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Engaging Communities Is a Critical Tobacco Control Strategy

Engaging Communities Is a Critical Tobacco Control Strategy Community Engagement Tobacco Control, Menthol Cigarette Disparities, Tobacco Control Learning Collaborative, Culturally Tailored Tobacco Interventions, Flavored Tobacco Product Legislation, United States, Flavored Tobacco Product, Health Equity, Youth and Young Adults, Tobacco Free, Cigarettes Smoked, Community Partners, Young People, Community Health, Youth Tobacco Survey, Flavored E-Cigarettes, Smoking Cessation, Tobacco Industry, Smoking Behavior, Study Showed, African American, Smoking Rates, Tobacco Marketing, Minority Populations, Hispanic Black, ASTHO, Association of State and Territorial Health Officials Charla Sutton, Matta Sannoh, Josh Berry, Kenny Ray, Ashley Hebert, Iman Byfield For decades, the tobacco industry has disproportionately targeted communities of color increasing rates of menthol cigarette use and tobacco-related health disparities. By prioritizing community efforts, health agencies can confront these disparities by fostering trust, inclusivity, and cultural responsiveness. Funded by CDC’s Office of Smoking and Health (OSH) and in partnership with The Center for Black Health & Equity (The Center), ASTHO initiated the Increasing State Menthol Capacity Learning Collaborative consisting of eight state tobacco use prevention teams each paired with a local community-based organization. The program fosters strong linkages between state commercial tobacco control programs and community-based partners to reduce menthol and flavored product use. The Role of Community Engagement Community-based initiatives are pivotal in tobacco control efforts, as they enable stakeholders to: Understand history, context, culture, and geography. Underserved communities possess a keen awareness of the origins of their problems and how decision-making processes affect them. Embrace community voices. “No one asked us” is the most common feeling communities most impacted by a problem share when decision-makers act without including them. Build organizational capacity that sustains change, creates credibility with decision-makers, and empowers communities to meet challenges head-on and garner support for their initiatives. Barriers to effective community engagement include insufficient training, funding, communication, and planning, plus disorganization, under-acknowledged communities, over-committed leaders, and inability to change course. Learning Collaborative at a Glance Eight state health teams (IN, MN, NY, PA, RI, MI, WA, WI)—each paired with a community-facing organization—kicked off the Increasing State Menthol Capacity Learning Collaborative in January 2023 with a shared vision and plan to reduce menthol and flavored product use. The Collaborative worked to: (1) improve capacity to identify and implement strategies to prevent menthol and other flavored tobacco product use, (2) strengthen collaboration between state commercial tobacco control programs and community-based partners, (3) tailor interventions to those most affected, and (4) understand the role of policy interventions and/or systems change and culturally-appropriate cessation strategies. ASTHO, OSH, and The Center provided peer-to-peer learning, technical assistance, and networking opportunities to help project teams draw from the group’s various resources, expertise, and experiences. For example, each state team participated in five virtual, expert-led learning sessions, which provided training on SMARTIE goals, equity-centered community engagement strategies, and effective communication messages for policies that restrict or eliminate the sale of flavored tobacco products. In addition, technical assistance provided the project teams guidance on their established workplan objectives and helped them navigate community-specific challenges. Menthol Capacity Building Strategies Each team worked to address health inequities of their chosen target population with culturally-tailored actions in one of three strategies: (1) Policy, Systems, and Environmental Change, (2) Menthol Cessation, or (3) Counter Marketing/Public Education. Teams focused on African Americans (nearly two-thirds of whom start by using tobacco with menthol), youth, Latinx, immigrant populations, and the LGBTQ+ community. Each team curated state-specific infographics, factsheets, webpages, and media campaigns to examine the role of policy in reducing menthol and flavored tobacco product use. Others engaged legislators or held educational events. Key Takeaways and Next Steps Community Engagement and the Menthol Landscape: Despite challenges, preemption should not stop community engagement work. While state or federal laws and regulations may change, the communities most impacted—and their voices, experiences, and advocacy efforts—remain and are essential in driving meaningful change. Ongoing awareness of the disproportionate impact of menthol and other flavored tobacco products on marginalized communities underscore a continuous need for community engagement and policies that prioritize health equity. Partnering for Influence and Advocacy: Community engagement fosters awareness of the unique challenges that marginalized populations face, ensuring that initiatives are tailored accordingly. In the face of preemption and other regulatory challenges, community voices are critical for national change. Mobilizing Support through Collaboration: Partnerships between state agencies and local organizations allow capacity building and resource sharing. Such partnerships help mobilize broader support with both constituents and legislators, share best practices/lessons learned, and collectively address challenges. Funding Local Initiatives: Effective community engagement often requires financial resources. Examples include facilitating quality meetings as needed, developing educational tools for community dissemination, using paid and social media, and obtaining individuals to implement key activities (e.g., employees or subject matter experts). The collaborative’s participants further encourage: Sustaining and strengthening partnerships with community-based organizations, state health agencies, and national partners to leverage stakeholder expertise and insights. Investing in ongoing capacity building efforts to equip communities with the knowledge, skills, and resources to address tobacco-related challenges effectively (e.g., training, resource sharing, offering technical assistance, and funding community-led initiatives). Engaging with policymakers, community leaders, and others to raise awareness about the negative impact of menthol and other tobacco products. Advocate for evidence-based policies (e.g., e-cigarette flavor restriction) at the local and state level to inform national discussion. Sharing lessons learned—both successes and challenges—with others. website yes

