IDAHO TOBACCO PREVENTION AND CONTROL 
PROGRAM GOAL AREAS

1. PREVENT INITIATION

2. ELIMINATE ENVIRONMENTAL TOBACCO SMOKE

3. PROMOTE SMOKING CESSATION

4. IDENTIFY AND ELIMINATE TOBACCO-RELATED DISPARITIES 


Goals and Action Plans	

     Goal I: Improving Data Systems	
     Goal II: Assuring Cultural Competency
     Goal III: Increasing Funding and Other Resources	
     Goal IV: Building Community Infrastructure	
     Goal V: Establishing Policy Expectations 	


EXECUTIVE SUMMARY

In January 2001, the Centers for Disease Control and Prevention (CDC) commissioned a
special effort with regard to the fourth goal area of the national tobacco prevention and 
control program for identifying and eliminating tobacco related disparities.  Nationally, 
this has been the most difficult goal area to address.  Funding was provided to Idaho to 
become a cooperative partner with CDC to act as a pilot state in identifying ways to 
build capacity for the identification and elimination of tobacco-related disparities by 
engaging a diverse and inclusive workgroup in a strategic planning process.  

The output for this ground-breaking endeavor is a strategic plan that could be used as a 
model for other states.  This resulting strategic plan will provide a framework for 
future programs, interventions, surveillance, and evaluation associated with tobacco-
related disparities in Idaho. It describes what our workgroup believes needs to take 
place in Idaho in order to address the fourth goal area.  It incorporates the most 
current information as well as diversity of thought from the groups affected by 
disparities.

The most effective tobacco control program is comprehensive and multifaceted.  It will 
use a state-coordinated, decentralized approach that puts many resources into communities 
and organizations outside of state government.  The direction specified in the plan will 
guide the efforts of our State Health Division of Health and its partners over the next 
several years, as well as aid the creation of action plans for the upcoming fiscal year.

This document describes five key issues that have been modified into five goal areas to 
be addressed.  Each goal has a corresponding set of strategies and tactics that are 
described.  The five specific key issues are:

•	Improving Data Systems
•	Assuring Cultural Competency
•	Enhancing Funding and Other Resources
•	Building Community Capacity and Infrastructure
•	Establishing Policy Expectations 

Idaho can successfully address disparities in tobacco use, despite the powerful tobacco 
industry that has targeted such groups.  This plan provides the blueprint for increasing 
many years of productive life among our residents, and reducing the social and economic 
costs of tobacco.  We stand ready to support this effort.

	--  The Idaho Eliminating Health Disparities Workgroup
	 
INTRODUCTION AND BACKGROUND

Consistent with the National Tobacco Control Program’s objectives, the four primary goal 
areas of the Idaho Tobacco Prevention and Control Program are: 

1.) Preventing initiation of tobacco use
2.) Eliminating environmental tobacco smoke (ETS)
3.) Promoting cessation
4.) Eliminating disparities among population groups.  

In January 2001, the CDC commissioned a special effort with regard to the fourth goal 
area of the national tobacco prevention and control program for identifying and 
eliminating tobacco related disparities.  Nationally, this has been the most difficult 
goal area to address.  Funding was provided to Idaho to become a cooperative partner with 
CDC to act as a pilot state in identifying ways to build capacity for the identification 
and elimination of tobacco-related disparities by engaging a diverse and inclusive 
workgroup in a strategic planning process.  

DEMOGRAPHIC DESCRIPTION OF IDAHO: 

Idaho has a population of 1.3 million people residing in a landmass of 82,751 square 
miles (2000).  The racial-ethnic make up of Idaho is 91.0% White, 1.4% Native American, 
1.0% Asian-Pacific Islander, and 0.4% African American.  Eight percent (7.9%) of Idahoans 
identify themselves as being of Hispanic descent.    The population is almost evenly 
divided between males (49.9%) and females (50.1%).

Being an agricultural state, there is a sizable population base with Migrant and Seasonal 
Farm Workers (MSFW).  A migrant farm worker is defined as a person who moves from outside 
or within the state to perform agricultural labor.  A seasonal farm worker is defined as 
a person who has permanent housing in Idaho and lives and works in Idaho throughout the 
year.  In 1989, the Migrant Health Branch, US DHHS, estimated that more than 119,000 
migrant and seasonal farm workers and their families resided in Idaho, at least 
temporarily.

