Identifying best practices in adoption, implementation and enforcement of flavoured tobacco product restrictions and bans: lessons from experts.

OBJECTIVE: To identify recommended components for adopting, implementing and enforcing bans or restrictions targeting flavoured tobacco products. METHODS: Between April and June 2019, semistructured interviews were conducted with 17 high-level experts across the USA and Canada with expertise in flavoured tobacco product policies. Participants included health department staff, researchers, legal professionals and local government officials. Interviews were recorded, transcribed and analysed for key themes. RESULTS: Major findings were organised into four categories: programme planning and legislative preparations; education and community outreach; implementation and enforcement; and policy impact. Critical pre-implementation elements included using comprehensive policy language, identifying enforcement agents, examining potential economic costs, deploying media campaigns and engaging community partners and retailers. Recommended implementation processes included a 6-month preparation timeline, focus on retailer education and clearly outlined enforcement procedures, particularly for concept flavours. CONCLUSIONS: Flavoured tobacco policies have successfully limited sales, withstood legal challenges and become more comprehensive over time, providing useful lessons to inform ongoing and future legislative and programmatic efforts. Identifying and sharing best practices can improve passage, implementation, efficacy and evaluation of flavoured tobacco policies.

The Healthy Hawai'i Strategic Plan 2030: A Roadmap for Preventing and Managing Chronic Disease and Envisioning a Healthy and Equitable Future.

In June 2021, over 200 stakeholders, advocates, and visionaries gathered to launch the Healthy Hawai'i Strategic Plan 2030 (HHSP), a 10-year strategic plan for improving the health of Hawai'i residents by preventing and reducing chronic disease and advancing health equity. The HHSP is a guide to enable coordination across common risk factors, program areas, interventions, and strategies for chronic disease prevention and control. Developed during the COVID-19 pandemic, which revealed major areas of susceptibility in our health system infrastructure and magnified existing disparities, the HHSP prioritizes health equity and strives to create sustainable change to transform communities, schools, health care and worksites to support the health of the people of Hawai'i. The HHSP is a living document and partners - present and future - are invited to work together to achieve a healthier future for the people of Hawai'i.

The Healthy Hawai'i Initiative: insights from two decades of building a culture of health in a multicultural state.

BACKGROUND: The Healthy Hawai'i Initiative was created in 2000 with tobacco settlement funds as a theory-based statewide effort to promote health-supporting environments through systems and policy change. Still active today, it is imbedded explicitly in a multi-sectoral, social ecological approach, effectively striving to build a culture of health before this was the name for such an ambitious effort. METHODS: From interviews with key informants, we analyze two decades of the Healthy Hawai'i Initiative (HHI) in the context of the Robert Wood Johnson Foundation (RWJF) Culture of Health Action Framework (CHAF). We list HHI accomplishments and examine how the Initiative achieved notable policy and environmental changes supportive of population health. RESULTS: The Healthy Hawai'i Initiative started with an elaborate concept-mapping process that resulted in a common vision about making "the healthy choice the easiest choice." Early on, the Initiative recognized that making health a shared value beyond the initial stakeholders required coalition and capacity building across a broad range of governmental and nonprofit actors. HHI coalitions were designed to promote grassroots mobilization and to link community leaders across sectors, and at their height, included over 500 members across all main islands of the state. Coalitions were particularly important for mobilizing rural communities. Additionally, the Initiative emphasized accessibility to public health data, published research, and evaluation reports, which strengthened the engagement to meet the shared vision and goals between diverse sector partners and HHI. Over the past two decades, HHI has capitalized on relationship building, data sharing, and storytelling to encourage a shared value of health among lawmakers, efforts which are believed to have led to the development of health policy champions. All of these factors combined, which centered on developing health as a shared value, have been fundamental to the success of the other three action areas of the CHAF over time. CONCLUSIONS: This evidence can provide critical insights for other communities at earlier stages of implementing broad, diverse, multifaceted system change and fills a key evidence gap around building a culture of health from a mature program in a notably multicultural state.

Insights in Public Health: Formative Factors for a Statewide Tobacco Control Advocacy Infrastructure: Insights from Hawai'i.

Hawai'i has comprehensive statewide tobacco control policies and was the first US state to raise the minimum age of sale, purchase, and possession of tobacco products to age 21 ("Tobacco 21") in a policy including not just cigarettes, but also electronic smoking devices and other tobacco products. This insights article provides strategic thinking about tobacco control advocacy planning. Specifically, we identify formative factors critical to building and sustaining our cross-sector, statewide advocacy infrastructure that has been able to address many ongoing challenges of tobacco-use prevention and control over time. This can provide new insights for other large-scale tobacco-control advocacy efforts.

The Childhood Obesity Prevention Task Force (ACT 269): recommendations for obesity prevention in Hawai'i.

Obesity in both adults and children is a critical issue in Hawai'i, as well as nationally and internationally. Today in Hawai'i, 57 percent of adults are overweight or obese as are almost 1 in 3 children entering kindergarten. Each year, obesity costs Hawai'i more than $470 million in medical expenditures alone.(1) These staggering human and economic costs underscore the serious need for Hawai'i to address obesity now. Due to the urgent need to reverse the current trends in obesity Senate Bill 2778 was signed into law, on July 6, 2012, as Act 269 by Governor Neil Abercrombie, creating The Childhood Obesity Prevention Task Force. The task force was charged with developing policy recommendations and proposed legislation for the 2013 legislature. The task force ultimately identified eleven recommendations for the 2013 legislative session and one recommendation for the 2014 legislative session. When implemented together, these recommendations could profoundly reshape Hawai'i's school, work, community, and health care environments, making healthier lifestyles obtainable for all Hawai'i residents.

Building school health programs through public health initiatives: the first three years of the Healthy Hawaii Initiative partnership for school health.

BACKGROUND: The Healthy Hawaii Initiative, funded through the Hawaii tobacco settlement, allocates funds from the Hawaii Department of Health to the Hawaii Department of Education for school programs that promote health and reduce the burden of chronic disease. This article outlines progress, challenges, and insights from the first 3 years of the Hawaii Partnership for Standards-based School Health Education (the Partnership). CONTEXT: The Hawaii Department of Education added health education as a content area to the Hawaii Content and Performance Standards in 1999. The American Cancer Society, Hawaii Pacific, Inc., convened a Comprehensive School Health Education Committee that initiated a school health professional development program for teachers. During the 2000-2001 academic year, new Healthy Hawaii Initiative funding began for school health programs. METHODS: Healthy Hawaii Initiative (HHI) funding has been used to provide new state and district resource teacher positions, professional development workshops for educators, tuition waivers and materials for graduate-level summer institutes for educators, annual statewide school health conferences, and pilot school implementation of coordinated school health programs. CONSEQUENCES: Schools across Hawaii demonstrate clear progress in implementing standards-based school health education and coordinated school health programs. The funding has led to increased support from other sources to build school health programs. INTERPRETATION: The ultimate beneficiaries of school health programs are the children and families of Hawaii. This health and education partnership continues to work toward improved health outcomes for young people as the future leaders and citizens of Hawaii.