Monthly Archives: January 2012

Funding Cut for Washington State Tobacco Program that Saved $5 per $1 Spent

In the December 2011 edition of the American Journal of Public Health a 10 year study of Washington state’s comprehensive tobacco control intervention found that for $1 spent by the state, they saved $5 in hospitalization and treatment costs. Wonderful! What an incredible investment! 5:1 return!

Here is a graph illustrating when their program went into effect and the decline in % Adults who smoke in Washington state (compared to the national rate).
Washington Smoking Trends

The program consisted of indoor smoking bans, tax increases on tobacco products, media campaigns, a tobacco quit line, and community and school programs, among other components. This state-based program was meant to serve as a model for other states. Well, it looks like they did a great job. In terms of public health programs and cost savings of $1:$5 is excellent. So what happened? Washington Governor Christine Gregoire and the state legislature cut nearly all the programs funding for fiscal year 2012. Wait, What?!

Why would you de-fund a state program that is saving the state millions of dollars? Instead of writing in a little spending on tobacco control, they are essentially writing in five times the spending in state health care costs. The only explanation I can think of is that the state is so hard up for cash in the short-term that they are willing to kick those unfettered health costs down the road (and basically allowing for increased human suffering over the coming years). And/Or, given the current attitudes towards decreasing the roles of government, it may be that some folks view government-run tobacco control as outside the appropriate scope of government. Since tobacco does cost governments so much money in terms of care, it seems to me that they do and should have the authority to control the impact that tobacco has on the monetary bottom line. The health protection aspect is another story, one that gets at the heart of the arguments about the role of government.

Clearly, there is a lot of work that needs to be done in terms of high-quality research that demonstrates the cost-savings and health-savings afforded by public health programs like tobacco control programs. There is also work that must be done to frame the issue as one that governments should and very much need to be involved in.

Public Health and Environmental Advocacy Groups: YOU NEED CITATIONS!

Citation Needed!This post is for everyone, but is aimed at public health and environmental advocacy organizations. First, I want to say that what you do is crucial to the success of individuals, communities and societies as a whole. I commend your hard work (most of it).

However, you often shoot yourself in the foot by failing to provide adequate citations and references in websites, flyers, radio and TV ads, PSAs, etc. Citations are often missing entirely, are incomplete, or only cite one of your own documents which is also missing the reference. This makes it impossible to find the article and will result in emails like this:

“Hello, I would like to know the facts behind your webpage regarding air pollution monitoring. Who is doing the monitoring? How regularly? What are the results and what standard is used? Does your group provide factual information or just distorted hype? Please have the fortitude to respond to simple factual inquiries. I have inquired multiple times without response.”

Painful, but he has a point. If you cannot provide the reference for a scientific study, you should not be using a specific number. For example, You can’t say that a certain law saved 100,000 lives unless there was some study or formulation done that came to that conclusion. Do not make claims that go beyond the scope of the research. Similarly, saying that a certain law or program would prevent “many” deaths, is a weak argument and is unlikely to garner support from funding agencies or politicians.

Failing to provide references and citations for actual scientific research that supports your arguments completely undermines an individual’s or organization’s ability to advocate for change.

The knee-jerk response to my point is often “Who cares, you can make statistics say anything you want.” That is true, to some extent, but that does not mean you should stop citing or conducting research. Providing a citation and reference enables someone from the outside your organization, outside the research, to examine the methods used to gather the data, look at the results, and see whether or not those methods and the claims that follow are appropriate.

This may remind you of high school science classes when you had to use at least 2 citations for a 3 page paper. However, the entire health and environmental advocacy field has shifting towards this standard, which it should! The way governments and organizations spend their money is being scrutinized at a higher level. That means that advocacy organizations need to step up their game in order to maintain relevance, earn respect from the public and public officials, as well as provide the most good for the most people using the least amount of money. Being more steadfast about basing advocacy work/products/literature on scientific research and using citations will not only improve your work, but will also preclude naysayers from claiming that environmental groups are radical zealots making unfounded claims. Like it or not, advocacy, especially in today’s world, requires some scientific prowess and familiarity with research methodologies.

If you, or your organization is uncomfortable with all of this, please, don’t avoid that discomfort. Instead embrace it as a new way for your organization to achieve it’s mission. Depending on your staff’s education, it may only mean that they need to be reminded to provide citations whenever possible. Or, it could mean that your organization needs to look at hiring individuals with a different skill set.

I know, it may be painful. Science and research are scary things to some people. Yet, they are some of the most powerful tools we have as health and environmental advocates. Good research is good advocacy. Good advocacy is based on good research.

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As a side note, unfortunately, many scientific articles are not available for free. However, many are! You just need to look. Open-access journals are out there. For example: Environmental Health. Also, many government websites provide their articles for free. Most other articles are available through college and university library systems. Institutions of higher learning spend millions of dollars annually to give their faculty and students access to the largest and latest research databases. HINT: Maintain staff or interns that are currently enrolled.
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If you have no idea what I am talking about, here is an example:

In your text:
“Research has shown that air pollution levels are higher in metropolitan areas (Dockery et al., 1993).”

At the bottom of your document/website
References
Krewski, D., Burnett, R., Jerrett, M., Pope, C.A., Rainham, D., Calle, E., Thurston, G., Thun, M. (2005) Mortality and long-term exposure to ambient air pollution: ongoing analyses based on the American Cancer Society cohort. Journal of Toxicology and Environmental Health, 68, 13-14.

For most purposes, don’t worry about the different citation styles, or having everything formatted perfectly. That would be great, but you must provide at least enough information for someone else who wants to find the article.
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A couple recommended links:

http://owl.english.purdue.edu/owl/resource/560/3/

Google Scholar