The project paired local tobacco advocates with activists from primarily developing countries, organized and implemented an educational exchange between these groups, and then supported joint actions between these global to address the tobacco industry’s influence both here and abroad. The intervention activities undertaken by the Global Action Task Force were divided into three major areas:

• Coordination/collaboration
• Community education and
• Training and technical assistance.
• Coordination/collaboration activity

Tobacco-Free Project health educators participated in a number of coordination and collaborations efforts with national and international tobacco control advocates.

In August 2006, the City and County of San Francisco joined Essential Action and other national groups in filing an Amicus Brief in support of the Department of Justice RICO case regarding potential international related remedies that could be applied. Staff provided technical assistance for this activity. TFP staff also served on a committee of the Framework Convention Alliance for Tobacco Control that drafted documents for the first Conference of the Parties of the FCTC, which took place in 2006. Finally, Tobacco-Free Project staff also worked with the Center for Policy Analysis on Trade and Health to ensure public health representation on U.S. Industry Trade Advisory Committees that advise the United States Trade Representative’s Office.

Several abstracts were submitted to World Conference on Tobacco Or Health (WCTOH) by the Tobacco-Free Project and its funded projects. One of the abstracts was accepted as a poster board session at the WCTOH and was presented by Queers Mobilizing Against Tobacco in San Francisco and MOVIHL from Chile, one of eight global partnerships. The poster board described the Global Action Task Force, the Intercambio, and the joint projects undertaken by these global partnerships.

With support from Tobacco-Free Project staff, the Tobacco-Free Coalition again formed a Global Action Task Force (a subset of Tobacco-Free Coalition members) to build on their tobacco control efforts nationally and internationally. GATF members included representatives from the community capacity building projects, the Chair of the Tobacco-Free Coalition, and other interested TFC members. During formulation of the 2003-2007 Plan, the Tobacco-Free Coalition elected to continues its international work by again sponsoring an Intercambio or educational exchange between local tobacco advocates and tobacco activists from abroad. Once the Plan was finalized, it was the GATF, with support from Tobacco-Free Project staff, that began taking on the coordination and collaboration necessary to plan and carry out an Intercambio in 2006 in Washington, DC. While any Coalition member interested in participating in the global partnering project was encouraged to do so, members were also advised that funding for buddy projects to attend the World Conference on Tobacco or Health (where the educational exchange was to be held) was available only to projects funded by the Tobacco-Free Project. A survey of interested Coalition members revealed that ten organizations were interested in forming global partnerships.

The GATF has sponsored three Intercambios—the first in 2000, the second in 2002, and the third in 2006. Initially the Tobacco-Free Project arranged the majority of partnerships between local projects and their international buddies. However in 2000, Essential Action in Washington DC started its own Global Action Partnerships Program and for the 2002 and 2006 Intercambios their Global Partnerships Program took on an increasing amount of the coordination involved in forming San Francisco’s global partnerships. Essential Action worked closely with Tobacco-Free Project staff to work on a number of Intercambio-related issues, e.g., logistics, scholarships for the WCTOH, travel plans, etc., and attended the Intercambio which took place directly before the start of the WCTOH.

Training and Technical Assistance

Tobacco-Free Project staff provided 7.5 hours of training and/or technical assistance related to this objective a number of occasions over the three year period.

Training Advocates

In May 2005, project staff trained both staff and advocates from community-capacity building projects that received Prop. 99 funds in how to implement the Community Action Model (CAM). Three provider training sessions were provided to orient the newly funded project coordinators and their advocates to tobacco control. The trainings took place on April 26, June 4 and June 22. The first training included sessions on tobacco and global issues for project coordinators. The second training addressed these issues in depth for project coordinators and their advocates. A total of 2 hours of training were provided by Tobacco-Free Project health educators. Training topics included: TNT targeting of women, youth and people of color and low income people, the impact of TNT on farmworkers and the environment, the links between the TNT and the structures and agreements of the corporate led global economy, the FCTC, examples of past GATF activities and buddy relationships and naming the issue – a group building activity whereby advocates analyze underlying social and economic factors leading to the devastation caused by TNT’s and search for solutions.

