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"Creating a sustainable program for long-term success" was the focus of Washington's 2000 strategic plan. In 2002, this theme was still evident. While Washington was faced with some difficult challenges, the foundation had been laid to continue to improve and expand its tobacco control program. The program benefited from a supportive leadership, ample funding, a health conscious public, and an improving tobacco control network. For this evaluation, preventing youth initiation and promoting cessation were identified as the top two program goals for FY 2002. Partners agreed with these priorities, emphasizing the importance of demonstrating to the Legislature that the program was affecting prevalence rates. Minor changes to the list were suggested: broadening the definition of youth to include 18-24 year olds due to the targeting of this group by the tobacco industry; and including cessation for pregnant women as a sub-goal of promoting cessation. The statewide quit line was generally viewed as a successful activity, partly due to good promotion and continued evaluation. The partners identified the following strengths and challenges of Washington's program: • The dedication and experience of the tobacco control professionals and advocates was identified as a major strength of the program, with recognition specifically given to the DOH program staff. • The timely development of a detailed strategic state plan that continued to provide guidance beyond the first year of the program was viewed as a strength. • The very existence of a tobacco control network was identified as a positive factor. However, the lack of cohesiveness among partners was seen as a challenge. • While some thought that the current funding level of the program was a positive factor, most felt that more funding was needed to reach the CDC minimum funding level. • Major political challenges were the state budget crisis and the securitization of future MSA funds. • The lack of capacity/infrastructure at the local and state levels also impeded the implementation of tobacco control activities.

"Creating a sustainable program for long-term success" was the focus of Washington's 2000 strategic plan. In 2002, this theme was still evident. While Washington was faced with some difficult challenges, the foundation had been laid to continue to improve and expand its tobacco control program. The program benefited from a supportive leadership, ample funding, a health conscious public, and an improving tobacco control network. For this evaluation, preventing youth initiation and promoting cessation were identified as the top two program goals for FY 2002. Partners agreed with these priorities, emphasizing the importance of demonstrating to the Legislature that the program was affecting prevalence rates. Minor changes to the list were suggested: broadening the definition of youth to include 18-24 year olds due to the targeting of this group by the tobacco industry; and including cessation for pregnant women as a sub-goal of promoting cessation. The statewide quit line was generally viewed as a successful activity, partly due to good promotion and continued evaluation. The partners identified the following strengths and challenges of Washington's program: • The dedication and experience of the tobacco control professionals and advocates was identified as a major strength of the program, with recognition specifically given to the DOH program staff. • The timely development of a detailed strategic state plan that continued to provide guidance beyond the first year of the program was viewed as a strength. • The very existence of a tobacco control network was identified as a positive factor. However, the lack of cohesiveness among partners was seen as a challenge. • While some thought that the current funding level of the program was a positive factor, most felt that more funding was needed to reach the CDC minimum funding level. • Major political challenges were the state budget crisis and the securitization of future MSA funds. • The lack of capacity/infrastructure at the local and state levels also impeded the implementation of tobacco control activities

Partners identified the following strengths and challenges of New York's tobacco control program: • The experience and leadership of the DOH TCP Director was a major strength of the program. • Clean indoor air efforts throughout the state were also a strength. • Partners were concerned about the security of funding due to the large state and city budget deficits. • The highly politicized DOH environment and slow grant process were viewed as barriers to the program. • Little support from state policymakers and the influence of the tobacco industry made implementing a comprehensive program challenging.

Purpose: To investigate tweets about marijuana edibles for surveillance into the content of edibles-related tweets among individuals socially networking about this topic on Twitter. Design: Cross-sectional analysis of tweets containing edible marijuana-related key words during 1 month. Setting: Twitter. Participants: Tweets sent during January 1 to 31, 2015. Methods: A random sample of 5000 tweets containing edibles-related key words was coded for sentiment (positive, negative, and neutral) by crowdsourced workers. Tweets normalizing or promoting edibles use were further analyzed, and demographic characteristics of the Twitter handles sending these tweets were inferred. Results: Of the 5000 tweets, 4166 (83%) were about marijuana edibles, and of those 75% (3134 of 4166) normalized or encouraged edibles use. Nearly half (48%, 1509 of 3134) of the tweets normalizing edibles mentioned wanting or planning to consume, currently consuming, or recently consuming edibles, and 12% (378 of 3134) described the intense or long-lasting effects following use. Individuals whose tweets promoted/encouraged edibles use were more likely to be young (between 17 and 24 years old) and of a racial/ethnic minority (52% black; 12% Hispanic) when compared to the Twitter average. Conclusion: Tweets that normalize edibles use have the potential to increase their popularity. The prevalence of tweets about edibles' intense high could have implications for tailoring prevention messages that could be important for youth and young adult minorities who were inferred to be disproportionately socially networking about edibles on Twitter.

