MOBILIZING COMMUNITIES FOR TOBACCO CONTROL
Adapted from
Bracht, N., and Kingsbury, L. "Community Organization Priciples".
in HEALTH PROMOTION AT THE COMMUNITY LEVEL.
Bracht, N. (Ed.) 1990, p.66-86

By: Barbara Silvestri, American Lung Association of Metropolitan Chicago

Mobilizing communities means channeling and coordinating resources such as people, materials, services, methods, meeting rooms, time and money toward a specific goal. Organizers engage individuals and groups from government, regulatory agencies, voluntary associations, health-care, institutions and special interest groups in coordinated efforts to activate a broad range of resources. In other words, the community mobilization process seeks to stimulate and bring together all community energies, interests and resources in a collective response to influence some type of change. According to Bracht and Kingsbury,

"Community organization/mobilization is a planned process to activate a community to use its own social structures and any available resources (internal or external) to accomplish community goals, decided primarily by community representatives and consistent with local values. Purposive social change interventions are organized by individuals, groups or organizations from within the community to attain and then sustain community improvements and/or new opportunities".

Bracht, N., and Kingsbury, L. "Community Organization Principles in Health Promotion". In HEALTH PROMOTION AT THE COMMUNITY LEVEL. Bracht, N. (Ed.) 1990, p. 66-86.

Before any group project can begin, attention must be paid to the development of the group. This means that groups and individuals must be identified for the task and ground rules, established. For example, will the decision-making process be accomplished by consensus? By majority vote? Pressure from other members? What type of communications will be used? Information development and sharing through meetings? facsimiles? teleconferences? phone calls? E-mail? What methods will be employed to ensure that every member's ideas have value? Through team-building exercises? Participatory management techniques? In other words, the coalition building process is as important as the choice of the task to be accomplished.

Bracht and Kingsbury (1990) propose a community health promotion model with five stages. This model can be used to help motivate communities for tobacco control.

1) community analysis,

2) design-initiation,

3) implementation,

4) maintenance-consolidation and

5) dissemination-reassessment.

STAGE I: COMMUNITY ANALYSIS
FOR TOBACCO-CONTROL INITIATIVES

When initiating plans for tobacco control, two things are necessary:
1) an analysis and understanding of how early tobacco use impedes a community's growth, needs, resources, social structure and values; and
2) strong leadership and organizational involvement committed to tobacco prevention. This can be achieved by building collaborative partnerships and facilitating broad and diverse community participation.

Key elements include:

1) Define the communities.

• Communities of a geographic nature can be defined by a neighborhood, town, city, county, school district, police district, precinct, ward, etc.
• Communities of shared concerns (may or may not be geographic) may be defined by members of a church, synagogue, mosque, local chambers of commerce, merchants, parents of children with asthma, victims of heart, cancer or lung disease, etc.

Assess level of knowledge.

• Values generally pertain to the health, social, economic, religious, civil, etc. concerns of the community. Knowing what the values are helps to build on strengths and remedy weaknesses or deficiencies.
• Assessing the level of tobacco-related knowledge would provide the assistance necessary to determine what goals are to be achieved and how they will be achieved. Information and knowledge about the following issues is recommended:
  + the health and economic consequences of tobacco use,
  + the concept that tobacco use serves as a gateway drug,
  + how tobacco advertising and promotion affects smoking prevalence among minors,
  + tobacco merchants' understanding of laws that prohibit the sale of tobacco to minors,
  + how ignoring the effects of tobacco use can damage the community, etc.

3) Collect data using various sources to support the need for change.

Data collection could include published studies about tobacco, or information specific to your own community. Some journals and other published articles are available at your local library. Others may be obtained from hospital or medical school libraries, law libraries or college and university libraries. Scientific publications which often contain tobacco-related articles include, but are not limited to the following publications:

• Surgeon Generals Reports, 1964-Present,
• Journal of the American Medical Association,
• Pediatrics,
• American Journal of Public Health,
• Tobacco Control, An International Journal.