Modernizing Public Health Data and Protecting Privacy

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ASTHO Legislative Prospectus | Previewing 2025 state legislative actions on data modernization and privacy.

Opportunities for Public Health Agencies to Advance Sustainable Financing of Community Health Worker Programs

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Opportunities for Public Health Agencies to Advance Sustainable Financing of Community Health Worker Programs Advancing Sustainable Financing of Community Health Workers Explore how health officials can play key roles as funders, administrators, and policy designers to advance sustainable financing of community health workers. Many states face upcoming funding gaps for community health worker (CHW) positions, with COVID-19 related grant funding streams expiring. Concurrently, many states are rapidly beginning to cover CHW services under Medicaid. In addition, Medicare launched a new reimbursement opportunity for CHWs in January 2024. These factors create an opportunity for state and territorial health agencies to develop or contribute to equitable reimbursement and robust implementation. This report details how health officials can play key roles as funders, administrators, and policy design champions to ultimately advance sustainable financing of CHW services. Get the Report (PDF) website yes

From the Chief Medical Officer: Braiding and Layering Funding Amplifies Public Health Impact

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Braiding and layering funding allows state health departments to leverage diverse fundings sources and amplify their impact. Learn more about this strategy and its importance.

Updated Rundown of State and Territorial COVID-19 Mask Requirements

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Guam,
Ohio,

Several states and territories, as well as many local governments, are going beyond recommendations and requiring individuals to wear face coverings when they are in public settings and spaces (i.e. grocery stores, retail stores, restaurants, public and private transportation services, parks, etc.). Ongoing research and evidence suggests the relationship between mandatory face coverings and declines in daily COVID-19 growth rates is statistically significant.

