Thinking beyond the silos: emerging priorities in workforce development for state and local government public health agencies.

CONTEXT: Discipline-specific workforce development initiatives have been a focus in recent years. This is due, in part, to competency-based training standards and funding sources that reinforce programmatic silos within state and local health departments. OBJECTIVE: National leadership groups representing the specific disciplines within public health were asked to look beyond their discipline-specific priorities and collectively assess the priorities, needs, and characteristics of the governmental public health workforce. DESIGN: The challenges and opportunities facing the public health workforce and crosscutting priority training needs of the public health workforce as a whole were evaluated. Key informant interviews were conducted with 31 representatives from public health member organizations and federal agencies. Interviews were coded and analyzed for major themes. Next, 10 content briefs were created on the basis of priority areas within workforce development. Finally, an in-person priority setting meeting was held to identify top workforce development needs and priorities across all disciplines within public health. PARTICIPANTS: Representatives from 31 of 37 invited public health organizations participated, including representatives from discipline-specific member organizations, from national organizations and from federal agencies. RESULTS: Systems thinking, communicating persuasively, change management, information and analytics, problem solving, and working with diverse populations were the major crosscutting areas prioritized. CONCLUSIONS: Decades of categorical funding created a highly specialized and knowledgeable workforce that lacks many of the foundational skills now most in demand. The balance between core and specialty training should be reconsidered.

Predictors of change on the smoking uptake continuum among adolescents.

CONTEXT: Understanding how advertising and other risk and demographic factors affect adolescent susceptibility to smoking would allow for the development of more effective youth-targeted tobacco prevention and cessation programs and policies. OBJECTIVE: To examine the effect of various demographic and risk factors on different stages of smoking among adolescents. DESIGN: A nationally representative cross-sectional survey, The Robert Wood Johnson Foundation's Survey of Tobacco Price Sensitivity, Behavior, and Attitudes Among Teenagers and Young Adults. SUBJECTS: The Robert Wood Johnson Foundation's Survey of Tobacco Price Sensitivity, Behavior, and Attitudes Among Teenagers and Young Adults included 17,287 adolescent respondents (aged, 13-19 years) in 1996. MAIN OUTCOME MEASURES: Stage of susceptibility and correlates of progression toward regular smoking. RESULTS: Of all never [corrected] smoking adolescents, 32% were susceptible smokers (have never smoked, but might) with younger adolescents almost 3 times more likely than older adolescents to be susceptible. Female subjects were 50% [corrected] more likely than male subjects to be susceptible. In addition to exposure to others' smoking, owning or willingness to own tobacco promotional items, having a favorite cigarette advertisement, skipping school, poor school performance, and lack of attendance in religious activities were associated with progression along the uptake continuum. CONCLUSIONS: Improved understanding of the tobacco use trajectories of adolescents and the risk factors associated with progression will help clinicians and tobacco control advocates create effective youth-targeted interventions and policies. Findings suggest that physicians and other health care providers should redouble their efforts to ask preadolescents and young adults about smoking or the likelihood of their smoking. Nonsmokers should also be advised about the addictive nature of tobacco products and the resulting loss of control that accompanies addiction.

Adolescents' acquisition of cigarettes through noncommercial sources.

PURPOSE: To examine the association between demographic and smoking behavior variables and the likelihood of acquiring cigarettes through noncommercial sources. The Robert Wood Johnson Foundation's 1996 National Study of Tobacco Price Sensitivity, Behavior, and Attitudes among Teenagers and Young Adults was the data source in this analysis. Respondents were high school students (grades 9 through 12) ages 13 to 19 years. The sample sizes, respondent selection procedures, and weighting procedures were designed to develop national estimates of adolescent smoking behaviors and attitudes. The questionnaire, modeled on previous surveys and input from leading tobacco control experts, was self-administered. Logistic regression was used to model the independent effects of each variable on the outcome while controlling for the influence of all other variables in the model. An inverse relationship was found between age and the likelihood of acquiring cigarettes through noncommercial sources. Females were 58% more likely to acquire cigarettes through noncommercial sources than were males. There were no differences among adolescents of different racial/ethnic groups in acquisition through noncommercial sources. Those who believed that cigarettes were difficult to acquire were more likely to obtain cigarettes by noncommercial means. Although point-of-sale restrictions have been a focal point of tobacco control legislation, these data suggest that younger smokers and those who view commercial purchase to be difficult are not using commercial sources. Therefore, more comprehensive approaches to limiting access may be required to address all sources of adolescents' acquisition. The proliferation of point-of-sale restrictions may have contributed to increases in noncommercial acquisition by creating the impression that cigarettes were more difficult to purchase. This reinforces the need for educational programs, interventions, and policies that more effectively target noncommercial sources of cigarettes.

Changes in adolescent cigarette-brand preference, 1989 to 1996.