Agencies with information specific to Illinois include

• Illinois Department of Public Health, Springfield, Illinois, (217) 785-2060 - call for their Tobacco Prevention Plan
• Illinois Liquor Control Commission, Chicago, Illinois, (312) 814-3930 - call for their Tobacco Sales to Minors study and report

Your community could also collect more formalized data through unannounced random inspections of tobacco merchants. See appendix for detailed step-by-step instructions.

Many groups throughout the country have published their results of inspections of tobacco merchants. In Illinois, Sgt. Talbot of the Woodridge Police Department and Dr. Leonard Jason of De Paul University were the first to employ the unannounced random tobacco inspections to determine how frequently merchants actually sell tobacco to minors. The baseline data indicated that tobacco merchants sold tobacco to minors approximately 80 per cent of the time. Once the interventions were firmly in place, the percentage rate of sales dropped to less than 10 percent. In addition smoking prevalence among minors has decreased by 50 percent. They have written extensively about their experiences.

Surveys and focus groups with children and adults can provide invaluable information. Some possible questions to ask include the following:

• Where do children obtain their tobacco products?
• If purchased, were they asked for proof of age? What type?
• Do tobacco merchants post signs indicating it is against the law for merchants to sell tobacco to minors?
• Are "loosies" sold? (cigarettes sold individually)
• Where are cigarette vending machines located?
• Where are tobacco billboards located?
• Does the community allow tobacco sponsors for special events?

Your data can be collected through informal observations of tobacco-related activities, such as point of purchase sales, the use of promotional items (T-shirts, caps, jackets, key chains, lighters, etc.), kids smoking around schools, parks, shopping malls, convenience stores, gas stations, etc. the number, location and nature of tobacco billboards and special community festivals where tobacco products are featured.

4) Assess community capacity.

What resources, such as money, manpower, goods, services materials, methods, meeting rooms, etc. are available to reduce and restrict tobacco use and availability among youth?

Once the resources are identified, they need to be coordinated into a tobacco-control action plan. By identifying key, influential individuals, these resources will be much easier to access.

5) Assess varying ethnic/cultural groups within the community.

• African American
  + While African American youth smoke at lower rates than other youth, the adults' smoking prevalence is the same or higher than other populations.
  + African Americans generally smoke menthol cigarettes.
  + The tobacco industry targets its advertising/promotion to minorities and especially African Americans.
  + The industry often sponsors African American events in order to gain greater acceptance.
• Hispanics
  + A very diverse group of Hispanics live throughout Illinois. There are Mexicans, Puerto Ricans, Cubans, Central and South Americans and more. Each represents very diverse cultures.
  + Hispanic women smoke less than Hispanic men. However, Hispanic women who are more enculturated smoke more than women who are not.
  + Hispanics' number one choice of cigarettes is Marlboro.
  + The tobacco industry also target markets Hispanics. This can be seen in Hispanic neighborhoods where tobacco billboards include advertising messages in Spanish.
• Asian Americans
  + A very diverse group of Asian American live throughout Illinois. There are groups from Vietnam, Laos, Cambodia, China, Korea, Japan and more.
  + Asian American men smoke at very high rates.
  + Smoking is widely accepted among this population.
• Eastern Europeans
  + People from Poland, the Ukraine, the former Soviet Union smoke at very high rates.
  + Smoking is widely accepted among this population.
• Lower Income Populations
  + Those with the lowest levels of education and income smoke at a higher rate than those with higher levels of education and income.
  + Many low income groups are unaware of the serious consequences of tobacco use.
  + Low income populations have no knowledge of the relationship between breathing environmental tobacco smoke and asthma.
  + Low income groups are also targeted by the tobacco industry.

The main point is this: Efforts to reach varying ethnic/cultural communities must be tailored made. A generic approach will not produce the awareness and behavior change that is desired.

Communities which promote and celebrate cultural diversity will often realize greater gains in tobacco-control initiatives than those communities which isolate themselves.

6) Assess community strengths and possible barriers.

Tobacco merchants attitudes and beliefs,
Law enforcement officers attitudes and beliefs,
Public officials attitudes and beliefs,
Restauranteurs attitudes and beliefs,
Business owners attitudes and beliefs,
General public attitudes and beliefs.