Domestic Holiday Travel Pandemic Restrictions and Recommendations

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Guam,
Iowa,
Ohio,
Utah,

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

States Support Postpartum Health with Medicaid Expansions

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Iowa,
Utah,

States Support Postpartum Health with Medicaid Expansions astho, association of state and territorial health officials, 2023 state legislative session, medicaid expansions, postpartum health, the consolidated appropriations act, national women s health week, postpartum coverage, affordable care act, premium tax credits, affordable care, 12 weeks, united states, extended postpartum coverage, health a priority, medicaid program, national women s health, mother s day, 2023 legislative, vaginal birth, physical activity, women s health week, postpartum care, coverage for 12 months, 60 days, state plan amendment, care act, postpartum depression, health care Sowmya Kuruganti National Women’s Health Week reminds us that postpartum care is critical for the long-term health of the birthing parent and baby. National Women’s Health Week’s 2023 theme—Women’s Health, Whole Health: Prevention, Care and Wellbeing—is a reminder that postpartum care is critical for the long-term health of the birthing parent and baby. The first year after pregnancy can be full of physical, emotional, and mental health challenges that have long-term or even life-threatening health impacts without timely diagnosis and treatment. In September 2022 CDC reported that 23% of pregnancy-related deaths occur from seven to 42 days postpartum, and 30% of deaths occur 43-365 days postpartum. Among all pregnancy-related deaths occurring from 2017 to 2019, approximately 84% were deemed preventable. Black and American Indian and Alaskan Native <!--(AI/AN)--> women have two to three times higher rates of pregnancy-related death compared to white women. These disparities, like others, are driven by social and economic factors that are rooted in structural and systemic racism and discrimination. Health insurance coverage is one such factor that supports positive maternal health outcomes by facilitating access to care before, during, and after pregnancy. In the United States, 40% of births are covered by Medicaid, which is the primary source of health coverage and access to care for those of low income. Organizations like ASTHO and the Association of Maternal and Child Health Programs support extending Medicaid coverage through one-year postpartum to combat disparities in maternal health outcomes. Federal Legislation for Postpartum Coverage under Medicaid For the majority of states that have adopted Medicaid expansion under the Affordable Care Act (ACA), all people with income up to 138% of the federal poverty level (FPL) are eligible for Medicaid. In states without Medicaid expansion, pregnant people can be eligible for coverage during pregnancy and up to 60 days postpartum under federal law. After 60 days postpartum, these people may lose coverage for the rest of the year-long postpartum period based on general state Medicaid eligibility requirements. Prior to 2021, states could extend Medicaid coverage to postpartum people through a section 1115 demonstration waiver or through state funds. The enactment of the 2021 American Rescue Plan Act, gave states another option to extend Medicaid coverage to 12 months postpartum via state plan amendment for five years. So far in 2023, CMS has approved the State Plan Amendments for five states (Alabama, Arizona, Colorado, Oklahoma, and Rhode Island) implementing a 12-month postpartum expansion. To date, a total of 33 states have expanded Medicaid coverage to 12 months postpartum via Section 1115 demonstration waiver or state plan amendment. 2023 State Legislative Session Depending on states rules for modifying Medicaid coverage the legislature may need to direct the health department to submit a state plan amendment. So far in 2023, three states enacted legislation related to expanding coverage to 12 months postpartum. In Mississippi, SB 2212 authorizes the state’s Division of Medicaid to provide 12 months continuous postpartum coverage to people who qualify. Utah’s SB 133 extends coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. In Wyoming, HB 4 temporarily extends Medicaid coverage for qualifying pregnant women for 12 months postpartum, ending March 31, 2027. Other states introduced bills to extend postpartum coverage during this session. The Alaska Legislature passed legislation (SB 58) directing the Department of Health to submit a state plan amendment extending postpartum coverage to 12 months, and to raise the household income level for eligibility to 225% of the FPL. The bill is currently awaiting action by the governor. Iowa introduced legislation (SF 57) to enact postpartum coverage for 12 months postpartum by Medicaid State Plan Amendment. This would extend the current 60-day postpartum coverage for Medicaid beneficiaries. The Missouri legislature passed (SB 45) that would extend MO HealthNet postpartum coverage from 60 days to 12 months postpartum for women who are either currently receiving or eligible to receive aid to families with dependent children, or eligible to receive benefits via the income eligibility standard. Pregnant women eligible for MO HealthNet and receiving mental health treatment for postpartum depression, related mental health conditions, or substance abuse treatment within sixty days of giving birth would remain eligible for benefits for those services for an additional 12 months. The bill is currently awaiting action by the governor. Nebraska introduced legislation (LB 419) to extend postpartum coverage for 12 months postpartum that would extend the current 60 day postpartum coverage. Texas introduced legislation (HB 12) to extend postpartum coverage to 12 months; it has passed in the House and is now pending in the Senate. Its passage would significantly change the current coverage structure, which uses state funds to provide postpartum people a limited package of postpartum services through the Healthy Texas Women program under HB 133, and subsequently submitted 1115 waivers to draw down federal funds for the program and extend coverage to six months postpartum. Wisconsin introduced companion bills (AB 114/SB 110) extending postpartum coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. This action would extend coverage from the current 60 days and amend the previous 90-day Section 1115 Waiver submitted in 2021. Studies have demonstrated numerous benefits of extending Medicaid coverage for postpartum people and, given these positive impacts, ASTHO expects that more states will take action to extend Medicaid to 12 months postpartum. ASTHO will continue to monitor and report on this essential maternal public health issue. website yes

Harm Reduction Policies Can Prevent Overdose Fatalities

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Adopting a public health approach to substance use by implementing harm reduction policies across all levels of government can help communities address the overdose crisis. This post analyzes e

Climate Change and Environmental Justice: A Snapshot of Jurisdiction Activities

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This report is on the overlap of climate change and environmental justice.

Addressing Overdose Through Collaboration and Opioid Settlement Funds

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Ohio,
Iowa,

Learn how strengthening collaboration and utilization of opioid settlement funds can help address overdose.

Jurisdictions Moving Many ASTHO Essential Tobacco Control Policies Forward

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Guam,
Iowa,

Over the past several years, states and jurisdictions have continued to implement important policies to reduce tobacco and nicotine use, including increasing tobacco prices, expanding areas deemed “smoke-free,” limiting the sale of flavored tobacco products, and supporting tobacco cessation programs.