# Presentation: 369699

## A New Resource for Heart Disease and Stroke Prevention Activities in Colorado 

- Dale Rogoff Greer, RN, MPH, CPHQ
- Program Manager
- Heart Disease Stroke Prevention Program
- Diabetes Prevention and Control Program
- September 19, 2007

## Tobacco History in Colorado

- Effort to increase tobacco tax failed in 1994
- Tobacco Prevention Program created by State Bill 00-71 in 2000, funded with some of the monies received from the Master Settlement Agreement.  The rest of money went into the State General Fund.
- A group of key stakeholders formed to propose a constitutional amendment to increase tobacco tax in Colorado and devote the monies to specific health initiatives.

## People’s Initiative 2004

- Grassroots effort by Cancer Research Center and its partners, the American Heart Association, the Colorado Prevention Center, National Jewish and other interested parties.
- No one from the State Health Department worked on the campaign during their work hours.
- Significant change in public response as compared to the 1994 attempt to increase tobacco tax.

## Constitutional amendment passed by Colorado voters in November 2004
Raised the excise tax to $.84 cents per pack of cigarettes (national average) and doubled the tax on other tobacco products
Generates ~$180 million per year for health-related purposes, as specified in the amendment
Requires a “declared fiscal emergency” by the General Assembly and Governor to change the allocations

**Constitutional amendment** passed by Colorado voters in November 2004
- Raised the excise tax to $.84 cents per pack of cigarettes (national average) and doubled the tax on other tobacco products
- Generates ~$180 million per year for health-related purposes, as specified in the amendment
- Requires a “declared fiscal emergency” by the General Assembly and Governor to change the allocations

## Amendment 35 – The Tobacco Tax

- CDPHE receives
- 16% dedicated to tobacco prevention and control (~$26 M/year)
- 16% dedicated to Cancer, Cardiovascular Disease and Pulmonary Disease (~$26 M/year)

## Enabling Legislation

- HB05-1262 signed into law in May 2005
- Establishes an appointed Review Committee to make grant recommendations and establish priorities
- Mandates that funded programs must be consistent with State Strategic Plans
- Explicitly prohibits lobbying

## Tobacco Taxes for Health-Related Purposes Major Components of HB 05-1262

**16%**
**Cancer, CVD, CPD**
**Prevention, Early Detection & Treatment Fund**

**3%**
**Infant Immunization Fund**
**Supplemental OAP Health & Medical Care Fund **
**Local Governments**

**46%**
**Health Care Expansion Fund, including reinstatement of Medicaid for legal immigrants**

**19%**
**Primary Care Fund**

**16%**
**Tobacco Education Prevention & Cessation Program**

**Breast and Cervical**
** ****Cancer Expansion**
**Not to exceed $5M**
**With $1.2 M to Medicaid **
**for treatment**

**Health Disparities****15% of total amount**

**Competitive Grants **
**funded with **
**remaining funds**

**Health Care Policy **
**& Financing****$2M ending FY 06-07**
**For disease **
**management**

**A majority of the monies shall prevent & reduce tobacco use among youth & youth adults**
** ****Up to 15% of the monies annually awarded shall be to grantees of the Tony Grampsas Youth Services program**

**At least 15% must be awarded to help eliminate tobacco-related health disparities**

## Health Disparities Program

- Funded with 15% of the early detection, prevention and treatment fund
- Goal is to reduce health disparities in cancer, cardiovascular disease and pulmonary disease
- Minority Health Advisory Commission (13 members) recommends funding awards
- 18 grants totaling $1,333,669 have been awarded

## Breast and Cervical Cancer Screening Program

- To increase the number of low income women screened through:
- Offering additional slots at existing provider sites
- Recruiting new providers in underserved areas
- Performing an analysis of reimbursement rates to align with medical community
- Innovative outreach efforts, such as “211” help line

## Tobacco Prevention

- At least 15% dedicated to reducing tobacco-related disparities
- Up to 15% for youth tobacco prevention and cessation
- Majority of funds must be for evidence-based programs to serve youth and young adults

## Cancer, Cardiovascular Disease and Pulmonary Disease Program

- Focused on prevention, early detection and treatment
- Designates 10% of funds awarded to rural areas and to each disease area
- Establishes a 16 member Review Committee and designates representation
- Evaluation of the effectiveness of the program is required
- The State Board of Health approves the recommendations for funding made by the Review Committee .

## Legislative Requirements

- Providing appropriate diagnosis and treatment for anyone with abnormalities found in screening and early detection
- Implementing education programs for the public and healthcare providers
- Providing evidence based strategies to overcome health disparities
- Grants for rural areas are forwarded to the Department of Local Affairs for input** **

## Key Components

- To assist in the implementation of the state strategic plans regarding cancer, cardiovascular disease, and pulmonary disease
- To fund *competitive* grants that will provide a comprehensive approach to decreasing cancer, cardiovascular disease and chronic pulmonary disease through prevention, early detection, and treatment
- To fund *evidence-based* education and intervention strategies (not research oriented)
- To administer the program with the goal of developing a comprehensive approach that will bring together stakeholders at the community and state level

## Review Committee

- Responsible for overseeing program strategies and ensuring compliance with the legislation
- The President of the Senate and Speaker of the House each appoint one member
- The Director of CDPHE appoints three staff members representing cancer, cardiovascular disease, and pulmonary disease
- The Executive Director of CDPHE or designee is a member
- The State Board of Health appoints 9 members

## Competitive Grants Program Criteria

- Grant applications must address at least one of the following:
- Translate evidence-based strategies regarding the prevention and early detection of cancer, cardiovascular disease, and chronic pulmonary disease into practical application in healthcare, workplace, and community settings.
- Provide appropriate diagnosis and treatment services for  abnormalities discovered in screening and early detection programs.
- Implement public and provider education programs regarding prevention, early detection and treatment.
- Provide evidence-based strategies to overcome health disparities in cancer, cardiovascular disease, and pulmonary disease.

## Building a Comprehensive Program for Colorado

- Grant applications
- Technical assistance and training
- Fiscal guidelines and policies
- Public information and media plans
- Prior approval is required before placement
- Evaluation of the overall program

## Building a Comprehensive Program for Colorado

- Quarterly and annual progress reports
- Fiscal audits
- Program budgets: carry forward is not allowed
- Program monitoring
- Scope of work
- Budget

## Diversity of Applicants 

**Applications RECEIVED**
**by CCPD program **
**Fiscal Years 2005-2008**

## Diversity of Applications Funded 

**Applications FUNDED**
**by CCPD program **
**Fiscal Years 2005-2008**** **

**Diversity of Applications Funded**

## Grant Award Summary

- Four funding cycles in two years
- Grants by disease area:
- 	     	Cardiovascular Disease		40%
- 	 	Cancer				36%
- 		Pulmonary				24%
- 		Rural Counties			30%

## Summary continued

- Grants by funding cycle:
- 	December 2005			$8.6 M
- 	April 2006				$4.4 M
- 	September 2006			$4.5 M
- 	April 2007				$2.9 M
- 	Total				$20.6 M

## Summary continued

**Continuation Awards for multi-year grants**
- 	FY 2006-07				$ 8.4  M
- 	FY 2007-08				$16.9 M
- 	Total amount				$ 25.3M
- 	Continuation and New
- 	Awards total				$ 45.9 M

## Geographic Range

- Rural
- Front Range
- Denver Metro
- Western Slope
- Eastern Plains

## For more information

- www.cdphe.state.co.us/pp/ccpd