Purpose. To explore the sentiment and themes of Twitter chatter that mentions both alcohol and marijuana. Design. Cross-sectional analysis of tweets mentioning both alcohol and marijuana during 1 month was performed. Setting. The study setting was Twitter. Participants. Tweets sent from February 4 to March 5, 2014, were studied. Method. A random sample (n = 5000) of tweets that mentioned alcohol and marijuana were qualitatively coded as normalizing both substances, preferring one substance over the other, or discouraging both substances. Other common themes were identified. Results. More than half (54%) of the tweets normalized marijuana and alcohol (without preferring one substance over the other), and 24% preferred marijuana over alcohol. Only 2% expressed a preference for alcohol over marijuana, 7% discouraged the use of both substances, and the sentiment was unknown for 13% of the tweets. Common themes among tweets that normalized both substances included using the substances with friends (17%) and mentioning substance use in the context of sex or romance (14%). Common themes among tweets that preferred marijuana over alcohol were the beliefs that marijuana is safer than alcohol (46%) and preferences for effects of marijuana over alcohol (40%). Conclusion. Tweets normalizing polysubstance use or encouraging marijuana use over alcohol use are common. Both online and offline prevention efforts are needed to increase awareness of the risks associated with polysubstance use and marijuana use.

Michigan's tobacco control program has been greatly challenged by an unsupportive political climate, a state budget deficit, and inadequate program funding. Despite these barriers, the program has benefited from strong tobacco control experience and leadership, a supportive network of tobacco control partners, and recent local clean indoor air efforts. It is hoped that the new Governor and Legislature will provide more support for tobacco control, helping Michigan's program to progress in its efforts. Program Strengths & Challenges Partners identified the following strengths and challenges of Michigan's tobacco control program: • Partners described the Tobacco Section staff as very dedicated, knowledgeable, and committed to tobacco control and a major strength of Michigan's program. • The statewide coalition, Tobacco Free Michigan Action Coalition, and its members were viewed as strengths. • A few partners identified local coalitions and their grassroots efforts as positive characteristics of Michigan's tobacco control program. • The lack of tobacco control program funding was the most significant challenge for the program. • Michigan's political climate was a challenge. In particular, many partners felt the lack of support by the previous Engler Administration impeded the program tremendously.

Partners identified the following strengths and challenges of New York's tobacco control program: • The experience and leadership of the DOH TCP Director was a major strength of the program. • Clean indoor air efforts throughout the state were also a strength. • Partners were concerned about the security of funding due to the large state and city budget deficits. • The highly politicized DOH environment and slow grant process were viewed as barriers to the program. • Little support from state policymakers and the influence of the tobacco industry made implementing a comprehensive program challenging.

The Center for Tobacco Policy Research at the Saint Louis University Prevention Research Center is conducting a three-year project examining the current status of 12-15 state tobacco control programs. The project aims to: 1) develop a comprehensive picture of a state's tobacco control program to be used as a resource for tobacco control agencies and policymakers; 2) examine the effects of political, organizational, and financial factors on state tobacco control programs; and 3) learn how the states are using the CDC's Best Practices for Comprehensive Tobacco Control Programs. This Profile has been developed as a resource for tobacco control partners and policymakers to use in their planning and advocacy efforts. The Indiana Profile presents both quantitative and qualitative results collected over a two-month period, beginning in July 2002.

Partners identified the following strengths and challenges of New York's tobacco control program: • The experience and leadership of the DOH; TCP Director was a major strength of the program. • Clean indoor air efforts throughout the state were also a strength. • Partners were concerned about the security of funding due to the large state and city budget deficits. • The highly politicized DOH environment and slow grant process were viewed as barriers to the program. • Little support from state policymakers and the influence of the tobacco industry made implementing a comprehensive program challenging.

Oklahoma's tobacco control program has made progress despite the challenges of inadequate program funding, an unsupportive political climate, and the pro-tobacco norm of its citizens. They have benefited from strong tobacco control leadership, a supportive network of tobacco control partners, and advances in secondhand smoke policy. These characteristics along with the strong commitment of the tobacco control community will continue to improve and expand Oklahoma's tobacco control efforts. In fiscal year 02, Oklahoma dedicated approximately $3.8 million ($1.10 per capita) to tobacco control, meeting 17% of CDC's lower funding estimate. Community programs received nearly half of the funding, while enforcement and chronic disease programs received no funding from the tobacco control program. The establishment of the Tobacco Settlement Endowment Trust Fund (Trust) and securing funding from other sources, such as the CDC and the American Legacy Foundation, were viewed as financial successes. Significant challenges to the program were the lack of funding for the tobacco control program and the delay in the disbursement of the Trust money. Partners agreed that the goals were appropriate due to their synergism and ability to impact a large number of people. Although attempts to repeal preemption had been unsuccessful, the Board of Health's Secondhand Smoke Rules Partners identified the following strengths and challenges of Oklahoma's tobacco control program: • The dedication of tobacco control professionals and advocates was identified as a major strength of the program. • The cooperation and coordination of the tobacco control network was viewed as a strength, but many partners believed that the network could be stronger. • The lack of adequate funding was a huge impediment to the tobacco control program. • A lack of awareness about the importance of tobacco control and lack of support from the public was a barrier. • Major political barriers were the influence of the tobacco industry and the lack of legislative support for tobacco control.

