based.

Wanted to get thoughts on the table. Recommend program and policy initiatives to Steering Committee (SC). Specific.

Want this group to meet again before Dec. 16th Steering Comm. Have some time to collect our thoughts.

Reason SC is meeting again - at request of SC - group includes legislators, not only were members of SC interested in how they can better integrate programs across agencies, but also looking for policy changes at the state level.

Workgroups - 1st document captures essence of recommendations from workgroup related to tobacco.

What are things in KS we can do that will clearly impact tobacco, what would you put forward.

With regards to HB 2495, is this something we can move forward, get support for?

Had strong hearing, but we do not have votes to get this out of committee at this point.

Dr. Michael Fox, emailed earlier about this bill.

From a lobbyist point of view, is there something we can do to help this move along?

We could. However, we're talking about a committee of 21 or 23. Don't have the required 11 or 12 votes to get it out. Once we get it out, have to go to the floor. Don't think leadership would permit this to be voted on. No reason to get out of committee if we aren't going to get a vote on it. Can identify those that we need the votes for to get this out of committee, but don't know this will help.
Were able to provide committee with a lot of data.
This misperception - that 2nd hand smoke isn't that dangerous.
Others agree.
We have good data, it's a perception issue.

Other issue, it wasn't really a good bill because it has an opt-out clause. Any community can vote to opt out within a year. We need a critical mass of communities.
See that those people on the committee, if working on a clean indoor air initiative in their committee, then the committee members would have the support of their community.

Started out with 1, then 6 committee, now 10 addressing in their comm. As we have more, will make it an easier process and will protect against preemption.

Colorado is going into 2nd year attempting smoke-free state law. Have between 11 and 20 cities with clean indoor air already on the books, have approached critical mass area. Have Colorado restaurant association on their side.
Depends on critical mass for numbers, kinds of cities approaching the issue.

Becomes an economic issue, if Aspens of world are smoke free, and others aren't, & Aspen is doing better, then eventually want to level the playing field. It does shift as you get a critical mass.
When these youth are outspoken and get their campuses smoke free, they help us along the way when they do that.
Now we have the hospitals on board. Now hospital campuses are going smoke-free.
May not seem important in the big scheme, but really they are.

If a smoke-free ordinance in a community is NOT a viable option, is a campus smoke-free policy a possibility? Junior Colleges?

Where is the government office on this issue?

If we can get Wichita, Kansas City, and Topeka to enact smoke-free ordinances, she will run by the state.

New gubernatorial candidate - did keg registration. Has been very supportive of anti-tobacco funding. Has also been involved with Community Health Center.

If he is front-running candidate, current government may have to have policy on this. Need to represent an opportunity if it presents itself.

Don't want to give anyone false hopes on HB2495.

Don't municipalities have ability to opt out anyway?


In conversation with committee members, have expressed opinion that it should be up to local communities to decide if they want to be smoke free. If committee does go smoke free, they say - see, they can do it if they want to.

Everyone wants to pass the responsibility so they don't get the flack.

It's not the 21% of people who are smoking, it's the industry. They are funding it, motivating it, moving the anti-ordinance issue along.

What does the discussion mean to this group? How should we address? Clean indoor air at the local level?

Yes, may be the only realistic thing we can achieve.

* Focus on effective clean indoor air ordinances. Model indoor air ordinances at local level. Monitor and take advantage of opportunities as they arise.

* Ask legislature for more money. MUST have more funding. Need to provide state support and expertise.

Are funds in form of local grants? Yes.
Additional money used for the same? Yes, maybe a few other things added when we get the money. Will always need statewide initiative, media initiative, Quitline - those things that are done more effectively and efficiently at the state. Committee still get the value of that in their communities.

Are we articulating the reason for additional funding?

Yes, think most legislators are familiar with the $18.1 million figure.

Gave us an additional $500K.

Why did they give it to us?

It's not because they hadn't heard we deserve it. Finishing it up - making the sale - Barnett did that for us.

Another cigarette tax. Directly related to funding. Designated tax. It’s a win/win situation. Drive down consumption, prevalence rates, increase revenue for state, provide funding for prevention & cessation.

Excise tax increase? Very expensive and labor intensive to push excise tax increase if partners have to do convincing.

If have recommendations from KS Comprehensive Cancer are a wide swath across the state...(1) increase tobacco tax with increased allocations for tobacco prevention & cessation & other health programs ,

Have since heard that advocates in Missouri increase 80 cents to 97 cents per pack

Now 27th in nation (ranking levels) for tax. Other states have surpassed us since last increase.

