Guide to community preventive services: state and local opportunities for tobacco use reduction.

For more than a decade now, the Institute of Medicine (IOM) has influenced state and local practitioners of public health by directing us to perform a set of core functions as we manage our agencies and serve our communities.1 Our first activity is to assess our community’s needs. We follow up on this effort by developing policies that address these concerns. Our final core function is to ensure that our policies are implemented through interventions that meet the objectives for which they were designed. While we have had several tools to perform the initial community assessment,2,3 we have lacked scientifically based guidance in developing sound and effective policies and interventions for the problems we collectively face. This lack of evidence has made our tasks that much more difficult, since elected public officials have increasingly asked us to “do more with fewer resources” and have held us accountable for achieving cost-effective results. Most recently, we have observed the value of “evidenced-based” practices in the field of clinical medicine4 and have incorporated many personal preventive services such as screening mammograms, into our public health activities. But we continue to need a similar approach that is uniquely suited to populationoriented, community-focused preventive services activities. The Guide to Community Preventive Services (the Community Guide)5 produced by the Task Force on Community Preventive Services (TFCPS) will serve this function and should be a tremendous help to those of us “in the trenches” of public health practice as we try to influence executive and legislative decision-makers to spend additional public dollars on effective public health practices. After reviewing the accompanying chapter of the Community Guide on interventions to reduce tobacco use and exposure to environmental tobacco smoke, I would like to describe its potential utility in the field. These observations are based on my nearly 25 years of service as both a local and state health officer in three counties and two states as well as 1 year in an academic setting developing a state plan for tobacco control utilizing dedicated funds from the $246 billion Master Settlement Agreement (MSA) recently signed collectively by the states’ attorneys general and the major tobacco companies. Tobacco-related illness causes more than 400,000 deaths annually in the United States6 and is clearly our nation’s (and the world’s) number one public health problem. Today, we direct some, but not sufficient, resources toward this problem. But, if we could demonstrate that certain strategies existed that were proven to reduce the use of tobacco, and therefore lower the burden of illness associated with this behavior, then perhaps additional resources might be provided. That money is currently available to state governments from the MSA. The Community Guide could serve that purpose and help us improve our efforts in combating this lethal product. The TFCPS guidelines have been developed through a systematic approach to the scientific literature: