1102: National Public Health Week Day 3: Community Leadership

John Sheehan (0:01): This is Public Health Review Morning Edition for Wednesday, 04/08/2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials. Today is day three of National Public Health Week. We'll be talking about community leadership and specifically tobacco control with Josh Barry, Director of Chronic Disease Risk Factors at ASTHO. Josh will explain how state and territorial programs partner with trusted on the ground community organizations to reach at risk populations and how these connections build credibility and deliver results where they matter most.

John Sheehan (0:34): He'll also discuss the shifting federal landscape now that CDC's Office on Smoking and Health has been eliminated, what it means for funding, and programs across the country that are being forced to adapt while maintaining core services like quit lines, surveillance, and policy engagement. Josh Berry, welcome to the show.

Josh Berry (0:53): Good to be on with you. Thanks for having me.

John Sheehan (0:54): So, Josh, what does community engagement look like for tobacco control efforts?

Josh Berry (1:00): Yeah. I mean, that's gonna vary pretty substantially across different states and territories. But the one commonality that we've seen is that deliberate partnerships with community based organizations with, good on the ground knowledge is essential. And, fortunately, state and territorial programs are, very good at that. And in fact, working with community organizations has long been a funding requirement in exchange for being part of the CDC Office on Smoking and Health's National Tobacco Control Program cooperative agreement.

Josh Berry (1:34): And so, that has resulted in some really productive and fruitful long standing partnerships between the state and territorial tobacco control programs and various community organizations that they're working with. And so even in today's uncertain environment, there's a long standing history of collaboration and, shared goals and values that encourage that strong, working relationship. And so I think that has been key to ensure that, specific at risk communities are being effectively reached by those state and territorial programs.

John Sheehan (2:05): Yeah. And that makes some sense. Having effective community groups that that are already made up of the members you're trying to reach, that goes a long way towards building credibility.

Josh Berry (2:16): Definitely.

John Sheehan (2:18): What are some challenges that jurisdictions are facing, especially given the recent elimination of the office of smoking and health?

Josh Berry (2:27): Yeah. There have been a lot of challenges, and I I can think of three main ones to bring up. First is the lack of certainty around funding as states have long been accustomed to receiving, direct funding support from CDC to support, the very basic essentials of their tobacco control program, staff and activities, as well as state based quit lines even with, other tobacco based revenues available, like, for example, from, settlement agreements or from, tobacco products taxes. They've still been accustomed to that CDC funding. So ensuring that that CDC funding remains in place and is accessible to states and territories is really important, and we want to see that continue as it has been since the elimination of the Office on Smoking and Health.

Josh Berry (3:14): So that's been very fortunate. Secondly, the Office on Smoking and Health or what we call OSH, has long served as a convener, of expertise on really important areas of technical assistance need for the state and territorial programs, including program implementation, evidence informed policy, the science around emerging products, and many others. And so this lack of readily available expertise has been an adjustment for state and territorial programs, and that's where we at ASTRO along with other partners, and colleagues in the field have taken deliberate steps to try to meet that need for technical assistance and fill that gap left by the elimination of OASH. And then the third thing I would point to is uncertainty around surveillance because CDC has long had an important role in fielding and analyzing numerous, surveys that are nationally representative that have state based data and breakouts as well, particularly around the prevalence of who is using different products, particularly emerging nicotine containing products. And so that lack of information potentially being available in a timely fashion is definitely a big loss for, tobacco control programs around the country.

John Sheehan (4:27): You know, it seems like there's almost never any replacement for effective funding. That said, now that there is less, and as we've sort of and as you've said that there's this environment of uncertainty, are there strategies for for working to continue efforts absent this, you know, dependable funding?

Josh Berry (4:51): Yeah. It's, again, no one size fits all approach. And in fact, what we've seen is that, some states are having to do more with less, and so that means there have been reductions in staff, and there has been reductions in the the reach of their programming. And I think it's it's all about, identifying, the top priorities and identifying perhaps new funding streams within the budget. Because, again, all states take in, tobacco based revenues from multiple different arenas, but it's all too easy for, those revenues to, support not only other important public health priorities, but priorities that are entirely outside the realm of public health.

Josh Berry (5:34): State budgets are hurting all over the place, and so it it's definitely about prioritizing and identifying, funding streams to the extent possible to keep the train running as as best as one can.

John Sheehan (5:45): Yeah. With that in mind, what would you say are, you know, state level or local agency must haves? Like, what are what has to be in place in order to keep these programs going?