That is something this group needs to endorse.

Senate president declined to comment when asked about increased tobacco tax.

Does this work in at all with Medicaid reform hearings? Tobacco use is helping to fuel increased Medicaid costs. Can't we make this connection with them?

So far...
3 different themes
1. Support for clean indoor air; effective state and local leadership for initiating clean indoor air
2. Funding for investing in best practices; need to articulate requests, exactly what $ would be used for.
3. Increase price of tobacco

* See for list of Steering Committee members

Not all about state legislation, but also policies within their organizations...

If you look at workgroup recommendations, much more than legislation.

#12 on page 3 (of Meeting #1 document #3), any opportunity to declare any environment tobacco free. Everything they do for a healthy community should have tobacco free attached and advertised. That's a statement they could do, helps to move the whole public opinion.

Employers - not employ smokers. Every little bit helps.

Elimination of disparities in goal.
One of recommendations for Access to care was to better correlate state expenses, health outcomes, social determinants. Has tobacco seen success in this area? Tobacco tied to certain disparate populations?

Yes, MSA was based on Medicaid expenditures to the state. That's what the restitution was for. They don't still connect those dots. Industry is good at turning this around.

Look at MSA money as money received from past-due.

As we look at agencies and organizations around the steering committee, a practice of always including economics as they disseminate information. Tie to tobacco.

Do think this has been effective...haven't moved as much as we wanted...but has been a positive vs. negative response in receiving this info.

But incorporate the extensive cost of tobacco in EVERY report.

Introducing Quitline to every medical practice, every dental office, each one should reference to it.
Under oral health issues, specifically the importance of spit tobacco to oral health, tie to oral health issues.

Having trouble figuring out what direction you expect this meeting to take in terms of a solution. Recommend to Steering Committee who will make recommendations to government?

2 things:
1. SC is taking recommendations, looking at what their organization (from organization’s perspective) can do.
2. Also SC looking to develop set of policy recommendations that can be shared with government plus SC members that are legislators looking for what they can share with their colleagues.

Sec looking to advance top issues.

Tobacco 2004 Report.
What we recommend should be related to each of the areas Terri outline earlier.

Will be on a lot of different fronts. Have in place SC who is interested in looking at indicators, moving things forward. Ideas on the table today clearly in scope of what SC is looking for.

What can we say to SC?

Process we had in mind for Action group, do a lot of brainstorming, then staff put together, then bring back to action group & identify targets, potential champions

(1) I like anytime a health problem area is mentioned, have money assigned to tobacco-use causes of that.
(2) Everyone do what they can in their org. e.g., KHA initiative - smoke free hospital campuses.

C-change: national organization, cancer, adopted policy that would only hold meetings in cities (or states) that are smoke free. What if KPHA - only hold meetings in smoke-free cities? Think of eventual economic push.

At least smoke-free facilities.

Don't have require legislative action, but have economic impact.

This is the opportunity to put these ideas on the table.

Largest opposition we've been getting locally is the hospitality industry. Maybe we should target them to get them on our side.

Chambers of Commerce. Work with them to show advantages of communities that have smoke-free, effective tobacco control policies. Work on business end to get their buy-in (youth policies, tobacco-free work environment, etc.)

Hospitals could have great impact. Generally, leaders in local Chambers of Commerce and also the university.

Hate to be naysayer, but can't even imagine state chamber going in that direction.

But if hospital association were to make an initiative, maybe this would make a difference.

Are there other ideas you want to put on the table?

Date for next meeting: Nov 10
1 - 3:30

Will have final discussion for recommendations.

Send additional ideas to Karry ( and/or Connie (

Meeting 1 Discussion Board is now closed. Please add additional comments to the General Discussion Board.
Thank you for your comments. Excellent suggestion! Karry explained that various communities have smoke-free restaurant guides available, but perhaps it would be an excellent suggestion to expand those guides to include meeting/conference and other facilities/ organizations/ municipalities. We'll check more into this issue, including checking to see if there is a state-wide restaurant guide available. (Does anyone else know?) Thank you!
Thank you for an excellent discussion and time to participate. I will review the documents and put some thought into other possible avenues of action before the Nov. 10 call.
This question occured to me during the discussion: Does anyone keep anything approaching a comprehensive list of facilities and organizations that are smoke-free?
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