There are six federally recognized Indian tribes that reside within Idaho borders.  The 
lands of two of these sovereign nations straddle Idaho and another state border (Utah and 
Nevada).  Traditional ceremonial use of tobacco remains a strong part of Indian culture 
in Idaho.  

Idaho’s per capita income (1996) is $19,865 compared to the national average of $24,439.  
In state fiscal year 1998, 24,810 households that included 64,117 individuals received 
food stamps (5.3% of the population).   In December 2000, there were 22,258 families 
(37,423 individuals) in Idaho using WIC services.


PURPOSE STATEMENT: 

There is sometimes the erroneous perception that because Idaho’s population is relatively 
homogenous that health behavior and health status is also relatively homogenous.  Because 
of this, populations at significantly higher risk that represent small percentages of the 
total may be lost in efforts to spread scarce public health resources in the most 
efficient manner.  The purpose of this project is to develop a plan that will 
systematically identify and describe those populations.  In this way, those same scarce 
public health resources can be allocated not only more efficiently, but also most 
effectively.   

This document is intentionally designed to be fluid and accommodating as new issues 
emerge, and as other populations are identified.  It suggests a process that will be 
monitored on a continued basis and one that is folded into the overall statewide tobacco 
plan.  While the overall plan reflects the basic foundations that are integral to 
identifying and eliminating disparities, it is expected that specific strategies, 
tactics, populations addressed, and priority areas will be adjusted as the process 
evolves. 

 
PROJECT DESCRIPTION

The Idaho Tobacco Prevention and Control Program (TPCP) was funded by the Centers of 
Disease Control and Prevention (CDC) to be a pilot state in developing a systematic and 
inclusive plan for identifying and eliminating disparities among populations in regard to 
tobacco use.

A group of diverse members from state, regional and local communities (See participant 
list) was convened to act as an advisory workgroup in this planning process.  As part of 
the cooperative agreement, CDC provided training to the Project Director and selected 
members of the workgroup in Atlanta, Georgia.  The entire workgroup met in Boise, Idaho 
three times during the planning period.  The process was sectioned into the following 
areas.  A description of activities from each of the sections follows.

Meeting 1 – Getting Organized, Assessing What We Know 
Meeting 2 – Setting Direction, Goals and Strategies 
Meeting 3 – Refining and Adopting 
     
Getting Organized, Assessing What We Know:  

Information collection was accomplished through two channels.  The first was through the 
use of existing surveillance instruments. Using data from the Behavior Risk Factor 
Surveillance System (BRFSS) and the Youth Risk Behavior Survey (YRBS) as a base, the TPCP 
broke out variables for comparison that included race/ethnicity, age, gender, income and 
geographic residency.  Other existing databases included information from the WIC and 
Substance Abuse and Mental Health programs.  A parent/youth telephone survey was 
administered to examine attitudes and behavior between people from smoking vs. non-
smoking households.  In conjunction with the Juvenile Justice Department, a survey was 
completed that compared behaviors of youth in detention centers to youth in public 
schools.  Public school data came from two CDC sponsored surveys; the Youth Tobacco 
Survey (7th-8th graders) and the first weighted data set from the YRBS (9th-12th grade) 
since 1993 (with additional tobacco questions added).  Four of the Idaho tribes 
participated in a modified Youth Tobacco Survey (convenience samples) and a similar one 
was conducted with Hispanic youth.

While the above data provided initial direction, it was also noted that the information 
was incomplete.  There was not enough quantitative data available to make a comprehensive 
assessment for identification.  The second strategy was to collect data through a 
qualitative process.  This is included an environmental scan and an assessment of 
Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis by workgroup members on 
their respective communities from a statewide perspective.  This information collecting 
strategy is still in process as communities that are currently under contract (two 
Hispanic communities and six Indian tribes) for services with the TPCP are also 
underway.  It is also noted that it was impossible to have representation from all 
communities at the table.  The TPCP conducted literature reviews to recognize other 
populations that were identified through research that exhibited disparities in tobacco 
use.  The ethos of the working group was to represent your constituency but to advocate 
for the whole.

Setting Direction, Goals and Strategies:

The data collected through the existing and created surveys and the SWOT analysis and the 
environmental scans generated discussion amongst the workgroup.  The facilitator of the 
meetings was able to lead the group in synthesizing the myriad of issues that emerged 
into five basic issue areas.   

