Q: As part of our Disparities Supplement grant from CDC-OSH in 2005, Ohio created an entity called the Ohio Cross-Cultural Tobacco Control Alliance and a statewide network that we wish to also create for other identified underserved communities. We would like to know how far other states have gone in the evolution of their coalitions/networks or alliances started with the CDC-OSH disparities supplemental funding. The Ohio CCTCA is trying to determine the best operating structure, meaning non-profit/stand alone versus continuous connection to the state. We want to get a sense from other Disparities Supplement grant recipients on the following: 

1. Was a formal coalition/network or alliance developed based upon the CDC-OSH disparities supplemental grant?  If so, what is the operating status of the coalition/network or alliance -- do they operate within the state health department system, are they a separate 501c3, or is another operating structure used?
2. What were the pros/cons/benefits/challenges of the operating structure used for the coalition/network or alliance?

A:

1. Alabama: A formal coalition was formed of internal and external partners.  The coalition operates within the state health department system. The challenges with the operating structure used for the coalition is getting all the members actively involved in the process.  Some members feel that the sole responsibility of the plan rests with health department. The benefit of the operating structure is that the health department can utilize existing funds allocated to disparities to do the tasks within the plan.
    
2. Iowa: Iowa has established tobacco control priority population networks and there is a statewide multicultural health advisory council, but these are not supported with CDC disparities funding.
    
   Background: Beginning July 1, 2008, Iowa Dept. of Public Health, Division of Tobacco Use Prevention and Control implemented three-year contracts with community-based organizations, faith-based organizations, public health agencies or other non-profit agencies with experience providing services which promote the health and well-being of the following populations:  African American, Native American, Asian American, Hispanic/Latino, and LGBT people.  Five Priority Population Networks were implemented to increase the level of community competency and capacity to ensure achievement of culturally and linguistically appropriate, evidence-based interventions to reduce the disproportionate toll of tobacco use in these priority populations in Iowa.  Each network will service the identified priority population throughout the State of Iowa.  This project is not funded with CDC-OSH disparities supplemental funding.
    
   The three-year project period for Priority Population Network will be divided into two phases:

• Phase 1 will be Capacity Building phase and shall be completed by the successful applicant during the first year of the project.  Capacity building shall include formation of an advisory coalition, assessment of the impacts of tobacco use within the specified priority population, and the development of a two-year strategic plan to reduce the identified impacts of tobacco use.
   
• Assessment:  During the first year of the project, the successful applicant will complete an assessment of the impact of tobacco use on the health and economic well-being of the specified priority population.  This assessment shall include information from all communities of the priority population wherever they are located throughout the state.
   
• Advisory Coalition:  During the first year of the project, the successful applicant will establish a coalition composed of members of the specified priority population, including youth members, and representatives of organizations serving the priority population to act as an advisory body involved in all aspects of strategic plan development and implementation.
   
• Strategic Plan:  During the first year of the project, the successful applicant will develop a Two-Year Strategic Plan for Fiscal Years 2010 through 2011 to reduce the impact of tobacco use on the health and well-being of the specified population to be served.
   
• Action plans that will be submitted in future years of the project will detail activities that will achieve objectives identified in the developed and submitted two-year strategic plan that will be developed during year one. The Annual Action Plan format will be provided by IDPH, Division of Tobacco Use Prevention and Control. 

• Phase 2 will be the Implementation phase and shall involve implementation of the two-year strategic plan during year two and three of the project period.  For project years two and three, an annual action plan will be implemented according to the developed two-year strategic plan.  Amendments to the plan shall occur as necessary for successful completion of the project.
   
  The Iowa Dept. of Public Health is developing a Multicultural Advisory committee.  It had its first meeting in February 2009.  This Committee has two objectives:
   
  1. To foster an active, influential and statewide climate of support for IDPH Office of Multicultural Health and its constituents.  This would include advocating for statewide policies and practices that support the mission and vision of the Office of Multicultural Health.  The first strategy was the establishment of the Multicultural Advisory Committee
      
     1. Once the advisory committee is established – a local Office of Multicultural Health coalition will be established in each of the six local public health regions.
         
  2. To institutionalize “continuous cultural competency” in the provision of health care and in the education of health care providers throughout the state.
      
     1. A goal is to establish Standards of Best Practices on continuous cultural competency for health care providers and for health care educators.
         
  The Priority Population Networks will be apprised of the meetings and coalitions of the Multicultural Advisory Committee, once this committee is established.  It is hoped that coalition members from the PPN and the Multicultural Advisory Committee can communicate and share what they learn about ascertaining cultural competency in public and health care organizations. The five PPN are currently assessing cultural competency in the tobacco control programs sponsored by the state.  Three of our networks have approached or have PP Commission members on their coalition. Because the PP Networks are in their planning phase of the grant, they have used their coalition members to direct which topics should be assessed in their community assessments and will be involved in the strategic planning for the next two years.
   
