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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

Following disruptions to daily life caused by the COVID-19 pandemic, emergency departments saw an increase of mental health-related visits. A June 2021 study showed a significant increase of mental health-related visits among 12–17-year-olds compared to the previous year. States and territories that implement a comprehensive public health approach to suicide prevention across all domains of life—an approach known as the socio-ecological model—can reduce contributing risk factors.

A mid-session legislative update on five of ASTHO's top 10 public health state policy issues to watch in 2023: data privacy and modernization, reproductive health, health equity, strengthening public health agencies, and immunization.

Public health agencies are working to reduce dementia risk and to optimize the health and well-being of people living with dementia and their caregivers.

The ASTHO State Health Policy team provides brief updates on 5 of the ten state health policy issues to watch in 2022: mental and behavioral health, rural health, e-cigarettes and flavored tobacco products, HIV and PFAS.

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.

ASTHO Celebrates Women’s History Through the Decades ASTHO, association of state and territorial health officials, public health infrastructure, vice president, population health, health science, health system, public health workers, american women, career path, environmental health, public health mph, national women s history, international women s day, public health careers, health education specialist, week of march, history month, master of public health, black women, women s history week, women s history, public health work, public health leadership, woman president, public health practitioner, racism and sexism, public health system, women s history month, women leaders, women in public health Kimberlee Wyche Etheridge ASTHO | Celebrating ASTHO's past, present, and future of women in leadership. With a movie ticket costing $2.50 and gas hovering at $1.10 / gallon, the year 1984 ushered in many new eras. Apple debuted the Macintosh personal computer with its Superbowl commercial based on George Orwell’s dystopic novel in the Winter. Over the next generation, this technology would change the way we interact with the world. Prince’s Purple Rain and the accompanying concert-type movie were released, ushering in a new generation of forever fans. Space travel catapulted into the future with the launch of the space shuttle Discovery, which flew an additional 38 times. Childhood hunger took center stage with the release of the benefit song, “Do They Know It’s Christmas?” by Band Aid, which would sell millions of copies and raise millions of dollars. It was the Eighties—a key decade in U.S. history. It also marked a critical first in ASTHO’s history. ASTHO has a long history of pioneering women leaders. Below, you'll find several of them whose work has inspired mine. (Read the full list of ASTHO's women presidents.) 1980s After 42 years of public health work and leadership, ASTHO elected its first woman president—Kristine Moore Gebbie, DrPH, RN (alumni-WA)—in 1984. Gebbie was an educator who taught generations of nursing students around the world. She was a public health practitioner and served as Secretary of Washington State’s Department of Health. Her legacy highlights the importance of working across multiple levels of government and healthcare agencies, especially as it relates to preparedness. As ASTHO president, she was a trailblazer, best known for her commitment to work focused on AIDS. While in this role, she was tapped to serve as the first White House AIDS Policy Coordinator. She received numerous awards and accolades from many different organizations, including the American Nursing Diagnosis Association (NANDA). 1990s In 1992, Joycelyn Elders, MD (alumni-AR) also celebrated a first—becoming ASTHO’s first African American woman president. Elders served as the Director of the Arkansas Department of Health. Her public health accomplishments include reducing teen pregnancy in her state, increasing early childhood screenings as well as the percent of children immunized at 24 months. During her time in Arkansas, she was recruited to serve as Surgeon General, where she became the first African American—and only the second woman—to hold the post. She contended with both racism and sexism while in the job, and despite criticism and waning support from the administration, she stayed true to her public health beliefs. She fervently believed that poverty plays a critical role in public health crises such as teen pregnancy, and that education is as an essential strategy to breaking the cycle of poverty. She became the first person to be board certified in pediatric endocrinology. She has published more than 100 papers focused primarily on juvenile diabetes and adolescent health. 