In November 2005 Tobacco-Free Project staff provided a one-hour power point presentation of the history and current state of the FCTC to funded providers. The presentation included the background on negotiations, the elements of the treaty, the status of country signing and ratification’s and the next steps. Providers were able to view a list of countries that had ratified the treaty with an eye to potential joint actions that could address treaty elements.

Training Public Health Students

In April 2006, Tobacco-Free Project health educators provided a two-hour workshop for masters level students at the University of California San Francisco Nursing Program. Training topics included global TNT issues, the global economy, updates, FCTC, ways that local groups can integrate TNT issues into ongoing work, partnership projects, and other issues. Several months later in June 2006 Tobacco-Free Project staff provided a 1.5 hour training for BA level students on these issues, and the Community Action Model for community-based tobacco control policy and integration of local and global work. Both workshops were well received and post workshop feedback was excellent indicating the students found the trainers to be knowledgeable and informative.

Finally Tobacco-Free Project health educators provided a one-hour presentation to students in a health class at San Francisco State University. The presentation also focused on tobacco control and public health, globalization and tobacco subsidiary food products.

Community Education Activities

The majority of activities related to this objective fall under the heading of community education activities and included:

• developing partnerships between locally funded tobacco projects and tobacco projects in the developing world,
• designing and implementing an educational exchange or Intercambio for these advocates to meet one another, share resources and develop joint projects designed to further the work of both projects, and
• providing support to these global partnerships in their efforts to complete their joint projects.

Developing Partnerships 

As described earlier, working with Essential Action’s Global Partnerships Project, Tobacco-Free funded projects were matched with organizations in the developing world that were working on, or wanted to start working on tobacco-related issues.

A total of 10 partnerships were initially developed.

 Prior to the intercambio a sign-up sheet/survey form was distributed to all funded projects with a timeline for them to complete with their advocates. The purpose of the form was to assess the interest of the SF-based funded groups regarding a partner abroad (looking at language, geographic and focus area of interest). Once completed, these surveys were sent to Global Partnerships for Tobacco Control in Washington DC. Staff at GPTC then matched the SF groups with potential partners

from abroad. TFP staff sent these recommendations to SF groups for discussion and for them to choose a partner. Materials were provided to these partnerships that described the project goals and requirements and included timelines, letters of introduction, and links to websites to assist partners in applying for scholarships to the WCTOH. Ten San Francisco groups elected to be matched with a global partner.

Prior to the Intercambio, a second survey was developed by the Tobacco-Free Project and completed by both members of each global partnership as a way to collect information about each other, assist partners in getting to know one another better, and begin to discuss potential joint actions. A complete description of the survey and its findings was submitted to the Tobacco Control Section as part of a progress report, however highlights included:

• All the projects were familiar with the FCTC and most countries involved in the global partnerships had ratified the treaty.
• There was a wide range of responses about the tobacco controls laws already in place. Nigeria has the fewest laws but it has ratified the FCTC. On the other hand, Uruguay (like the United States) had enacted extensive national smokefree public laws and in Uruguay’s case even adopted graphic warning labels requirements but neither country had yet ratified the Framework Convention on Tobacco Control.
• EDUCA is an organization in Oaxaca Mexico that utilizes population education strategies to work with indigenous communities for social justice. They reported that Mexico was the second largest Latin American country that produces tobacco and that there are government agencies for tobacco control policy development but implementation does not exist in the practical sense.

 Also in preparation for the July 2006 Intercambio, Tobacco-Free Project staff developed an English/Spanish game board for partners to email to each other. SF partners were then asked to complete an enlarged version of the board with materials and information collected from both partners. These were sent to the Intercambio location in Washington DC.

Materials Provided to Buddy Projects Prior to the Intercambio

• Global Partnerships for Tobacco Control Sign up sheet (Essential Action)
• Letter of introduction to partners abroad
• Description of the Global Action Task Force (Tobacco-Free Coalition)
• Letters of invitation from the SFTFP for buddies to take to the US consulate in their home countries for visa application
• Important Dates for Buddy Projects in the WCTOH/Intercambio Education Exchange
• Survey tools in English and Spanish for both partners to complete that provide an orientation of the tobacco control work and of conditions in their home countries
• Ongoing correspondence containing important dates

In addition to the materials provided to the participating international organizations, Tobacco-Free Project staff arranged hotels rooms, helped with flight arrangements and WCTOH registrations, ensured that the advocates received stipends, and a million other tasks required to ensure a smooth trip for advocates from these organizations.

