TOBACCO EDUCATION AND RESEARCH OVERSIGHT COMMITTEE (TEROC)

Achieving Health Equity: Toward a Commercial Tobacco-Free California, 2021-2022

Objective 2: Strengthen capacity for tobacco control

Achieving health equity in tobacco control requires strengthening capacity to serve California's diverse communities.

TEROC recommends investing greater resources where people do not have equal opportunities to be healthy; developing diverse new leaders; and, building power and influence in marginalized and underserved groups experiencing institutionalized racism, homophobia, transphobia, and other patterns of bias exclusion.

Questions to determine the needs and opportunities for capacity building in tobacco control include:

Which communities and populations have the highest tobacco prevalence rates? Which are disproportionately affected by tobacco-related disease?
Which communities are targeted by the tobacco industry? Which struggle with the triangulum of tobacco, cannabis, and e-cigarettes?
Which communities have the least infrastructure to undertake tobacco control work or have been under-resourced in the past?
Which communities, underrepresented in tobacco research, have strong youth advocates who can become the next generation of researchers? Which have strong health workforce development alliances that can help advance tobacco control initiatives?
What new partners can help advance structural equity work in tobacco control?
What new strength-based assessments within marginalized communities are needed to generate sustained, measurable impacts relevant to tobacco work?

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One Page Summary of Objective 2: Strengthen capacity for tobacco control, 2021 (PDF)

The full Achieving Health Equity: Toward a Commercial Tobacco-Free California, 2021-2022 Plan, (PDF)

Achieving Health Equity also includes objectives on the following topics. Click on the links to learn more:

1 -Reducing Disparities

2 - Strengthening Capacity

3 - Overlap of Tobacco and Cannabis

4 - Youth and Young Adults

5 - Effects on Pepole and Environment

6 - Cessation

7 - Countering the Industry

Strategies

1. Ensure that the tobacco control workforce reflects the communities it serves.

TEROC recommends the development, implementation, and evaluation of organizational plans to increase California’s tobacco control workforce diversity, especially where priority populations are underrepresented, including monitoring the progress made to retain and foster career advancement.

2. Develop new leaders with diverse perspectives throughout the movement.

The inclusion of diverse perspectives strengthens organizational capacity.
TEROC recommends embedding succession planning into program and organizational operations that includes career and skills development opportunities and offering mentorships to help young people and others move into tobacco control and research careers. Widely promoting career development and job opportunities to local tobacco control coalitions, youth advocates, local colleges, and internship and fellowship programs will expand access to potential candidates.

3. Strengthen partnerships among state, regional, local, and Tribal entities.

Working together on a shared goal leads to better outcomes than working alone. Thus, partnerships among government and community organizations are key to continued success in tobacco control. Improved coordination and collaboration between state, regional, local, and Tribal entities will achieve greater collective impact.
TEROC recommends providing high-quality training and technical assistance to community organizations, school districts, coalitions, and other entities; the promotion of innovation through peer modeling by sharing lessons learned; and, improved data transparency and access. For example, the California Department of Tax and Fee Administration (CDTFA) could take steps to make tobacco and cannabis retailer licensing data fully accessible, and it could implement a tobacco track and trace program to make tobacco sales data available to evaluate the impact of tobacco control policies on tobacco sales.

4. Strengthen and diversify coalitions by engaging a wide range of partners.

Historically, coalitions have included traditional partners such as health departments, health care organizations, social service and voluntary organizations, universities and researchers, school staff, law enforcement agencies, dental health programs, and early childhood development programs. However, the engagement of nontraditional partners is key to building the tobacco control movement.

TEROC recommends expanding coalitions to include nontraditional partners such as economic development organizations, employers and business groups, labor unions, faith-based communities, social justice and equity groups, environmental advocates, and community planners. Tools to encourage non-funded partners' participation in coalitions and advisory groups could include providing opportunities for members to participate virtually or providing travel reimbursement. At the same time, engagement in workplan activities could be fostered through internships or community engagement grants.

