Advancing tobacco control policies at the municipal level: A framework for local health department and community action

Tobacco control policies play a vital role in local efforts to reduce tobacco use. The Los Angeles County Tobacco Control and Prevention Program (TCPP) embarked on a comprehensive restructuring in 2004 to improve its capacity for local policy adoption. The multi-level reorganization included six components: 1) creating a team approach by integrating a newly formed policy unit with existing contract management and research and evaluation units in TCPP to coordinate with and provide policy analysis support to community-based organizations (CBOs) spearheading tobacco control efforts locally; 2) partnering with state-funded tobacco control organizations to provide ongoing technical assistance and training to TCPP and CBO staff; 3) developing a five-phase policy adoption model for use by CBOs to provide a highly structured framework for planning and implementing tobacco policy campaigns; 4) supporting use of the policy adoption model by TCPP and CBO staff through the development and dissemination of policy campaign tools, and through workshops, webinars, and regular one-on-one technical assistance; 5) establishing fiscal incentives for funded CBOs to implement the policy adoption model by instituting a fee-for-service billing structure linking completion of each phase-specific activity to a specified reimbursement rate; and 6) establishing community coalitions to increase public support and facilitate community mobilization for the tobacco policy under consideration. Six years after restructuring (2004-2010), 79 tobacco policies directly linked to program and community efforts were enacted as compared to 16 from 1998-2003. Lessons learned suggest that similar program restructuring to expand policy adoption capacity may be achievable in other local jurisdictions.