The Educational Exchange (Intercambio) in Washington DC 

The educational exchange or Intercambio took place on July 12 in Washington DC, the day before the start of the World Conference on Tobacco or Health, also taking place in Washington DC. Twenty-five people representing nine countries attended the Intercambio including youth advocates, representatives of partner organizations, Global Partnership staff. and other partners. These included representatives from India, Columbia, Korea, Nigeria, Hong Kong, Uruguay, Chile and Uganda.

The agenda for the Intercambio included a brief description of prior educational exchanges (this was the third Intercambio hosted by the GATF), a discussion of the Framework Convention on Tobacco Control, an ice breaker designed to help the partners meet and get to know one another face to face, and finally each partnership presented to the group a description of the joint projects each had agreed to pursue over the next 5 months.

Unfortunately the representative from the project in Mexico (EDUCA) was unable to obtain a visa application appointment before August (a month after the Intercambio) so was unable to attend the Intercambio. However, that global partnership decided to host their own educational exchange in San Francisco. This educational exchange (called an Encuentro) between POWER and their partner in Mexico took place in SF on November 15, 2006 from 4-6 p.m. The agenda for this educational exchange included a go-around introduction activity where each person stated their name, where they work, their duties there, how long they’ve been there and what they are most inspired about in world events. This was followed by each of the San Francisco providers presenting on their joint action (YLI, LEJ, CPA) to members of POWER and Miguel from EDUCA. Miguel then talked about his organization’s work in popular education with indigenous communities in Mexico and their tobacco joint action with POWER.

The Joint Projects

Eight local community-capacity building projects and their global partners completed joint projects. The types of joint projects completed by the global partnerships are discussed below.

Queers Mobilized Against Tobacco (SF) and Movimiento de Integracion y Lliberacion Homosexual (Chile). The two groups collaborated on a survey of the LGBT community in Santiago (the first of its kind) to establish baseline prevalence data regarding smoking rates among the LGBT community in Chile.

Thad Brown Boys Academy (SF) and Liga Colombiana en Control del Cancer (Columbia). Thad Brown provided youth peer education and training materials to the Columbian group who conducted peer education trainings and workshops in Columbia.

RIDE (SF) and ASH/Korea collaborated on a 12-minute video. Both groups interviewed youth about tobacco sponsorship and the impact of the tobacco industry on their respective communities.. RIDE then edited the footage and assembled the video, which was made available to both groups and will be used for community outreach and to raise awareness among youth in both locations.

POWER (SF) and EDUCA Oaxaca Mexico. The Oaxacan group was unable to attend WCTOH intercambio due to the inability of their staff to get an appointment with the U.S. Consulate in Mexico in time for the WCTOH. Instead, the two partners held their own educational exchange in San Francisco in October 2006. In order to assist EDUCA in their work, POWER advocates searched for training materials on the global impact of tobacco that might be useful to EDUCA and translated them for use by the training center in Oaxaca. May 2007 EDUCA staff used their materials to train 350 health workers who work in agriculture and/or are farmworkers in Oaxaca, Mexico.

LEJ (SF) and Hriday Shan (India). Hriday Shan provided an endorsement of LEJ/YLI’s local campaign to enact a tobacco manufacturer mitigation fee in SF and in turn, LEJ co-sponsored Hriday 2006 Global Youth Meeting on Health (GYM) in India. The Global Youth Meeting on Health was organized by HRIDAY in India and held in November 2006. Youth from 35 countries and 11 states of India participated in this youth conclave to discuss issues related to health. Tobacco control was one of the important themes covered during GYM 2006. The GYM delegates resolved to work on smoke free schools and college campuses as an outcome of GYM 2006.