Obstacles to tobacco control in your community might include both individuals and groups. Business people may oppose restrictions on indoor smoking or inspection of merchants as "too much government control". Or, this can be seen as measures which add cost and inconvenience to management. Some law enforcement officers do not believe that tobacco control is a priority issue. Some individuals, public officials, business owners, etc. are often opposed to tobacco control policies because of insufficient and inaccurate information about early tobacco use. Frequently, unfounded fears of loss of business can be an obstacle.

However, others in the business community might favor tobacco restrictions. Some business people recognize that nonsmokers use fewer sick days, are often more productive than smokers and have lower health insurance costs. Smoke-free workplaces require less maintenance. Many restauranteurs know that the majority of people do not smoke and would welcome mandated smoke-free restaurants because they will not be seen as the "bad guy" in enforcing smoking restrictions. They often welcome strong local ordinance enforcement so that the onus will not be on the restaurant owners or business people.

Law enforcement officers and elected officials might welcome additional regulations. Many recognize that tobacco is a "gateway drug". Youngsters who smoke are at risk for using illegal drugs, such as marijuana, heroin and cocaine. In addition, youngsters who smoke are known to engage in other risk-taking behaviors. Public officials, such as Aldermen Eugene Schulter and Ed Burke, of the Chicago City Council, have been instrumental in the promotion and passage of several city tobacco-control ordinances. They recognize the health and economic seriousness of tobacco use by children.

7) Evaluate the barriers of the tobacco industry and tobacco- related groups in your community.

The tobacco industry often initiates programs that are designed to appear to restrict youth access to tobacco. However, most are ineffective and are designed to forestall any government intervention. For example, the Tobacco Institute has designed a campaign, "It's the Law". This campaign gives the impression that the Tobacco Institute truly cares about tobacco sales to minors. It claims that the goal of "It's the Law" is to eliminate the illegal sale of tobacco to minors.

Dr. Joe DiFranza with the Department of Family and Community Medicine at the University of Massachusetts, a physician with expertise in tobacco sales to minors, completed a study, "The Tobacco Institute's `It's the Law' Campaign: Has It Halted Illegal Sales of Tobacco to Children?" The conclusion of this study is this: 86 percent of the retailers who were participating in the program were willing to illegally sell cigarettes to children, compared with 88 percent of the retailers who were not participating. (Am J Public Health 1992; 82:1271-1273).

Another example where the tobacco industry appears to restrict youth access to tobacco involves the Food and Drug Administration (FDA). During the summer of 1995, the FDA submitted a report to the White House concluding that tobacco is a drug and, therefore, requires the agency's regulation. The tobacco industry has responded by offering to negotiate and compromise to avoid nicotine from being called a drug. Therefore, several legislators who support and attempt to protect the industry, have urged the president to accept a compromise plan on combatting juvenile smoking. The plan proposes a compromise where tobacco companies voluntarily ban unattended vending machines, curb ads directed at teenagers and give states $100 million to help enforce laws barring underage smoking. Many pro tobacco legislators see this compromise as a way of saving tobacco revenue and jobs from moving overseas and depriving state and local governments of billions of dollars in revenue.

The tobacco industry is always opposed to any intervention that may be effective. They prefer weak state legislation to strong local legislation. Any policy that the tobacco industry supports is probably ineffective. The tobacco industry is never an ally in effective community mobilization.

Other groups that are related to the tobacco industry may also present obstacles. As an example, several years ago in the Chicago City Council, attempts were made to eliminate tobacco billboards throughout the city. All billboard companies were opposed, citing Free Speech protection. Another group that presented opposition was the vending machine industry. Attempts were made to restrict cigarette vending machines wherever children have access. All vending machine companies expressed strong opposition. When planning strategy to oppose the tobacco industry, always anticipate who may be your adversaries and who could be your allies.

Each barrier and strength in your community must be analyzed to determine how to build on strengths or overcome obstacles. This information must be communicated to the public in order to garner further support.