Those five issue areas were modified and reshaped into five goal areas to be addressed.  
Although there was much discussion about specific populations that were identified 
through the collected information, the five goal areas are intentionally generic to 
accommodate all identified and yet to be identified populations.  The five specific key 
issues are:

•	Improving Data Systems
•	Assuring Cultural Competency
•	Enhancing Funding and Other Resources
•	Building Community Capacity and Infrastructure
•	Establishing Policy Expectations 

While the workgroup shaped the five overall goal areas, the Project Director from the 
TPCP was charged to take these goals and apply a draft plan for specific strategies and 
tactics to accomplish these goals.  Timelines, feasibility, logical lead organizations or 
persons, and budgets were considered.  This draft plan was sent out in advance to all 
workgroup members for review.  It became the centerpiece for discussion during the final 
meeting of the workgroup.  

Refining and Adopting:
 
Members of the workgroup reviewed the draft plan and came to the third Boise meeting to 
refine and adopt.  Each goal was assigned a corresponding set of strategies and tactics.  
This document is the final product of this project.  It was accepted and ratified 
unanimously and plans for implementation are in progress.

   
WORKING DEFINITIONS

Working definitions are different from academic ones.  These definitions were designed so 
that the workgroup members and other parties could find practical and relevant 
applications for targeted effort.  They are designed to elicit action.

Increasing Diversity and Inclusivity (Promoting Representation and Involvement): 
Increasing diversity and inclusivity requires including representatives from populations 
at all levels of decision-making about tobacco-related health issues. Diverse populations 
include, but should not be limited to, racial and ethnic populations; examples include 
low socioeconomic status populations, out-of-school youth, and lesbian, gay, bisexual, 
and transgender communities.

Identifying and Eliminating Disparities (Closing the Gap): Identifying disparities 
involves using data and/or other sources to identify groups with significantly higher 
tobacco use and exposure to secondhand smoke. Eliminating disparities involves ensuring 
diverse communities’ access to planning and decision-making, capacity and infrastructure 
building, funding opportunities, services, and comprehensive initiatives to address the 
disproportional use of tobacco and/or exposure to secondhand smoke.

Developing Cultural Competency (Cultural Appropriateness): Assuring the implementation of 
interventions that are specifically designed to meet the needs of identified disparate 
populations.  Cultural competence is a set of congruent behaviors, attitudes, and 
policies that come together in a system, agency, or among professionals and enables this 
system, agency or those professionals to work effectively in cross-cultural situations 

Building Community Capacity and Infrastructure:  Creating or enhancing community capacity 
with a two-tiered approach.  There are two primary constructs.  The first may be 
considered in the classic sense of capacity building.  This includes developing programs, 
leaders, organizations, networks and research/researchers in the community.  The second 
is a more expansive approach to cultural competency.  It is a social capital model that 
includes developing trust, collaboration, cooperation and synergy. 

Improving Data Systems: Enhancing existing or creating new systems that are sensitive 
enough to identify disparities need to be creative.  In some cases, it may just be a 
matter of increasing sample sizes.  In most cases, it will involve creating data 
instruments that are both qualitative and quantitative.  Part of the system development 
may include discovering non-traditional avenues for access to population.

 
KEY FINDINGS

Idaho’s adult use of tobacco has remained at around 20% for the past ten years.  The 
Healthy People 2010 goal is 12%.

• Forty percent (40%) of Idaho Native American Indian adults smoke.

• Pregnant women in WIC smoke (21%) over one-an-half times more than other pregnant women 
in Idaho (13%)

• Seven out ten Native American youth and five out of ten Idaho youth have been in the 
same room as a smoker in the past 7 days.

• High School aged children have decreased smoking from 27% to 19% in the past eight 
years. 

• The 18 to 24 year old age group (30%) is the only group that has shown a steady 
increase in smoking behavior in the past ten years.

• In the 18 to 24 year old age group, non-college student smoke more than college 
students (30% v 24%)

• There is a direct linear relationship between educational attainment and smoking 
behavior (less than HS = 32%, college grad = 10%)

• Native American and Hispanic children (especially Migrant) continue to show lower 
educational attainment.

• There is a direct linear relationship between income level and smoking behavior.  (less 
than $10k = 32%, over $50k = 13%)

• Thirty-six percent (36%) of the Medicaid eligible population are current smokers.