Girls After School Academy (SF) and PADDI (Nigeria) worked together on developing school book covers for school children in Nigeria and in San Francisco with messages about tobacco control and solidarity. In January 2000 book covers were printed. Of these, 1500 were distributed to youth for a tobacco awareness campaign in Nigerian private and public schools. GASA also distributed 500 additional book covers to youth in SF. PADDI conducted seminars in conjunction with distribution of the book covers. These seminars, called the Public Awareness Lecture Series (PALS) on substance abuse and tobacco control are part of an ongoing vocation for PADDI. Printing the book covers was accomplished through the use of San Francisco’s Master Settlement funds.

Chinese Progressive Association (SF) and Hong Kong Workers Health Center. The two groups collaborated on a newsletter to distribute to unions and assist in smoke free workplace policies in Hong Kong.

Polaris Research and Development, Inc. (SF) and The Environmental Action Network (Uganda). Polaris organized a letter writing campaign urging the Minister of Health in Uganda to ratify the FCTC. (A total of 4 letters from organizations – Polaris Research and Development, Inc., the Tobacco-Free Coalition, PODER and YLI were written to the Ugandan Ministry of Health).

Following the intercambio, local projects continued working with their global partners to complete their joint projects. In some cases the projects were modified or simplified in order to be completed in the five months allotted for project completion. Two of the 10 original partnerships were unable to continue their partnerships, both from Uruguay, and both for different reasons.

The Intercambio and Joint Projects

The Tobacco-Free Coalition’s Global Action Task Force exceeded its objective (to hold an educational exchange with tobacco control activists in the U.S. and abroad that results in the development and implementation of two joint projects between local tobacco advocates and their international counterparts). A total of eight projects were implemented following the Intercambio, some requiring minimum effort, others requiring a great deal of work from local advocates as well as their international buddies.

Complete results of the follow-up interviews/surveys conducted with participants 60 days after the Intercambio may be found in Appendix A of this report, however highlights from these documents are indicated below.

 Using a scale from 5-point scale with 1 being “not effective” and 5 being “highly effective”, Intercambio participants rated all eight out of nine dimensions of the Intercambio with ratings of 3.91 to 4.58. The only dimension of the Intercambio that received a lower rating (2.81) was the length of the Intercambio (many people wished it was longer, allowing more time to spend with their global partners).

When international advocates were asked what the biggest surprise for them was regarding the tobacco control work being done in the United States, responses included:

• “The tobacco control in the U.S. often focuses on particular communities, LGBT, African American, etc.”
• “It seems there are more young people around the world working on tobacco control issues than ever before.”
• “That litigation against the tobacco industry is often led by the government.”
• “That different states in the U.S. are at different stages regarding their tobacco control work.”

Advocates were also asked if they had any comments they would like to make about the Intercambio that weren’t addressed in the interviews or surveys. Samples from their comments included:

• “This Intercambio was a unique opportunity for our organization. We are a mainly volunteer organization so getting the chance to participate in the Intercambio and the World conference was wonderful.”
• “This Intercambio renewed by commitment to work on tobacco issues.”
• “ I wish I had more time to share with other participants at the Intercambio and learn more about what other joints projects are being undertaken.”
• “Longer would have been better, but it was great.”
• “I really hope more Intercambios can take place in the future.”
• “The Intercambio is an excellent way to build true partnerships among international organizations.”

Finally participants were asked to rate their satisfaction with the Intercambio. Fifty percent of participants said it was “better than expected”, and 50% said it was “same as expected”. However it should be noted that among those that said it was the same as expected, two of the five had attended one of the previous Intercambios.

Tobacco-Free Coalition/Globlal Action Task Force Survey 

At least every two years the project evaluator administers a survey to the Tobacco-Free Coalition and to Global Action Task Force members. The purpose of the survey is to ‘take the pulse’ of the coalition to make sure coalition members feel they are determining the agenda of the coalition, being provided opportunities to get involved in projects of interest, etc. A complete description of the results is located in Appendix B, but highlights from that survey include:

• 94% of those surveyed felt the Coalition’s work with international tobacco advocates enriches and inspires their local tobacco work.
• 70% of Coalition members were aware of the Framework Convention on Tobacco Control, and of these, 100% were aware the U.S. has not ratified the treaty.