8) Assess readiness for change

How urgent a problem is tobacco use? Is the community ready for change? Often, a crisis will upset the status quo. Can a crisis or dramatic event be highlighted to demonstrate the seriousness of early tobacco use? For example: How would the community react if a tobacco merchant sells tobacco across from the local high school? Or, how would members respond if a teenager is diagnosed with mouth cancer due to smokeless tobacco use?

9) Set priorities based on data collected, compiled and collated. What is the most obvious need/problem to be solved? Develop a list in order of importance. Be certain that all coalition members participate in the list-making, especially those of multicultural backgrounds.

STAGE 2: DESIGN AND INITIATION OF TOBACCO-CONTROL INITIATIVES

Key elements include:

1) Establish a core planning group and a local organizer/coordinator.

This group should have tobacco control expertise. Their purpose is to raise awareness of the community's tobacco problems and needs; to write a mission statement; to choose the most efficient structure for the organization; and to identify and recruit members.

2) Choose an organizational structure.

Possible structures for community involvement include an advisory board, a council, a panel, a coalition, a lead agency, an informal network, a grass-roots or advocacy movement. Tailor the organization to the specific demographic make-up and special interest groups in the community. Be certain to attend to the decision-making process and patterns of communication.

3) Identify, select and recruit organization members.

All local major institutions (universities, hospitals, clinics), groups, including for profit, nonprofit, political, minority, religious/churches, recreational, health departments, law enforcement, parents, teachers, business leaders, chambers of commerce, Jaycees, Lions Clubs, interested citizens and media should be represented. Some obvious choices for tobacco-control initiatives include health departments, substance abuse personnel, health-care providers, law enforcement, PTA's and groups that work with children and youth. Some coalitions are all volunteers; others may have volunteers and part and full time staff; agencies like the heart and lung associations have staff and volunteers. There are many, many ways to form coalitions and ensure that task get done.

4) Discuss the organization's mission or vision. Outline the goals or outcomes to be achieved List the objectives or strategies.

A mission statement provides the organization with its purpose. A mission/vision statement communicates who and what is to be achieved. Once the vision/mission is determined, the goals/strategies need to be outlined. The objectives/strategies need to be specific, measurable, attainable and time bound. These will be the measures of success.

5) Clarify roles and responsibilities of participants.

Defining roles and responsibilities for members will help determine who will do what and who is accountable to whom. In formal organization, written job descriptions will help to specify tasks, commitments, functions, etc. In less formally organized groups, members who have a specific skill or expertise can use those skills for the implementation of tobacco-control initiatives.

6) Provide training for tobacco-control initiatives.

Training can take many shapes and forms. It could be a retreat, planned sequential sessions, on-the-job training, community meetings, etc.

Dealing with tobacco control policy is often extremely complex. Health, social, legal, educational, cultural and economic issues must be considered.

Health Issues
Doctors, nurses, dentists, substance-abuse counselors, school nurses and other health-care providers witness first hand the devastation of tobacco-related diseases and death. It is natural, therefore, to include them as both coalition members and trainers. They can provide current health-related information. They can assist with support, testimony and training when needed.

Social Science Issues
Social scientists from your local college or university can help provide insight into the processes of social change. These experts analyze how change affects the community. Studies of communities can generate data for use in public policy initiatives. For instance, Dr. Leonard Jason of DePaul University, and Sergeant Bruce Talbot of the Woodridge Police Department, hypothesized that if tobacco merchants had a license to sell tobacco, and if that license were suspended or revoked as a penalty for selling tobacco to minors, merchants would be less likely to sell tobacco to children. Moreover, they speculated that as sales to minors decreased, there would be decreased prevalence of smoking among children. Studies in Woodridge, Illinois have confirmed that merchants who are licensed and face the threat of fines or license revocation are less likely to sell to minors. Since the enforcement of tobacco sales to minors in that community, the smoking prevalence among minors has been reduced by 50 percent.

