The Role of Tobacco Surveillance to obtain Policy, Systems, and Environmental Changes
Authors: Chung Alina , Coleman Anne-Marie , OLUWAYOMI FABAYO , Lloyd Kayla , Bicego Emma 
Published: May 2017

ObjectiveTo analyze tobacco use in Georgia to influence policy, systemsand environmental changes as tools to reduce its burden on healthoutcomesIntroductionTobacco use is the leading cause of preventable illness and deathsin Georgia. About 10.1% of deaths among adults in Georgia arelinked to smoking related illnesses. Most first use of cigarettes occursby age 18 (87%), with nearly all-first use by 26 years of age (98%).Although cigarette smoking has declined significantly since 1964,very large disparities in tobacco use remain across different sub-groups of the population. Multiple environmental, psychological, andsocial factors have been associated with tobacco use, including raceand ethnicity, age, SES, educational accomplishment, gender, andsexual orientation. These factors within the social environment havea huge influence on motivation to begin and to continue using tobaccoproducts for not just the individual but also certain community groupwithin the population. Established in 2000, Georgia Tobacco UsePrevention Program (GTUPP) is a program designed to meet theoverall goal of reducing the health and economic burden associatedwith tobacco use for all members of the community. By working withvarious partners, GTUPP plans, implements and evaluates policy,systems, and environmental changes designed to reduce tobacco-related illnesses and deaths. Best practice strategies focus on thefollowing goals: preventing the initiation of tobacco use amongyoung people; promoting quitting among young people and adults(e.g. Georgia Tobacco Quit Line (GTQL); eliminating exposureto secondhand tobacco smoke; and identifying and eliminating thedisparities related to tobacco use among various population groups.MethodsThe following data collection tools were used to educatecommunity members, local coalition groups and policy decisionmakers on the burden of tobacco use in Georgia: Youth TobaccoSurvey (YTS), Youth Risk Behavioral Survey (YRBS) and BehavioralRisk Factor Surveillance System (BRFSS). These tools allows publichealth professionals to create messaging needed to reach differentstakeholders. The following are examples of key data points thatwere used to influence policy, systems, and environmental change:27,000 of middle school students and 79,000 of high school currentlyuse tobacco (cigarettes, smokeless tobacco or cigars). Approximately32,400 of middle school students and 72,900 of high school studentssay they have tried smoking electronic cigarettes (e-cigarettes).Smoking prevalence among adult males 740,000 is significantlyhigher than among females 510,000, and the overall smokingprevalence is highest among adults’ ages 25-34 years 292,000.ResultsCurrently, the following policies have been adopted as a resultof using surveillance to educate policy decision makers and multi-sector groups in the community at large: 116 school district are100% tobacco free, 28 parks and recreation are 100% tobacco/smokefree, 46 colleges/universities are tobacco free, 6 cities in Georgiahave a comprehensive smoke free air law, 65 multi-unit housing(private/public) are smoke free, and 132 hospitals are tobacco free.Between June 2015 and July 2016, over 15,000 Georgia tobaccousers used the GTQL services to make a quit attempt, and healthcareproviders through a systems change referral approach referred 13%of the users to the GTQL.ConclusionsWorking with schools (K-12), parks, colleges/universities,hospitals, worksites, and municipalities to adopt tobacco freepolicies and promote cessation services provides an opportunityfor all members of the community to be tobacco free. As tobaccouse is associated with chronic diseases it is imperative to engageall members of the community in tobacco free living. Removingavoidable structural and social barriers and equally implementingtobacco use prevention programs and policies is essential.