Health advocates and administrators across the United States continue to develop and revise state-level strategic plans to prevent tobacco use and promote cessation. There is a growing body of literature to document the effectiveness of different approaches to tobacco control to achieve these goals and decrease the prevalence of cancer;however, there is little known about the process by which states develop such plans for tobacco control. Previous research conducted by the Association of State and Territorial Health Officers has documented the existence of tobacco control plans and analyzed the composition of those plans. However, there have been major changes in the tobacco control environment since that time, including the 1998 Master Settlement Agreement which altered the practices of the tobacco industry and provided significant funding to the states for tobacco control efforts, as well as a shift in the social norm making tobacco use more and more unacceptable. The purpose of this study is to examine the structures and processes used by states to develop strategic plans to reduce tobacco use and prevent initiation. To address these issues, we will survey the Departments of Health from the 50 states and the District of Columbia to determine the process by which their state tobacco control plans have been developed. The first step is to contact each of the Departments of Health and confirm the key players involved in the process. Once the list of appropriate contacts is confirmed, a questionnaire will be mailed to each of the parties identified. The survey instrument will inquire about the content of their existing strategic plan, the people involved in the development of the plan and the factors influencing the development of the plan, including what scientific information or best practices guided the process. To address issues of recall bias and socially desirable responses, we will also collected secondary data on tobacco-related state characteristics, such as tobacco use behaviors, existing tobacco-related policies, and funding for tobacco control, as well as state demographics including population density, economic indicators, and partisanship. Following the quantitative data collection, we will conduct follow-up interviews with the states that have produced multiple editions of the strategic plans over time to determine if the same factors were considered each time. The information collected on states'experiences in developing tobacco control plans can help other states as they revise their own tobacco control plans or develop other plans for health promotion and prevention. Given limited public health resources, including funding, personnel and time, it is imperative that states work wisely to protect the health of the public by reducing tobacco use and preventing exposure to secondhand smoke.
While there is documented evidence that tobacco control efforts are effective in reducing tobacco use and preventing initiation thereby reducing the risks of developing cancer and heart-related conditions, resources for tobacco control efforts are dwindling. Therefore, it is important to understand the process by which states are developing strategic plans for tobacco control to ensure that the plans are meaningful, based on the existing scientific literature regarding the effectiveness of tobacco control strategies and used as a guide in developing tobacco-related legislation or tobacco-related programs, and not merely an exercise.