Using a 5-point scale with 1 being “strongly disagree” and 5 being “strongly agree,” participants were asked to indicate their agreement or disagreement with the following statements.

In July 2006, the Tobacco-Free Project hosted an international educational “Intercambio” directly before the World Conference on Tobacco or Health, which took place in Washington, D.C. Eight advocates from seven U.S. organizations along with advocates representing six different countries attended the Intercambio including Chile, Uruguay, Hong Kong, Korea, Nigeria, and Uganda.

Prior to the Intercambio, advocates from the U.S. were paired up with international advocates or “buddies.” At the Intercambio, they decided on a joint project they would work on and evaluators conducted key informant interviews with each advocate during the meeting. Approximately 90 days following the Intercambio, an email key informant survey and satisfaction survey was emailed to each advocate in order to learn what each team had accomplished. The results of the follow-up survey are indicated below.

1) On a scale from 1 to 5 where 1 is “Not effective” and 5 is “Extremely effective”, respondents rated the following components of the Tobacco or Health Intercambio 2006?

2) Was there any information you would have liked to be included in the Intercambio?

Respondents mentioned several different types of information they would have liked to receive at the Intercambio, including:

• “More information about the joint projects completed at previous Intercambios.”
• “A written description of the other joint projects being done by the other advocates.”
• “More information on smoking issues among adult labor organizations.”

3) What joint action did you and your buddy agree to work on?

The joint projects taken on by the advocate teams were really quite varied, and included:

• Producing book covers with an anti-tobacco message for students in Nigeria.
• Exchanging ideas and materials to distribute as part of a peer education program in Columbia.
• Helping Hong Kong Workers’ Centre produce a newsletter to advocate for smokefree work places.
• Help sponsor a Global Youth Meeting focusing on health issues (including tobacco) for youth in India.
• Provide international support for U.S. advocates’ efforts to institute a mitigation fee that holds tobacco manufacturers responsible for the harm caused by smoking in San Francisco.
• Help a group in Chile conduct the first smoking prevalence survey among lesbian and gay folks in Santiago.
• Collaborate in the production of a youth video highlighting on the tobacco industry’s targeting of youth and the need to reduce the industry’s sponsorship of community events.
• Conduct a youth survey and hold a series of educational workshops in Uruguay.
• Get letters of support from organizations urging Uganda’s Ministry of Health to ratify the Framework Convention on Tobacco Control.
• Continued litigation in Ugandan courts regarding use of graphic warning labels and smoking ban in public places.

4) What steps have you taken since the Intercambio towards completing your joint action?

Only one of the projects that attended the Intercambio did not complete their joint project. All of the other participants reported working on their joint projects since returning to their home countries following the Intercambio.

5) How would you describe your Intercambio experience?

Response :
Better than expected: 5 (50.0%)
Same as expected: 5( 50.0%)
Worse than expected: 0 (0.0%)

Advocates that had attended a prior Intercambio were the ones to answer “same as expected”.

6) Does the joint project you selected support the work your organization is already doing?

Response:
Yes: 10 (90.9%)
No: 1 (9.1%)

7) This partnership has included:

1. Pre- conference communication
2. Attendance at the Intercambio
3. Attendance at the World Conference on Tobacco or Health
4. Completion of a joint project after the Intercambio

• Of the above, which has been most used to advance the work of your organization. Please explain.

The overwhelming majority of participants cited a minimum of two of the responses above, confirming that all aspects of the partnerships (listed above) have been beneficial to Intercambio participants, with particular emphasis on attending the Intercambio and the World Conference on Tobacco or Health.

8) What was the biggest surprise for you about the anti-tobacco work being done by advocates in the U.S.?

The Intercambio engendered a number of surprises among participants, including:

• “That there is a young generation of advocates out there.”
• “That U.S. tobacco work often focuses on particular communities, e.g. LGBT, etc.”
• “The U.S has many resources and advocates so that is why they are so far ahead of us.”
• “There are a lot of tobacco advocates, some progressive, some not, but working together we can be powerful.”
• “That litigation (against the tobacco industry) in the U.S. is led by the government.”
• “I learned so much about the great work being done by youth around the world.”
• “It seems like there are even more youth advocates from around the world working on tobacco issues than ever before.”
• “That different states within the U.S. are at different stages of tobacco work.”
• “I was surprised that I came back from the Intercambio feeling like tobacco advocates from the U.S. should be doing more to pressure our government (re: tobacco issues).”
• 9) Would you like to share any comments or thoughts on your “Intercambio” experience?

