Goal / Mission

Asian Pacific Partners for Empowerment, Advocacy, and Leadership (APPEAL) sought to develop a model to provide a framework for Asian American (AA) and Native Hawaiian/Pacific Islander (NH/PI) communities to engage in policy change. This model allows for communities to address four different levels of policy change to make an impact.

Description:

Policy change is recognized for underlying much of the success of tobacco control. Asian Pacific Partners for Empowerment, Advocacy, and Leadership (APPEAL) worked to develop and implement policy change for Asian American and Native Hawaiian and Pacific Islander (AA and NH/PI) communities. This model was developed to provide a framework for AA and NH/PI communities to engage in policy change. APPEAL developed a 4-prong policy change model to help communities that accounts for varying levels of readiness and leadership capacity. The model targets four different levels of policy change (community, mainstream institution, legislative, and corporate).

Community-level policy change refers to policy change (broadly defined) primarily within local communities (for APPEAL this often includes AA and NH/PIs) and other priority populations. This includes voluntary policy initiatives and activities such as developing smoke-free policies in multiunit housing, at community events, and through community organizations. For example, APPEAL partnered with its affiliates to promote tobacco-free community events that also rejected tobacco industry- sponsorship.

Mainstream tobacco control organizations have not always incorporated tobacco disparity issues for AAs and NH/PIs and other priority populations in their efforts. Disparities have widened between those who are engaged and benefit from tobacco control and policy change and those who are still marginalized. On the mainstream institutional level, policy change includes leading parity efforts to ensure that priority populations have access to tobacco control resources and are included in the mainstream tobacco control movement. The disproportionate negative health outcomes borne by communities of color today can be easily exacerbated if policies and decisions continue to be made without real commitment to diversity, inclusivity and a vision for parity. APPEAL’s experience on this level includes facilitating the convening of key meetings with leadership of CDC and other agencies to advance parity issues (e.g. meetings between the National Network Consortium on Tobacco, CDC, FDA and Truth Initiative).

Legislative policy change can involve the policy-making process leading to laws. APPEAL has provided technical assistance and training to communities on advocating for policy change with policy makers like state legislators, mayors, and governors and educating policymakers about the impact of tobacco on the health of AAs and NH/PIs. One example includes the collaboration between APPEAL and Families in Good Health (FIGH) on a community based participatory research project exploring environmental influences of tobacco use among AA, NH, and PI youth. The involvement of youth in this study led to  them sharing the results on their community to legislators in Long Beach, CA.

The corporate level may be the hardest level to work on when it comes to tobacco control because the tobacco industry has rarely been a willing partner in effective tobacco control efforts. On the corporate level, APPEAL and/or its affiliates have led campaigns to hold the tobacco industry accountable for marketing campaigns such as the Virginia Slims campaign, which targeted women and girls from communities of color and the Kauai Kolada campaign, which used traditional Native Hawaiian images to market their products. Developing relationships and trust with multi-sector partners takes time and APPEAL’s investment in developing trust is shown by longstanding relationships with its partners.

The 4-Prong Policy Change Model framework for tobacco control policy engagement can be used for health promotion. It allows for improving understanding of effective pathways to policy change, promoting innovative methods for policy analysis, and translating them into effective implementation and sustainability of policy initiatives. The APPEAL strategic framework can be used by and further transcend into other communities and health topics that ultimately may contribute to the elimination of health disparities.

Implementation Process

Assess all four levels of change: community level, institutional level, legislative level, and corporate level

1. Decide where organization would like to target current policy needs
2. Use framework as a guide and reach out to APPEAL for technical assistance and training or webinar content
3. APPEAL will help walk organizations through levels of change
4. Identify policy champions
5. Create policies for implementation with community input and organizational buy in from administration leadership down to ground level participants

Impact / Results / Accomplishments / Outcomes

APPEAL’s strategic framework for policy change identifies the components and tools for communities to engage in policy change. Challenges for AA and NH/PI communities include racial/ethnic and geographic diversity and the availability and access to tobacco data that accurately represents the communities. Through understanding the policy-making process demonstrated by the 4-prong policy change model, communities may more effectively determine their level of engagement. The APPEAL strategic framework can transcend into other communities and health topics. Use of the model can help contribute to the elimination of health disparities.

APPEAL’s framework for policy change has greatly impacted policy each level. The following are examples of successful implementation of policy change:

Community Level

For example, the Chinese Progressive Association in San Francisco launched a focused, culturally tailored initiative to create smoke-free policies in single residency occupancy apartment buildings where mostly low-income, and often elderly, Chinese immigrants lived. Also, a community may work on community policy changes such as refusal of tobacco industry sponsorship or organizational policies to provide incentives for employees who want to quit smoking. For example, the Pacific Island Festival Association board eliminated tobacco industry sponsorship from their events in San Diego.

These community policies, which may be considered voluntary and may not provide as strong and lasting a policy as those that are legislatively mandated, may still provide a more appropriate entre into policy change particularly for immigrant communities who respond to authority differently than mainstream. Within some U.S.-associated Pacific Islands, communities may still be led and influenced by traditional leaders and may include village chiefs and elders and traditional healers. Although it may not have the Western legal impact that legislative policy has, it can greatly influence the community’s social norm regarding tobacco. For example, in 2012 the Palau Council of Chiefs signed a declaration calling for the ban of tobacco products.

