Local Tobacco Control Initiatives

CRF Tobacco Use Prevention and Cessation Programs

Introduction and Purpose

The Cigarette Restitution Fund (CRF), established as a result of a multi-state settlement with the tobacco industry in 1998, provides the funding for this program. The legislation (Maryland General Health Article 13-1001- through 13-1014) directs the Department of Health and Mental Hygiene (DHMH) to fund tobacco use prevention and cessation activities following the Best Practice recommendations from the Centers for Disease Control and Prevention​ and the Task Force Report to End Smoking in Maryland. 

The purpose of the Local Public Health Component is to maximize the effectiveness of tobacco use prevention and cessation initiatives in Maryland by authorizing Local Health Departments (LHDs) to develop programs in coordination with Community Health Coalitions and DHMH. Local Health Department Tobacco Prevention and Cessation Initiatives address the four goal areas of the CRF Tobacco Program: 1) Preventing the initiation of tobacco use among young people; 2) Promoting quitting among adults and young people; 3) Eliminating exposure to environmental tobacco smoke; and 4) Identifying and eliminating the disparities related to tobacco use and its effects among different population groups. 

The program elements that constitute the Local Public Health Component includes:

  • Community Initiatives
  • School-Based Initiatives
  • Tobacco Enforcement Initiatives
  • Cessation Initiatives
  • Administration

Community Health Coalitions

Each Local Health Officer must document the demographics of the county Community Health Coalition to ensure it reflects the diversity of the county. Health-General 13-1009 also recommends inclusion of local management boards, public school systems, hospitals, clinics, physicians, other health care providers, law enforcement, businesses, religious organizations, media, and institutions of higher learning. Representatives of community-based groups (including minority, rural, and medically underserved populations) and youth that are familiar with all communities and cultures in the county must be included.

Community Initiatives

The Community component strives to mobilize community actions through coalition participation, tobacco prevention education, marketing, grassroots and faith based campaigns to promote non-smoking norms, eliminate disparities associated with tobacco use, and to encourage policy interventions.  Local health departments with technical assistance from the state health department engage key stakeholders through local tobacco coalitions and community organizations.

Key Accomplishments – FY11 – FY15

·         6,192 advocates and community leaders were trained on smoking cessation programs and tobacco use prevention strategies.

·         94 faith-based organizations were funded to incorporate tobacco prevention and cessation messages into various programs.

·         110 minority organizations were funded by local health departments to conduct tobacco control activities in targeted communities. 

School-based Initiatives

The School-based component promotes tobacco use prevention education for youth Pre-K through 12th grade within the school environment. Local health departments engage in partnership with school systems to enhance youth awareness of the dangers of tobacco and nicotine use through instruction, peer support programs, parent involvement, and policy promotions.

Key Accomplishments – FY11 – FY15

·         4,544 teachers, nurses, daycare providers, and school administrators were trained on available tobacco use prevention and cessation curricula, programs and strategies.

·         13,318 Pre K students received multiple tobacco use prevention education sessions.

·         447,512 K-12 students received tobacco use prevention education sessions in school.

Tobacco Enforcement Initiatives

The Enforcement component ensures the public, youth and tobacco retailers are aware of and follow the tobacco sales laws that prohibit the sale of tobacco products to minors.  Utilizing youth under the age of 18, local health departments, designees and local law enforcement agencies conduct random and unannounced tobacco sale compliance checks to monitor store compliance with the law. Local community organizations engage and educate tobacco retailers with education campaigns, as well as increase community awareness and vigilance on the issue.

Key Accomplishments – FY11 – FY15

·          8,904 tobacco retailer (stores) compliance checks were conducted.

·         1,068 tobacco retailers (stores) were issued citations for sales to minors.


Cessation Initiatives/ Tobacco Cessation

The Cessation component promotes the cessation of tobacco products among adults and youth. Local health department programs offer behavior change cessation sessions individually or as a group, free nicotine replacement products, and ongoing assistance to quit tobacco use. 

Key Accomplishments – FY11 – FY15

·         41,297 adults participated in smoking cessation classes and counseling sessions in local programs.

·         2,544 pregnant women received smoking cessation counseling in local programs

Tobacco Enforcement Initiative to Support Synar Compliance

The Center for Tobacco Prevention and Control (CTPC) in the Prevention and Health Promotion Administration (PHPA), along with the Behavioral Health Administration (BHA) in Federal Fiscal Year 2015, launched a Tobacco Enforcement Initiative to Support Synar Compliance. This initiative was designed to address high rates of tobacco sales to Maryland youth (under the age of 18) identified by the Synar Retailer Violation rates in the Federal Fiscal Year (FFY14) Synar Report.  This initiative enforces existing tobacco sales laws and promotes responsible retailing at tobacco sales outlets.

The Tobacco Enforcement Initiative to Support Synar Compliance provided funding, training, staffing, and guidance to all 24 Local Health Departments (LHD) in an effort to enhance local enforcement, improve tobacco vendor education and engage leadership and communities to play a more active part in preventing youth access to tobacco products. Under this initiative local health departments fund police agencies to conduct routine compliance checks, incentivizing community partners to conduct retailer education programs, organize training programs for merchants and develop marketing campaigns to support better compliance with federal, state and local laws.

Local Tobacco Enforcement Accomplishments FY 15

·         3,798 tobacco retailer (stores) compliance checks were conducted.

·         545 tobacco retailer (stores) were issued citations for sales to minors.

·         3,899 in-person vendor education sessions were conducted by community partners and health department staff.


In Fiscal Year 2015, there were some parallel enforcement activities under the CRF Tobacco Grant.  In Fiscal Year 2016, all Tobacco Enforcement activities were consolidated under the Tobacco Enforcement Initiative to Support Synar Compliance.

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Prevention (CSAP) oversees implementation of the Synar Amendment, which requires states to have laws in place prohibiting the sale and distribution of tobacco products to persons under the age of 18 and to enforce those laws effectively. In Maryland, the BHA within the Department of Health and Mental Hygiene (DHMH) is responsible for SYNAR compliance. Maryland’s Synar retailer violation rate in FFY14 was 24.1% and increased to 31.9% in FFY15, which is well above the 20% non-compliance rate allowed by SAMSHA.​

As a result of the efforts of the Tobacco Enforcement Initiative to Support Synar Compliance, the Synar retailer violation rate decreased to 13.8% for FFY 16.


Minority and Community Outreach

The Center for Tobacco Prevention and Control works very close with the Office of Minority Health and Health Disparities to ensure that our messaging and programming are cultural and community sensitive.  We are a collaborative partner of their Minority Outreach and Technical Assistance (MOTA) Initiative that funds community organizations to champion public health issues in minority and low income communities across Maryland.  These organizations listed below have helped the Center’s Smoke-free Housing, Pregnancy and Tobacco Cessation Help (PATCH), and the Tobacco Enforcement to Support Synar Initiative. They have clearly been instrumental in the success of these campaigns because of their reputation in need communities, communication skills and passion for helping others.

Anne Arundel: Restoration Community Development Corporation

Baltimore County: St. Stephen's Office Management & Technology, Inc.

Caroline: Union Bethel AME

Charles: Lifestyles of Maryland Foundation, Inc.

Dorchester: Associated Black Charities

Frederick: Asian American Center

Harford: Inner County Outreach

Howard: Foreign Born Information and Referral Network

Kent: Mt. Olive AME

St. Mary's: Minority Outreach Coalition

Washington: Brother's Who Care, Inc.

Wicomico: St. James AME Zion Church​