OBJECTIVE: To understand changes in cigarette-brand choice by adolescents in the context of demographic differences and advertising. METHODS: Data from 3 nationally representative cross-sectional surveys of adolescents were analyzed. RESULTS: Marlboro, Camel, and Newport brand cigarettes accounted for over 80% of the cigarettes usually bought by adolescents in 1989, 1993, and 1996. Between 1989 and 1996, Marlboro and Camel market shares changed little, whereas preference for Newport doubled among white and Hispanic adolescents. CONCLUSIONS: Brand preference among adolescents has been steadily concentrated among 3 brands. More attention may need to be focused on mentholated brands given the increase in Newport's market share.

Tobacco use and cessation behavior among adolescents participating in organized sports.

OBJECTIVES: To examine the difference in tobacco use between adolescents who participate in organized sports and those who do not. METHODS: Using a cross-sectional study design, this study uses data from a nationally representative sample of adolescents enrolled in public high schools in the United States. RESULTS: Those participating in organized sports were 25% less likely to be current cigarette smokers. However, smokeless tobacco use was found to be associated with participation in organized sports. CONCLUSIONS: Given the large proportion of students involved in organized sports, intervening through this venue to address tobacco use has the potential to reach significant numbers of adolescents.

External community review committee: a new strategy for engaging community stakeholders in research funding decisions.

BACKGROUND: Major gaps exist between what we know and what we do in clinical practice and community health programs and narrowing this gap will require substantive partnerships between academic researchers and the communities they serve. OBJECTIVES: We describe a research pilot award program that makes a unique commitment to community engagement through the addition of an External Community Review Committee to the typical research review process that gives external stakeholders decision-making power over research funding. METHODS: Whereas engaging community reviewers in discussion and rating of research proposals is not novel, the ICTR ECRC review process is distinct in that it is subsequent to peer review and uses different criteria and methodology. This method of engagement allows for the community review panel to re-rank scientifically meritorious proposals-such that proposals funded do not necessarily follow the rank order from scientific peer review. The approach taken by UW ICTR differs from those discussed in the literature that present a model of community-academic co-review. RESULTS: This article provides guidance for others interested in this model of community engagement and reviews insights gained during the evolution of this strategy; including how we addressed conflict, how the committee was able to change the pilot award program over time, and individual roles that were crucial to the success of this approach. CONCLUSIONS: The advantages of this approach include success through traditional academic metrics while achieving an innovative shared-power mechanism for community engagement which we believe is critical for narrowing the gap between knowledge and practice.

The association among adolescents' tobacco use, their beliefs and attitudes, and friends' and parents' opinions of smoking.

OBJECTIVE: To examine adolescents' attitudes toward smoking, the presence of a false consensus effect, and the influence of peer and parental attitudes about smoking choices on being a susceptible, never smoker; an experimenter; and a current smoker. METHODS: Data from The Robert Wood Johnson Foundation's 1996 National Study of Tobacco Price Sensitivity, Behavior, and Attitudes Among Teenagers and Young Adults (RWJF survey) were used to produce national estimates of the tobacco use behaviors and attitudes of adolescents enrolled in high school. Three logistic regression models were estimated to examine which psychosocial variables were associated with three different stages of smoking uptake. RESULTS: Positive attitudes toward tobacco use were associated with a greater likelihood of being a susceptible, never smoker (OR = 1.50), an experimenter (OR = 1.27), and a current smoker (OR = 2.96). Those respondents who believed that 50% or more of all adolescents smoked were more likely to be current smokers (OR = 1.45). The importance of the opinions of one's friends and parents about his/her choice to smoke was also found to be associated with smoking behavior. CONCLUSIONS: Preventing the initiation and continuation of smoking among adolescents will require interventions that address individual attitudes with respect to tobacco and will also need to present a clear picture of adolescent smoking. In addition, prevention and intervention messages should emphasize the importance of parental opinions on youth tobacco use regardless of parental tobacco use behavior.

Association of point-of-purchase tobacco advertising and promotions with choice of usual brand among teenage smokers.

The objective is to determine the relationship between brand-specific advertising and promotions in convenience stores for Marlboro and Camel cigarettes and choice of usual brand among school students. A cross-sectional survey was designed that merged records of store tobacco advertising and promotions. The survey was administered to 3,890 U.S. high school smokers with a usual brand, matched to 196 convenience stores. Choice of Marlboro as a usual brand was associated with presence of a Marlboro gift with purchase (p <.001) and a greater brand share of interior (p = .05) and exterior (p = .05) advertising voice for Marlboro. Choice of Camel as a usual brand was associated with a greater share of interior advertising voice for Camel (p <.001) but was unrelated to a Camel gift with purchase promotions (p > .05) and negatively associated with a greater share of exterior advertising voice for Camel (p < .001). The results are consistent with the notion that Marlboro-specific advertising and promotions may influence choice of Marlboro as a usual brand to smoke among teens, but resultsfor Camel are mixed and inconclusive. Further research is required to confirm and extend these findings.