• Within the Hispanic Medicaid population, over half (54%) are smokers.

• Although national data suggests that African-Americans, Gay-Lesbian and some Asian 
populations have high smoking rates, little is known about these populations in Idaho.

THE FIVE ISSUE AREAS OF THE WORKPLAN

I. DATA SYSTEMS: 

Establishing a data plan that is targeted and focused, yet flexible enough to enable 
continued identification and monitoring.

"All things that count can't be counted, and not all things that canb counted, count" 
Albert Einstein
 

II. CULTURAL COMPETENCY: 

Assure cross-cultural competency among providers, funding sources, decision-maker and the 
populations served.

“Cultural competence is a set of congruent behaviors, attitudes, and policies that come 
together in a system, agency, or among professionals and enables this system, agency or 
those professionals to work effectively in cross-cultural situations.”  - Racial & Ethnic 
Disparities in Urban MCH

III. FUNDING AND RESOURCES: 

Securing external funds and resources to augment current state efforts, and expanding 
these efforts into implementing components identified in this planning process.

"While Talcott Parsons usggerst that form follows function, I suggest that with health 
care, form follows finances."  - Galen Louis

 
IV. COMMUNITY INFRASTRUCTURE: 

Building capacity and infrastructure through training and education of communities and 
providers.

"Never doubt that a small group of thoughtful and committed people can change the world. 
Indeed, it's the only thing that ever has!" – Margaret Meade


V. POLICY ADVOCACY: 

To build an expectation that includes the disparate and diverse populations

"Difficulty is the excuse history never accepts."  - Edward Morrow

 
Eliminating Disparities Workgroup Participant List

Shirley Alvarez		Shoshone-Bannock Tribes, Tribal Administration
Valerie Albert		Nezperce Tribal Health
Roberto Astorga		Region X Cancer Information Service, Latino Outreach Coordinator
James Aydelotte		Idaho Dept. of H&W, Research Supervisor for Health Statistics
Sam Byrd		Diversity Works, Inc., Executive Director
Karen Cross		Woman of Color Alliance, Black Student Alliance (BSU)
JamieLou Delavan	Public Education/Outreach Coordinator, Bureau of Health Promotion
Mari DeLeon		Council on Hispanic Education, Tobacco Coordinator
Joseph Finkbonner	NW Portland Area Indian Health Board, Epidemiology Director
Kathy Gardner		Coalition for Healthy Idaho, Smokeless States Program Coordinator
James Girvan		Boise State University, Dean of College of Health Sciences
Teresa Guthrie		American Indian/Alaska Native Leadership Initiative on Cancer
Josephine Halfhide	Idaho Dept. of H&W, Indian Child Welfare Act Coordinator
Lawrence Honena		Northwestern Band of Shoshone Nations, Chief Finance Officer
Sayaka Kanade		NW Portland Area Indian Health Board, Technical Writer/IRB  
Nicole LeFavour		Your Family, Friends and Neighbors, Executive Board Member
Galen Louis		Idaho Dept. of Health and Welfare, Disparate Populations Project Maggi Mann		Idaho Public Health Districts, Council on Health Promotion Liaison
Kristin McKie-Bergeson	Idaho Dept. of H&W, WIC Clinical Operations Coordinator
Linda Morton		Idaho Dept. of H&W, WIC Breast Feeding Promotion Coordinator
Jennifer Oatman	        Nezperce Tribe, Executive Council Member
Don Pena		Idaho Council on Hispanic Affairs, Executive Director
Laura Rowen		Idaho Department of Health and Welfare, Primary Care Program 
Al Sanchez		Idaho Hispanic Caucus, Executive Committee Member
Vivian Shields		Cancer Information Service for the Pacific Region, Program Mgr.
Kathy Simplot		BRFSS Coordinator, Bureau of Health Policy and Vital Statistics
Dieuwke Spencer		Central District Health Department, Office of Epidemiology
Sharon Stoeffel		Boise State University, Nursing Department
Randy C. Thompson	Chief Academic Officer, Idaho State Board of Education
Fanny Vidales		Idaho Commission on Hispanic Affairs, Outreach Reach Coordinator 
Diana Willis		Idaho Dept. of H&W, Prenatal Assessment Tracking System Manager
Becky Wilson-Simpson	Nezperce Tribe, Community Health Programs Director
Jean Woodward		Idaho Dept. of H&W, Asthma Program Manager