Michigan's tobacco control program has been greatly challenged by an unsupportive political climate, a state budget deficit, and inadequate program funding. Despite these barriers, the program has benefited from strong tobacco control experience and leadership, a supportive network of tobacco control partners, and recent local clean indoor air efforts. It is hoped that the new Governor and Legislature will provide more support for tobacco control, helping Michigan's program to progress in its efforts. Program Strengths & Challenges Partners identified the following strengths and challenges of Michigan's tobacco control program: • Partners described the Tobacco Section staff as very dedicated, knowledgeable, and committed to tobacco control and a major strength of Michigan's program. • The statewide coalition, Tobacco Free Michigan Action Coalition, and its members were viewed as strengths. • A few partners identified local coalitions and their grassroots efforts as positive characteristics of Michigan's tobacco control program. • The lack of tobacco control program funding was the most significant challenge for the program. • Michigan's political climate was a challenge. In particular, many partners felt the lack of support by the previous Engler Administration impeded the program tremendously.

Strong policy changes, respectable funding, and new direction at the Department of Health Tobacco Control Program (DOH TCP) have contributed to the next phase of New York's tobacco control efforts. New York has been able to pass strong legislation in the areas of product placement, penalties for sales to minors, an excise tax increase, and a fire safe cigarettes law, despite somewhat unsupportive state policymakers. An improving tobacco control network and the work of local tobacco control champions helped push local clean indoor air policies, which led to a strong statewide clean indoor air law. These positive changes should lead to more progress by tobacco control advocates in New York provided funding can be maintained in the face of a large budget deficit. Program Strengths & Challenges Partners identified the following strengths and challenges of New York's tobacco control program: • The experience and leadership of the DOH TCP Director was a major strength of the program. • Clean indoor air efforts throughout the state were also a strength. • Partners were concerned about the security of funding due to the large state and city budget deficits. • The highly politicized DOH environment and slow grant process were viewed as barriers to the program. • Little support from state policymakers and the influence of the tobacco industry made implementing a comprehensive program challenging.

The tobacco control program in Pennsylvania was well established due to adequate funding, political support from previous Administrations, and dedicated tobacco control professionals across the state. The passage of Act 77 of 2001, allocating all the Master Settlement monies to health initiatives, including tobacco control, provided the foundation to establish a comprehensive program. Tobacco control advocates used the CDC's Best Practices guidelines to model their program and have developed a statewide monitoring system to track program progress. The program does face several challenges including the uncertainty of future funding due to the state's budget crisis, a change in administration, and preemption. The significant progress the program has attained should serve as an indicator of the potential successes it will be able to achieve if a supportive environment is maintained. Partners identified the following strengths and challenges of Pennsylvania's tobacco control program: • The dedication of the DOH TPC staff and their management of the program were strengths of the program. • The allocation of adequate funding for Pennsylvania's tobacco control program was a major strength. However, partners felt that the short time the program had been in place was a challenge. • The slow DOH approval process caused delays in implementation of tobacco control activities. • Preemption in the clean indoor air and youth access laws prohibited Pennsylvania from enacting strong tobacco control legislation.

Abstract. Background: Social networking about depression can be indicative of self-reported depression and/or can normalize risk behaviors such as self-harm and suicidal ideation. Aim: To gain a better understanding of the depression, self-harm, and suicidal content that is being shared on Tumblr. Method: From April 16 to May 10, 2014, 17 popular depression-related Tumblr accounts were monitored for new posts and engagement with other Tumblr users. A total of 3,360 posts were randomly selected from all historical posts from these accounts and coded based on themes ascertained by the research team. Results: The 17 Tumblr accounts posted a median number of 185 posts (range = 0–2,954). Content was engaged with (i.e., re-blogged or liked) a median number of 1,677,362 times (range = 0–122,186,504). Of the 3,360 randomly selected posts, 2,739 (82%) were related to depression, suicide, or self-harm. Common themes were self-loathing (412, 15%), loneliness/feeling unloved (405, 15%), self-harm (407, 15%), and suicide (372, 14%). Conclusion: This study takes an important first step at better understanding the displayed depression-related references on Tumblr. The findings signal a need for suicide prevention efforts to intervene on Tumblr and use this platform in a strategic way, given the depression and suicidal content that was readily observed on Tumblr.