Mainstream Institution Level

On the mainstream institutional level, APPEAL has led parity efforts to ensure that priority populations have access to tobacco control resources and are included in the tobacco control movement. These efforts led to the development of the independent multicultural Task Force on Advancing Parity and Leadership for Priority Populations (now known as the Parity Alliance) and the adoption of the theme of parity at the 2002 National Conference on Tobacco or Health. On the state and local levels, many AA and NHPI communities and other priority populations have worked to advance parity with mainstream tobacco control and health institutions. For example, in Washington State, the Asian Pacific Islander Coalition Against Tobacco and the Center for MultiCultural Health worked with the Washington Department of Health to advocate for providing resources to build capacity of priority populations on tobacco, resulting in a series of cross-cultural leadership institutes on tobacco. Another example of mainstream institution-level change is in Minnesota through the efforts of the LAAMPP, which trains about 30 fellows from five different priority populations. After the success of the LAAMPP, LAAMPP Fellows were given two slots to have an active role on the statewide tobacco control advisory boards working on policy change.

Legislative Level

One example includes the collaboration between APPEAL and Families in Good Health on the previously mentioned community-based participatory research project exploring environmental influences of AA and NH/PI youth tobacco use. The involvement of youth in this study led to them sharing the results on their community to legislators in Long Beach. Although this was only one part of a much larger advocacy campaign, the Long Beach City Council passed a bill requiring licensure of tobacco retail outlets. By being actively engaged in this policy change initiative, the AA and NHPI youth involved in this process could see that their efforts to assess community needs and using these tools to advocate for better tobacco control legislative measures could result in policy change.

Another example of APPEAL’s involvement in policy change is the capacity building and technical assistance provided to Guam’s tobacco control partners, particularly those involving Chamorro and other Pacific Islander communities. Again, this was only a part of a larger advocacy effort, but eventually, Guam passed Bill 150, which increased their tobacco tax to $3 per pack of cigarettes, now making their tobacco tax one of the highest in the United States. The lesson from APPEAL’s work was the importance of building community capacity over time to engage in policy change that could eventually result in substantive measures.

Corporate Level

The corporate level may be the hardest level to work on when it comes to tobacco control because the tobacco industry has rarely been a willing partner in effective tobacco control efforts. Specifically for the AA and NH/PI communities, an analysis of internal tobacco industry documents demonstrated that targeted marketing campaigns existed for AA and NHPI communities, including Philip Morris’ strategic marketing approaches called “Push,” “Pull,” and “Corporate Goodwill” (Muggli, Pollay, Lew, & Joseph, 2002). For example, the “Push” strategy recognized the high numbers of Asian retailers and their role in promoting tobacco products.

The Master Settlement Agreement in 1998 between the tobacco industry and 46 State Attorneys General is an example of a corporate-level policy change. Although the overall impact of the Master Settlement Agreement is debatable (with many states diverting funds away from tobacco control), it did result in the creation of the American Legacy Foundation, which developed the highly acclaimed Truth Campaign ads targeting youth.

Although partnering with the tobacco industry on tobacco control is not feasible or effective, APPEAL and affiliates have led campaigns using media advocacy to hold the tobacco industry accountable for marketing campaigns such as the Virginia Slims campaign, which targeted women and girls from communities of color

Lessons Learned

The success of the APPEAL Policy Model can be applied and adapted through the following lessons learned:

• AA and NH/PI communities may require different pathways to be engaged intobacco control policy change given historical and cultural challenges.
• Engaging in voluntary policy or community policy provides entry into policy change for those new to policy and can directly impact AA and NH/PI community norm change. This can lead to the ultimate goal of legislative level of policy change.
• Conducting community readiness levels may better prepare the appropriate level of technical assistance provided to effectively engage communities in policy change.
• Capacity building, and particularly leadership development, is key for communities of color to engage in policy change.

About this Promising Practice (Contact information)

1. Organization(s): University of California, Davis, Sacramento, CA, USA; Asian Pacific Partnership for Empowerment, Advocacy and Leadership, Oakland, CA, USA; The Centers for Disease Control and Prevention; ClearWay Minnesota; TheAmerican Cancer Society; National Cancer Institute Center to Reduce Cancer Health Disparities; National Institutes of Health Fogarty International Center
2. Primary Contact(s): Rod Lew – APPEAL staff
3. Authors: Elisa K. Tong, MD, MA and Rod Lew, MPH
4. Topic(s): Asians/Asian Americans, Native Hawaiian/Pacific Islanders, minority health, tobacco prevention and control, program planning and evaluation, public health law/policies, policy change, priority populations, health equity
5. Source: APPEAL Website – appealforhealth.org; NIH Public Access Article – Moving Communities Towards Policy Change: APPEAL’s 4-Prong Policy Change Model
6. Date of Publication: September 2013
7. Date of Implementation:
8. Location: Oakland, CA
9. More details (web address for study): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280858/ and https://appealforhealth.org/about/action/appeal-policy-change-model/
10. Target Audience: Community Based Organizations, State and National Level Policy Makers, Researchers, Policy Advocates