5. Collaborate with Tribes to help advance their priorities for commercial tobacco control.

Collaborating with Tribes and Tribal community members can help to advance commercial tobacco control. Successful collaboration begins with an awareness that each Tribe is sovereign and unique. Given there are over 100 federally recognized Tribes and many Urban Indian populations in California, there is no one-size-fits-all approach to working with California’s Tribes and American Indian populations. It is important to focus first on relationship building to establish trust, which includes starting from a position of deference and acknowledging that Tribes have their own hierarchy of needs and their own priorities for commercial tobacco control.
TEROC recommends that in working with Tribal communities, consider the appropriateness of requiring the use of evidence-based practices developed from non-Tribal communities, and instead listen to how each Tribe envisions successful program implementation, respecting the use of traditional tobacco as a cultural and religious practice, provide funding and resources that help build the readiness of Tribes to work on tobacco use prevention and cessation efforts, and facilitating the development of best practices and an evidence-base for Tribal tobacco use prevention and cessation efforts.

6. Build and maintain capacity by ensuring equity and transparency in tobacco taxation and allocation of revenues.
a. Ensure that all tobacco products are taxed equitably.

The taxation of tobacco products in California is complex. Not all tobacco products are taxed equitably. Tax evasion may occur when California residents buy tobacco in jurisdictions with lower tax rates, such as military bases, other states, and Tribal lands. Additionally, as sovereign nations, Tribes have the authority to set their own tax policies. Another issue is inflation, which gradually erodes the power of tobacco taxes to prevent initiation and promote cessation.

TEROC recommends exploring mechanisms to create parity among tax rates, including keeping tax laws up to date with the evolving product landscape; partnering with Tribal authorities to reach mutually beneficial agreements to reduce price differentials while raising revenue for Tribal priorities;34 and, indexing tobacco taxes to the medical care component of the Consumer Price Index to counter inflation and preserve funding for critical health care priorities.

b. Ensure that tobacco control is prioritized appropriately in the distribution of tax revenue.

The methodology used by the California Department of Finance (DOF) to allocate tobacco tax revenue is opaque and leads to uncertainty and instability in program funding. Continued monitoring and collaboration with DOF is necessary to ensure that tobacco control is fully funded.

TEROC recommends DOF provide greater transparency in how tobacco tax funds are allocated, including how much is allocated to CDTFA before other fund distributions. Also needed are more accurate fiscal forecasting, more limited withholding of funds, and more timely communication with CTCP, CDE, and TRDRP. Similar efforts are required to ensure that cannabis tax revenues are used for cannabis prevention and control.

7. Protect state and local authority from federal pre-emption.

The federal government's actions could undermine California’s tobacco control movement by preempting state action or otherwise infringing on state and local authority.

TEROC recommends monitoring and countering federal actions, when necessary, by mobilizing coalitions or taking legal action through the California State Attorney General’s Office, including publicizing any steps taken to ensure that stakeholders and the general public are aware.

Featured Story

Rakiah Anderson, MPH, hails from Pasadena. While doing her undergraduate work at UC Berkeley, Rakiah was a Health Career Connection intern at TRDRP, which sparked her interest in becoming a tobacco control advocate. She then received a TRDRP Cornelius Hopper Diversity Supplement to do work with Dr. Juliet Lee on social media research on dual use of tobacco and cannabis. Rakiah participated in the Youth Activism Fellowship program at the Truth Initiative, serving as Youth Trainer and Youth Board Liaison. In 2020 she received her MPH from the University of North Carolina at Chapel Hill, Gillings School of Global Public. During her studies there, she chaired the Minority Health Conference and received the American Evaluation Association's Graduate Education Diversity Internship. Her research interests focus on tobacco prevention and health equity.

Rakiah Anderson in front of her poster presentation