Legal Issues
Legal expertise may be required to interpret how the existing or proposed laws can affect tobacco-control initiatives. One specific area includes the legality of tobacco advertising and promotion. Professor Don Garner, a constitutional lawyer at Southern Illinois University, has written extensively concerning the difference between free speech and commercial speech, with specific emphasis on tobacco billboards. Because free speech and commercial speech are legally different, First Amendment protection does not always apply to commercial speech. The Supreme Court has made it clear that commercial speech holds a position inferior to other forms of speech protected by the First Amendment. Therefore, communities may want to consider banning outdoor advertising of tobacco on billboards, on public transit, around places of worship, schools or playgrounds, etc. Many communities, including, Baltimore, Maryland, and the entire state of Utah, have successfully banned tobacco billboards.

Economic Issues
Business leaders are often concerned with the economic impact of tobacco policies. In general, tobacco use is a drain on the economy of Illinois.

An economist, especially one with expertise in how increased prices affect consumption, can aid with rationale for increasing tobacco excise taxes. Frank Chaloupka, PhD., a faculty member of the University of Illinois at Chicago has published numerous studies related to increased taxes and decreased consumption. He says that these studies suggests that an increase in cigarette excise taxes reduces consumption among adults and children. The additional revenue generated by the excise tax increase can be earmarked for specific needs. In Illinois, both Chicago and Cook County have local tobacco excise taxes, the only municipalities in the state with such a tax. Currently, other home rule communities in Illinois are prohibited by statute from raising their excise tax on tobacco products.

Team Building Issues
For members of an organization wishing to initiate change in a community, training for tobacco control is a multifaceted project. There is also decision making, planning, conflict resolution and coalition building to consider. Training increases the likelihood of success which, in turn, provides contributions to the community.

7) Recognize your volunteers and participants.

Specific rewards, benefits and recognition enhance the program success. Participants who are recognized for their efforts have increased awareness, enhanced morale and feelings of accomplishment. Attempt to determine what motivates your volunteers and then, if possible, provide it as often as necessary. What may be important to one may be a source of embarrassment to another. A great deal of information about volunteerism is available, if interested.

STAGE 3: IMPLEMENTATION OF TOBACCO-CONTROL INITIATIVES

Key elements include:

1) Generate broad-based citizen support.

There are many individuals and organizations that would be natural allies for tobacco control initiatives. People with smoking-related diseases such as heart disease, strokes, emphysema, lung cancer, chronic bronchitis and asthma may be interested in tobacco control. Others may include the family members of those suffering from these diseases, especially families of asthmatic children. More members can be recruited from the staff and volunteers of health agencies; substance abuse prevention counselors; school personnel; parent-teacher groups; health department staff, medical societies, clergy, tobacco merchants, etc.

Continue to recruit new members as ideas and plans become a reality. Groups can be brought together through task forces, work groups, committees, partnerships and, sometimes, paid staff.

2) Develop a sequential work plan.

Continue to work cooperatively and collaboratively in order to maintain unity among all members while devising a practical and sequential workplan. An example of a sequential tobacco control workplan is PATCH, Planned Approach to Community Health, designed and funded by the Centers for Disease Control and Prevention, 1987. The workplan consists of five steps. They are

a) Determine priority intervention activities. Analyze the pros and cons of each activity.

b) Plan the intervention. Set goals and objectives. Develop a timetable.

c) Obtain resource support. Identify and involve all the appropriate people. Determine financial and material resources. Estimate all costs. Develop a budget. Solicit support for personnel, equipment, materials, equipment, etc.

d) Design the evaluation. This is your measure of success. Determine your criteria for success.

e) Provide feedback. Determine how you will communicate the effects of your intervention.

3) Use comprehensive, integrated strategies.

In order to ensure that your tobacco control plans are comprehensive and integrative, nurture your diverse group of members. Make them aware of possible sources of resistance.

The general public realizes that the tobacco industry cannot be trusted and is generally suspicious of their actions. The industry, therefore, seeks to align itself with organizations and associations of a pro-health, economy, freedom, success, fun, beauty, femininity, masculinity, nature as a way to hide its deceptive and misleading practices from the public's view. Because of these alignments, it is not always to easy to identify sources of opposition.