2000s Known for saving many lives by successfully cutting smoking rates by one-third during her time as Washington State Secretary of Health, Mary Selecky (alumni-WA) served as ASTHO president in 2003 and 2004. She holds the title as one of the nation’s longest serving secretaries of health having worked under three governors. During her time as the top state health official, Selecky moved Washington to become one of the first state health agencies to receive national accreditation. Childhood immunization rates in the state catapulted from among the bottom in the nation to in the top third. She worked to improve the state’s public health system after a 2001 earthquake. As ASTHO president, Selecky worked to elevate ASTHO’s status as a vital partner after the 9/11 terrorist attacks. She worked to ensure that public health preparedness funds were granted to health departments. 2010s Jewel Mullen, MD, MPH (alumni-CT) was serving as the Commissioner for the Connecticut Department of Public Health when she was elected President of ASTHO in 2014. During her time in Connecticut, Mullen focused on the state’s public health system, specifically chronic disease prevention programs and improving coordination between public health and medical care. She was also a crucial figure in bringing the community to the public health table. She created an Office of Health Equity Research, Evaluation and Policy while in her role to ensure integration of health equity in the states programming. Mullen used her ASTHO presidential challenge to highlight healthy aging and issue a call to action to help older adults live and age well in their communities. Through her Presidential Challenge, states committed to healthy and safe community environments, injury and falls prevention, empowered people, Alzheimer’s plan, active living, and clinical and community preventive services. Nicole Alexander-Scott, MD, MPH (alumni-RI) was elected ASTHO president in 2018. In that role, she led a presidential initiative encouraging state, local, tribal, and territorial health departments to build healthier, more resilient communities through community-led, place-based approaches. This initiative mobilized strategic investments to address socioeconomic and environmental determinants of health to transform systems and policies in ways to empower local communities. Alexander-Scott has also worked as a specialist in infectious diseases for children and adults. She is board certified in pediatrics, internal medicine, pediatric infectious diseases, and adult infectious diseases, and served as faculty at Brown University in pediatrics, medicine, and public health (with a focus on health services, policy, and practice). She continues to work with ASTHO to promote health equity. 2020s Rachel Levine, MD (alumni-PA) served as president of ASTHO in 2020. She is the first openly transgender woman to serve in the role. Levine is a pediatric and adolescent medicine physician and an educator. In 2015, while practicing clinical medicine at the Penn State Hershey Medical Center, she was nominated by the governor-elect to serve as Pennsylvania’s physician in general. Two years later, she was named as Pennsylvania Secretary of Health. Levine led the state through the COVID-19 public health response and helped the state respond to the growing opioid epidemic. While serving as ASTHO president, the White House nominated Levine to serve as Assistant Secretary for Health. She achieved another first when she was commissioned as the first woman four-star admiral in the U.S. Public Health Service Commissioned Corps. She remains a strong advocate for the well-being of LGBTQI+ youth. Continuing in this strong tradition of trailblazing women in leadership, Anne Zink, MD (SHO-AK) took the reins as ASTHO President in September 2022. Zink plans to focus her presidency on improving health information systems to empower the public, healthcare providers, and the public health workforce with the tools and information they need to promote individual and population health. There are others who have helped pave the way for future women leaders at ASTHO. This month of March, we celebrate all the past, present, and future women who have served as Presidents of ASTHO. We are because they were. ASTHO's Women Presidents: 2023  Anne Zink, MD, FACEP (SHO-AK) 2021  Rachel Levine, MD (alumni-PA) 2019  Nicole Alexander-Scott, MD, MPH (alumni-RI) 2015  Jewel Mullen, MD, MPH, (alumni-CT) 2009  Judith Monroe, MD (alumni-IN) 2007  Mary M. Hansen, RN, PhD (alumni-IA) 2006  Leah Devlin, DDS, MPH (alumni-NC) 2004  Mary C. Selecky (alumni-WA) 2003  Mary C. Selecky (alumni-WA) 2000  Patricia A. Nolan, MD, MPH (alumni-RI) 1993  Molly Coye, MD (alumni-CA) 1992  M. Joycelyn Elders, MD (alumni-AR) 1990  Suzanne Dandoy, MD (alumni-VA) 1985  Joan K. Leavitt, MD (alumni-OK) 1984  Kristine Gebbie, RN (alumni-WA) website yes

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.

ASTHO staff identified a range of evidence-supported policies considered by state legislatures that could prevent ACEs. This report synthesizes these research and policy proposals and is intended for public health practitioners and policymakers who are considering adopting similar policies.

Creating community gathering spaces, or placemaking, has garnered considerable attention in the wake of the COVID-19 pandemic. Youth sports is an important outgrowth of placemaking as they can be a protective factor in preventing ACEs and chronic diseases across the lifespan.

Continuing ASTHO’s Legislative Prospectus series—which highlights the top 10 public health policy issues for 2022—this post focuses on mental and behavioral health, as well as supporting the public health workforce.