Obstacles and drivers of the sustainability of anti-tobacco programs in the United States

A study has identified the barriers and enablers to the sustainability of tobacco control programs. Budgetary uncertainties, staff shortages, and variable partner involvement are identified as the main obstacles to these programs. The context of the Covid-19 pandemic has also highlighted the fragility of health priorities. Planning, evaluating, and adapting programs can, on the contrary, improve their sustainability.

Tobacco control programs often need to be extended over several years before they can bear fruit. The continuation of these programs is, therefore, an essential condition for their effectiveness.

To assess factors that may promote or hinder the sustainability of tobacco control programs, researchers at Washington University in St. Louis, Missouri, conducted a qualitative study for the Centers for Disease Control and Prevention (CDC).[1]. Local stakeholders in the tobacco control programs (PACT, Plans, Actions and Capacity to Sustain Tobacco Control) deployed in different states of the country had benefited from training and technical assistance. The study is based on the analysis of interviews between these local stakeholders and the correspondents providing them with this technical assistance. The eleven tobacco control programs evaluated were deployed at the state level between 2018 and 2022.

Political and financial uncertainty, the main obstacle to anti-smoking programs

Low political buy-in and legislative uncertainties, with their direct financial consequences, are perceived as the main obstacles to the sustainability of tobacco control programs. Staff shortages, staff turnover, and recruitment difficulties stem from the insufficient resources devoted to these programs. The Covid-19 pandemic has also led to a shift in health policy priorities and significantly delayed the rollout of tobacco control programs, even though smoking remains a major health issue. The variability in the level of partner commitment also undermines the stability of tobacco control programs.

Conversely, strategic planning, program evaluation, and adaptation to local contexts are among the factors that facilitate their continuity. Benefiting from technical assistance and participating in preparatory workshops, in particular, promote the design of effective planning. The sustained involvement of partners significantly contributes to the success of these programs. It depends on the quality of established relationships and the reciprocal nature of exchanges with these partners. For both partners and the public, the consistency, transparency, and frequency of these programs are essential communication elements to generate greater support.

The role of continued political engagement

Although not representative, this study sheds light on current practices. The obstacles and drivers identified by the authors are not entirely new, but are clearly identified here in terms of program sustainability. They confirm that, as with other public health issues, the fight against tobacco is highly dependent on the political will that drives it and determines the financial and human resources devoted to it. Finally, the study highlights that networking and the provision of technical assistance also contribute to the success of anti-smoking programs.

Keywords: anti-tobacco programs, sustainability, evaluation, technical assistance

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[1] Han K, Gannon J, Moreland-Russell S. Barriers and Facilitators to Program Sustainability Among State Tobacco Control Programs. Prev Chronic Dis 2024;21:230211. DOI: http://dx.doi.org/10.5888/pcd21.230211

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