Examples of these associations can be found in tobacco advertising, marketing, promotion and media events. The industry preys upon, exploits and targets those who may be less able to make informed decisions about tobacco use. In order to initiate and maintain these"bogus" groups, the tobacco industry hires and pays for "front" groups that sound like innocent and ethical organizations that would be beneficial to the community. Their main purpose, though, is to hide from the public's view.

Some prominent alliances may be "front groups" for the tobacco industry. For instance, for those interested in protecting nonsmokers from environmental tobacco smoke, beware of HEALTHY BUILDINGS INTERNATIONAL (HBI). Known to communities in Illinois, specifically, Chicago, Evanston and Wilmette, this organization was summoned to testify at these city councils when each municipalities attempted to enact clean indoor air ordinances. During testimony HBI often claims that sick building syndrome is the cause of poor indoor air quality. Any mention of environmental tobacco smoke is dismissed as insignificant because "not enough research exists to confirm the findings", according HBI. Moreover, this organization, funded by the tobacco industry, exists only to travel throughout the United States offering testimony opposed to clean air legislation. (See Public Interest Pretenders in the Appendix)

The restaurant and the hospitality industries may express opposition to smoke-free restaurants, hotels and recreational functions locations. The reason they often cite is fear of loss of revenue which is often promoted by the tobacco industry.

In California, the Beverly Hills Restaurant Association, Restaurants for a Sensible Voluntary Policy on Smoking (RSVP), Californians for Fair Business Policy and the California Business and Restaurant Alliance are employed by the tobacco industry to promote false statistics with the hope of scaring restauranteurs and others from implementing clean indoor air policies. These are not legitimate merchant groups.

Professor Stan Glantz, Institute for Health Policy Studies, Department of Medicine, University of California, San Francisco, has published numerous studies on the effect of clean indoor air legislation on restaurant revenue in order to challenge the tobacco industry's strategies. His latest, publication is "The Effect of Ordinances Requiring Smokefree Restaurants on Restaurant Sales" and can be found in the AMERICAN JOURNAL OF PUBLIC HEALTH, 1994;84;1081-1085. He concluded that smoke-free restaurant ordinances do not adversely affect restaurant sales.

These groups claim that public places that do not accommodate smokers will suffer a decrease in sales. While fear of loss of business is a legitimate concern, it has little basis in fact.

For those interested in restricting tobacco sales to minors, beware of merchants' groups who claim the additional regulations, such as tobacco licensure, more personnel, signage, the time it takes to check identifications and the possible loss of customers will cost revenues the merchants can't afford. The costs of implementing these measures, the merchants report, would be prohibitive. However, there is no evidence to support this claim. Merchants are already required to conform to many health and safety regulations. The only loss of revenue they would experience would be loss of profits made from illegal sales to minors. Since these sales are unlawful, there is no basis for objecting to measures that enhance conformance to accepted business practice. Owners and operators of all types of vending machines, especially cigarette vending machines, will report unnecessary revenue losses in part from additional staff needed to monitor sales. Also promoted by the tobacco industry is the inconvenience to smokers who will not be able to purchase cigarettes at all types of outlets. No data exist to support the tobacco industry claims. Having a license to conduct business is a privilege. Merchants must comply with all types of laws. There is no reason to exempt merchants from tobacco laws since they comply with other laws.

All of this rationale is promoted and paid for by the tobacco industry which states that it does not target youth for its lethal product. The tobacco and billboard industries and some advertisers claim that restricting tobacco advertising, whether it be billboards, point of purchase ads or promotional items, violate First Amendment rights. This obviously is a scare tactic, which does not have a basis in constitutional law. First Amendment protection may not apply equally to advertisement. Even though tobacco use is lawful, a community still has a substantial interest in preventing "disruption of moral and cultural patterns," especially of children.

The state of Utah has banned tobacco billboards for 40 years and the city of Baltimore has recently passed such an ordinance. Therefore, it is both doable and legal at the local and state levels.

4) Integrate community values into the programs.

Interventions to protect a community from the effects of tobacco must include multi-cultural and culturally sensitive materials and methods. Differences in smoking prevalence and tobacco do vary from one culture to another. There are numerous resources and materials available, specific to the African American and the Hispanic populations to assist with tobacco-control implementation. As stated previously, build upon the needs values, interests and concerns of your members, rather than force values upon the community.

STAGE 4: PROGRAM MAINTENANCE-CONSOLIDATION OF TOBACCO-CONTROL INITIATIVES

Key elements include:

1) Integrate intervention activities into all community networks.

Groups not specially organized for tobacco control should be brought into the network. For instance, a group of pastors from Chicago's south side have been extremely committed to reducing the tobacco advertising effects on its African American community. They therefore, would be natural members. Another group who would be supportive of the tobacco-control movement is the National Organization for Women (NOW). At the national level, they recognize the tobacco industry's aggressive marketing toward women and girls and are coordinating efforts to promote awareness about the danger of this advertising and promotion. Some of these groups may be your best allies.

Draw everyone into the tobacco-control plan in order to promote ownership and cooperation by the whole community. If key influential members or organizations endorse the intervention, there is a greater chance for success. Tobacco control should be a major activity of many community groups.

2) Establish a positive organizational culture.

A positive environment fosters cooperation and improves retention of staff and volunteers. It is in this stage that trust, nurturing and openness is developed. Stressing strengths rather than weaknesses, resolving conflicts quickly and openly and using mistakes as training opportunities are examples of establishing a positive organization culture. Here is where the coalition building practices will fit. When obstacles are present, they can be used as "stepping stones" to alternative actions rather than barriers that could cause discouragement and delay.

3) Establish an ongoing recruitment plan.

Turnover exists in every organization, especially one that is primarily volunteer driven. Anticipating turnover can avoid future problems. Knowing and assessing the strengths and weaknesses of the group is advisable in order to promote a diverse, integrative and well balanced committee.

STAGE 5: DISSEMINATION-REASSESSMENT OF TOBACCO-CONTROL INITIATIVES

Evaluation and reassessment of tobacco-control activities must be an ongoing process. This is done to determine if strategies are successful or not. Adjustments will be necessary to modify, expand, and/or abandon the action plan.

Key elements include:

1) Update and analyze the community membership.

Changes in community trends, norms, roles, interest, culture and commitment are expected. It is essential to continually identify new members, leaders, trends, sponsors, etc. It is also necessary to keep current with the membership of the main adversary, the tobacco industry. The industry, while positioning itself as a business invested in the welfare of the community is a business invested in defeating all meaningful tobacco-control efforts.

2) Assess the effectiveness of interventions/programs.

Evaluation of the success or the failure of the interventions is accomplished through periodic reviews of status and progress.

Monitoring involves establishing appropriate record-keeping systems that collect data for analysis and summary. In many cases, it will be necessary to begin collecting data at the beginning stages (baseline data) of the program in order to determine what effects the intervention has had.

3) Chart future directions and modifications.

At this stage, the long-term strategic plan needs evaluation. Shifts and changes will be observed. Goals and objectives may need to be revised. Seeking new sources of funding may be required as part of the continuing effort.

4) Summarize and disseminate results.

Effective communication is necessary for community and project visibility. Maintaining high visibility is essential to support and maintenance of the project. If the skills of a media person are available, it will be easier to discern when and how to distribute and promote information and results. There are many ways to communicate. Some include reports, letters, newsletters, press releases, charts, graphs, media events, etc.

CONCLUSION

The set of tasks from Bracht's and Kingsbury's health promotion model has been adapted to assist those who desire to

MOBILIZE COMMUNITIES FOR TOBACCO CONTROL.

Authors Bracht and Kingsbury have identified the most common issues that arise:

• community representations and partnerships,
• identification of resistance and facilitating forces,
• volunteer involvement,
• training and reinforcement,
• staff recruitment and competencies,
• resources for maintenance and local ownership and
• dissemination of results.

A final note......

Attending to the welfare of your group and the completion of your task(s) contributes to the improved health of your community.