Comments from participants included:

• This Intercambio was a unique opportunity for our organization. We are a mainly volunteer organization so getting the chance to participate in the Intercambio and the World Conference was wonderful.
• The Intercambio renewed my commitment to work on tobacco issues.
• I wish we had more time to share with other participants at the Intercambio and learn about their joint projects.
• Longer would have been even better, but it was great.
• The Intercambio is an excellent way to build partnership among international organizations.
• I really hope more Intercambios can take place in the future.

The survey was administered to all Tobacco-Free Coalition members including all members of the Global Action Task Force. In 2004 a total of 17 members responded to the survey, in 2006, completed surveys were received from 20 respondents.

1. What do you think is the purpose or mission of the TFC?

Respondent’s answers for both years centered around similar themes, which are highlighted below.

• To improve the health of San Francisco residents
• To reduce smoking rates in San Francisco
• To improve our communities
• To work collectively to promote health among San Francisco residents
• To limit the tobacco industry’s impact on our communities
• To take a leadership role in tobacco policy
• To help communities of color struggling against the tobacco industry

2. Why are you participating in the TFC?

Again, similar themes emerged in both years the survey was administered.:

• As an agency working on tobacco control on the statewide level, working with the TFC allows me to work on the local level as well
• To learn new skills
• Part of our grant requires it
• To limit the tobacco industry’s co-optation of my community
• Want to help my community
• Want to reduce smoking and improve the health of my community
• Want to mobilize people to act against the tobacco industry

3. Are you designated by your organization to attend all TFC meetings/events?

4. On a scale of 1 to 5 where 1 is “not at all representative” and 5 is “very representative” how representative do you think the TFC is of the people of San Francisco?

Survey participants were asked to indicate how representative the Tobacco-Free Coalition is of the people of San Francisco. Using a 5-point scale, with 1 being “not at all representative” and 5 being “very representative”, Coalition members in both years rated the Coalition being from “representative” to “very representative of the people of San Francisco. In 2004, the mean score was 4.3, in 2006 the mean score was 4.8 (out of 5).

5. On a scale from 1 to 5, where 1 is “strongly disagree” and 5 is ”strongly agree,” please circle the number which best indicates your position for each of the following statements.

6. Are you familiar with any of the following TFC actions/activities? (Check all that apply.)

7. Please indicate whether in your opinion the TFC has (or does) the following:

(Check either “yes”, “no” or “don’t know” for each statement.)

9. Are you familiar with the Framework Convention for Tobacco Control (FCTC)?

9a. If yes to question 9, are you aware whether or not the US government has ratified the FCTC?

In both 2004 and 2006, 100% of respondents that indicated they were familiar with the FCTC also knew the United States had not yet ratified the treaty.

10. In the development of trade agreements, rules or policies, do you think that increasing profits is more important than public health and environmental considerations?

11. Do you think that working on International/Global Tobacco issues makes your local tobacco work more meaningful?

This comment best summarizes the responses received from the vast majority of coalition members. “It reminds us all that we are part of a global community, also, if something is working someplace else it keeps us from reinventing the wheel, we can learn from others.”

12. Will you participate in the TFC-sponsored “Intercambio 2006” with the TFC buddies from abroad?

Please tell us something about yourself

 What is your gender?

What is your ethnic/racial background?

What is your group affiliation? 

Alyonik Hrushow, Director
Tobacco-Free Project
Community Health Promotion and Prevention Branch
San Francisco Department of Public Health
30 Van Ness Avenue, Suite 2300
San Francisco, CA 94102

Date of Submission: June 30, 2007

This report made possible by funds received from the California Department of Health Services, Tobacco Control Section under agreement number TCS-038, agreement term: 07/01/04-06/30/07

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