  501c3 structure: The Iowa Dept. of Public Health, Division of Tobacco Use Prevention and Control is not using CDC-OSH disparities supplemental grant money.  We did develop formal statewide networks.  The PPN contractors are 501c3 organizations.
   
  Benefits/challenges to 501c3 operating structure:  This is the operating structure we use in other tobacco control contracts; two of our PPN grantees were contracted in the past for CDC funded Priority Population tobacco grants – they were familiar with the fiscal structure of our contract process.  A challenge is the scope of our grant, which is development of a statewide network servicing the specified populations.

3. Michigan: Michigan is currently providing funding to 12 communities of color contracts.  Those contracts can be distinguished by (1) agencies that work with populations disparately impacted by tobacco use and second hand smoke (pregnant and post partum women, day care centers, LGBTQ for example...) and (2) ethnic populations disparately impacted by tobacco use and second hand smoke.  The latter group works together to form the Michigan Multicultural Tobacco Prevention Network (MCN).
   
   To address the questions specifically:
    
   1. Although the Michigan Multicultural Tobacco Prevention Network (MCN) has elected a Chair, Vice Chair and Secretary, and has established By-Laws, members opted not to establish themselves as a 501(c)(3) organization.  With the support of the Sate Department, providing technical assistance and some guidance, they essentially function as their own body.  The MCN is comprised of representation from each of the five major ethnic groups here in Michigan.  This includes six organizations serving these populations which include:  Asian American, African American, Chaldean and Arab American, Native American and Hispanic/Latino American.   This network aims to promote awareness about the risks of tobacco use and its impact on people of color.   Their mission can be summarized as follows:  to educate, promote and advocate involvement in tobacco prevention and related issues, collectively addressing ethnic and culturally competent perspectives.  There have been discussions about becoming their own non-profit in order to increase autonomy, funding as a network, and impact /  benefits to these communities across the State.
       
   2. To say this group works very well together is an understatement.  They work interdependently with each other and find ways to use both their differences as well as their similarities as their strengths.   The agencies are all currently funded to conduct tobacco program related activities.  Hence they all have separate initiatives (workplan modules), in addition to functioning as a Network.    The greatest problem for this group is a lack of time (as they plan and work on different projects together) and a need for more funding.  The group has most discussed organizing an additional "MCN community group" in order to bring together other like minded organizations who may also be doing similar work, in order to increase the impact that can be made on the community, while learning from each other.
       
4. Utah: In FY05 Utah began funding four community based organizations that represent the Latino, African American, Pacific Islander, and American Indian communities in Utah. Over the last 5 years, these four community based organizations have built an infrastructure that has evolved to become the Tobacco Control Ethnic Networks (Harambee, Utah Latino Network, Networking to Keep Tobacco Sacred in Utah, Pacific Islander Ethnic Network) under the direction of the state health department's Tobacco Prevention and Control program (TPCP).
    
   The Ethnic Networks each consist of an active steering committee that meets on a regular basis as well as youth groups. The design of the Ethnic Networks in Utah is to provide cultural competency to all TPCP programs and efforts to ensure that all Utahns are reached. In fact, the Ethnic Networks were originally chosen for their capacity to mobilize and organize their communities. The Ethnic Networks also act as a resource to all TPCP partners and contractors. The Ethnic Networks have continued to mobilize communities, act as a resource to all partners, and provide expertise in cultural competency but are expanding to also focus on policy change and making their measures more sustainable.  The Ethnic Networks are useful to a comprehensive tobacco control program. It has taken years for the Ethnic Networks to mold into what they are today.
    
   One of the challenges that we are currently facing stems from the change in emerging priority populations. We are considering expanding our Ethnic Networks to become Tobacco Control Networks which would include any population group that is disparately affected by tobacco and not just ethnic and minority populations. Another challenge that we face is how to continue and sustain the efforts of the Ethnic Networks when their funding cycle is over and we have to go out on competitive re-bid. One of the benefits that I have seen in the last couple of months is how the Ethnic Networks have helped create an atmosphere of integration within our Bureau of Health Promotion at the state level as they address in their communities, the affects tobacco has on multiple health issues including chronic conditions.
    
   Utah’s Ethnic Networks are funded through the DOH. It helps in having more control of the Network if funded through the DOH in setting standard protocol and guidelines. It also helps the Network take a little more responsibility because they have to report to someone and are under another agency’s jurisdiction. Funding the network through a DOH also gives the DOH more ownership to expand the Network responsibilities to more than one program, etc.
    
   See Utah’s Strategic Plan.
    
5. West Virginia: West Virginia, having small populations of all disparities and little (if any) data to support these grants, has pretty much incorporated addressing these at-risk populations in all programs, especially in our Cessation Program efforts. We do not anticipate forming a specific coalition/network or alliance for disparities, but maintain representation in all of our advisory committees.

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