Smoking represents a clear example of the challenge facing everyone to enhance the public's health. Increasing the productive and healthful years of life for every person requires a broad health promotion effort, a partnership between researchers and well-designed programs to implement the knowledge from prevention research. This challenge of translating knowledge into programs is the Arizona tobacco control challenge, and the challenge we face as public health educators.
The major causes of loss of healthy years of life for Americans, in addition to tobacco use, are diet too high in calories and fats, sedentary life style and alcohol abuse. For each set of risks, we have serious gaps between the status of knowledge about what we should not do and our consistent behavior based on that knowledge.
The University of Arizona Health Sciences Center has recognized the pressing need to join forces with community groups to attack these health problems. To emphasize the commitment to applying the wealth of prevention research and knowledge at the AHSC, the Arizona Prevention Center (APC) was created by the merger of faculty with expertise in prevention and health promotion research, the Arizona Graduate Program in Public Health, the International Health Program, and the epidemiology and biostatistics programs.
The APC has been charged with conducting health promotion research and program development dealing with the priority problems facing Arizona. New and more effective partnerships with key community groups and implementers of prevention programs are being developed. AHSC will more directly contribute to the health of Arizona.
APC collaborates with other AHSC departments and centers, notably the Arizona Cancer Center, the Steele Memorial Children's Research Center and University Heart Center to facilitate prevention research programs and to identify opportunities for application of our knowledge to state health promotion efforts.
The APC program emphasizes three health promotion challenges. We are working to develop models for comprehensive health promotion programs in Arizona. Historically, most health promotion efforts have focused on a limited number of health issues, such as cardiovascular diseases, and, while these may be highly effective, they may fail to capitalize on synergistic effects that accrue when multiple health risks are addressed. Individuals and communities want health promotion programs that address a broad range health risks, and not just a single disease focus.
A second challenge is intensifying efforts to help youth develop health habits and to avoid the risks of smoking, violence, alcohol, and diseases and pregnancy resulting from unplanned and unprotected sex. APC has formed coalitions with several programs at the UA and in the community to systematically assess strategies that will more effectively engage youth in protecting their health.
AHSC and APC also are working to prepare a new generation of physicians and health care providers to meet the health promotion and prevention challenges of the next millennium. To do this, a broad coalition at the College of Medicine has formed to redesign the curriculum so that preventions being taught and learned are integrated in the medical student experience. Prevention no longer can be relegated to an alternative approach, but must form the first-line attack for a healthier Arizona.
Carlos C. Campbell, M.D., M.P.H.
Director, Arizona Prevention Center
Are we outraged? Lung cancer recently replaced breast cancer as the leading cause of cancer death in women. Are we mortified? Tobacco company CEOs testify under oath that nicotine is not an addicting drug. Do we take action? Our federal government funds both the marketing of tobacco and the treatment of tobacco dependence. Do we say "enough is enough"? Increasingly the answer in Arizona is "yes."
In 1994, Arizona voters passed a tobacco tax_with portions to be spent on tobacco-use prevention and education, and on tobacco-related research. Funds for prevention and education are used for youth and pregnant adult tobacco users. Approximately half of the prevention funds have been awarded for media, such as ads to stop youth tobacco use.
Funds also will go to local programs, such as those coordinated by county health departments that support coalitions dedicated to tobacco-use prevention. Examples include a statewide clearinghouse, a repository for tobacco-use prevention materials, a smoking cessation help line for youth and a World Wide Web page, and an evaluation program for out-of-school youth.
An important feature of the Arizona plan is emphasis on collaborative programs and development of rapid communication networks to disseminate information to all funded programs.
The challenge Arizona faces is to create a balanced research program to define more effective strategies for curtailing smoking and tobacco use. Specific adult smoking cessation treatments (such as nicotine patch) lead to relatively predictable decreases in tobacco-use behavior. The same can't be said for preventing people from starting to smoke. It appears that comprehensive programs similar to those developed in Arizona have the greatest chance of decreasing tobacco use. Community-based programs that include a strong media component; and school- based programs emphasizing knowledge, attitudes, skill training and behavior, appear to lessen tobacco use.
The Arizona Program for Nicotine and Tobacco Research, an Arizona Prevention Center program, has been conducting research into optimal methods to help smokers quit. Last year, the Arizona Smokers Helpline was established. It has been funded to expand its telephone-based tobacco-use education and prevention services to youth and pregnant women. In addition, an Arizona Cancer Center will evaluate the "Full Court Press" tobacco-use prevention program for Tucson that is funded by the Robert Wood Johnson Foundation.
New technologies for prevention education are under development. An APC program funded by the tobacco tax is developing a World Wide Web page for prevention and education.
The challenges of translating knowledge about the development of nicotine addiction into prevention programs is difficult because much must be learned about how and why nicotine addiction occurs.
Factors that appear to play a role in initial use or continued use of tobacco products include parental use (genetic and/or behavioral), peer use, tobacco advertising, cost and emotional stability. When adults in a household smoke, the probability is high that at least some of the children in that household will develop a nicotine addiction. However, a challenge in Arizona will be to show actual decreases in youth tobacco-use incidence and prevalence since there will be no tobacco tax-funded programs to help their tobacco-using parents quit. Yet another challenge will be to develop the means of evaluating and comparing programs so that we can learn what works and what doesn't.
Scott J. Leischow, Ph.D.
Director, Arizona Program for Nicotine and Tobacco Research
Arizona Prevention Center