Josh Berry (5:58): If I had to stick with two top things, it would be ensuring that there is funding support for the existing program staff and the existing program initiatives like the state quit line, and also making sure that the state and territory can stay engaged in the policy space. The first is obviously necessary to maintain a successful comprehensive program, which we know is an important evidence based strategy to reduce tobacco use in a state or territory. And the policy piece is so important because so many of the gold standard evidence based strategies and interventions that we have in tobacco control are policies. So, like, for example, do you have a really robust pricing policy on cigarettes, through taxation, for example? Are there pricing policies in place for ecigarettes and other emerging nicotine containing products?

Josh Berry (6:48): Are there comprehensive, smoke free and aerosol free air laws that are protecting all residents of a state? Is there any restriction to the sale of flavored products? There are so many options in the policy arena, so, staying engaged in that area is definitely an opportunity for state and territorial programs.

John Sheehan (7:07): Yeah. And what has ASTHO been doing to change its approach to enabling resources or reaching out to state and local agencies?

Josh Berry (7:16): Yeah. The the changes the elimination of OSH has been a paradigm shift for the whole field, and that includes us at ASTHO because our, CDC funding for our own tobacco control support that we provide to the states and territories was cut soon after, OSH was eliminated, last spring. And so that that has changed how we work with our state and territorial members and our partners in the tobacco control field in two key ways. First, we had to identify new funding streams to prevent, an interruption to the services that we provide, to state and territorial tobacco control programs. And so we're very grateful that we have new contributions from Campaign for Tobacco from Kids and the CDC Foundation that has prevented that elimination of services, and we're also in the process of rolling out a state membership dues model to see if that can be a long term viable way to continue a lack of interruption of the services that that we are providing to our state and territorial members.

Josh Berry (8:13): And then secondly, we've definitely been collaborating more intentionally with other national level partners to identify what we've lost with the elimination of Osh, what are the opportunities that we have as partners in the field to provide some of that assistance that has been lost as a result. And so I've been very fortunate to personally be involved in a lot of different recurring webinars that have been, made available to the state and territorial programs, a lot of recurring strategy calls with different partners to understand, what the best opportunities, are available to us to be a value add to the field all in service to state and territorial programs. So it's definitely been a shift, but one that we have been prepared to be able to address, and I think that we've done a a really strong job at continuing to be a value add to our membership programs.

John Sheehan (9:04): So, Josh, it strikes me as wild that we're seeing less tobacco control messaging now, because it was such a big part of certainly my growing up in the past few decades. Like, it was nonsmoke anti smoking messaging was definitely a big deal. Is there a concern, more broadly that by taking our foot off the gas here that we're gonna be sort of inviting back a a kind of a big public health problem?

Josh Berry (9:31): I think it's definitely a concern, and I think what we fight against in the tobacco control field pretty constantly is a feeling of complacency of, oh, we've made so much great progress as a field. Oh, the the prevalence of combustible the use of combustible products and cigarettes and cigars and the like, those are all way down. So it it's essentially mission accomplished at this point. And what we in the field would say to that is definitely not for two main reasons. In in my view, first, that tobacco use remains the number one preventable cause of disease and death in this country.

Josh Berry (10:05): And so, until that is no longer the the the case by a significant margin, I think continued investments are in in tobacco control are worthwhile in terms of, saving lives, preventing disease and death, saving money. All of those things are worthwhile. And secondly, it remains a really dynamic field because, again, we're up against an industry that is constantly looking to innovate, to introduce new products to market, to continue to, make sales. And so I think continuing the push for research and surveillance and practice and communications and messaging, all the things that a comprehensive state and territorial program do, all of those things are really important to make sure that we're continuing to meet the moment and continuing to help prevent additional death and disease from tobacco products in the future.

John Sheehan (10:59): Josh Berry is director of chronic disease risk factors at ASTHO. Pull up a chair and join ASTHO for a fireside chat with a subject matter expert in radiation readiness communications, Jessica Weider. In this webinar titled Past, Present, and Reflections from a Radiation Readiness Professional, Jessica will share reflections on her career and insights from her experience in radiological preparedness and emergency communications. This webinar will include discussions around key considerations for effective radiological risk communication from a public health preparedness perspective, including coordinating messages across partners and addressing public concern and false and misleading information. Find a link to the webinar in the show notes.

John Sheehan (11:44): ASTHO Newsletter subscription options feature updates, analysis, resources, and events on pressing issues in state and territorial public health. Subscribe to receive legislative alerts, news releases, public health weekly, events, and FIG connections. Find the link to subscribe in the show notes. This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.