Manufacturing credibility: the National Energy Management Institute and the Tobacco Institute's strategy for indoor air quality

Objectives. We studied tobacco industry efforts during the 1980s and 1990s to promote the National Energy Management Institute (NEMI), a nonprofit organization, as an authority on indoor air quality as part of the industry''s strategy to oppose smoke-free worksite policies.Methods. We analyzed tobacco industry documents, conducted literature searches in Lexis–Nexis for background and historical literature, and reviewed relevant public health and policy literature.Results. The tobacco industry provided more than US $6 million to NEMI to establish it as an authority on indoor air quality and to work with it to undermine support for smoke-free air policies by promoting ventilation as a solution to indoor air quality problems. Tobacco industry support for NEMI was not publicly disclosed.Conclusions. NEMI was a valuable ally for the tobacco industry through NEMI''s ties to organized labor, its technical background, and its status as a third-party actor. NEMI also helped the industry to portray ventilation to improve overall indoor air quality and smoke-free worksites as an either–or choice; in fact, both can improve worker health.In the 1980s, the National Energy Management Institute (NEMI), a nonprofit association of sheet metal contractors, and the Sheet Metal Workers International Association (SMWIA) became active advocates for improving indoor air quality. NEMI promoted ventilation, rather than source control, to solve indoor air problems. NEMI made presentations at trade shows and conferences, published a quarterly newsletter, offered legislative testimony at the state and federal levels, and gave media interviews about clean indoor air.^1–5 Although NEMI was expansive in proclaiming its indoor air quality expertise, it was less forthcoming about its financial support from the tobacco industry.The tobacco industry had a significant interest in undermining efforts to control the sources of indoor pollution, such as smoke-free worksite policies. It pursued this interest by arguing that ventilation could improve indoor air quality, which, it further argued, would eliminate the need to ban smoking indoors. Smoke-free worksites threatened the industry''s economic interests by reducing cigarette consumption and undermining the social acceptability of smoking.^6–8 Between 1987 and 1998, the tobacco industry (via the Tobacco Institute, the trade association for US tobacco companies) provided more than US $6 million to NEMI,^9–18 which promoted the industry''s message that tobacco smoke is a minor contributor to indoor air problems.^8,19 NEMI''s interests were also served by this focus, as stronger ventilation standards meant more work for sheet metal contractors and workers. Tobacco Institute funding for NEMI is shown in

Building Alliances in Unlikely Places: Progressive Allies and the Tobacco Institute's Coalition Strategy on Cigarette Excise Taxes

The tobacco industry often utilizes third parties to advance its policy agenda. One such utilization occurred when the industry identified organized labor and progressive groups as potential allies whose advocacy could undermine public support for excise tax increases. To attract such collaboration, the industry framed the issue as one of tax fairness, creating a labor management committee to provide distance from tobacco companies and furthering progressive allies'' interests through financial and logistical support. Internal industry documents indicate that this strategic use of ideas, institutions, and interests facilitated the recruitment of leading progressive organizations as allies. By placing excise taxes within a strategic policy nexus that promotes mutual public interest goals, public health advocates may use a similar strategy in forging their own excise tax coalitions.In its efforts to oppose cigarette excise tax increases in the 1980s, the tobacco industry devised a coalition strategy of recruiting outside groups to advocate its positions at the federal, state, and local levels.¹ Although forming coalitions was not a new industry practice, it became an increasingly important tactic as the industry sought to create an image of broad support for its positions in the face of growing public pressure around tobacco control.² Roger Mozingo, a vice president for the Tobacco Institute (the tobacco industry''s trade association; hereafter referred to as “the Institute”), underscored the importance of excise taxes in 1987 when he wrote that “the cigarette tax issue is our oldest and remains the one [issue] that most immediately and directly affects our bottom line.”³ He emphasized that excise taxes were being levied not only to raise revenue, but also as “punitive attacks on industry.”³ Additionally, research had demonstrated that tobacco tax increases were among the most effective ways to reduce smoking prevalence.^4,5Acknowledging that the “political acceptability of ‘sin’ taxes made further increases a certainty,”¹ the Institute''s strategy included recruiting “organized labor, minorities, and other liberal groups” to provide early warnings of legislative tax initiatives, help tobacco industry lobbyists gain access to legislators who were not industry allies, demonstrate constituent support for protobacco votes, and testify on the industry''s behalf.¹ The Institute was successful in forging relationships with—and providing significant financial support to—two prominent progressive organizations, Citizens for Tax Justice (CTJ) and Citizen Action, to oppose cigarette excise tax increases as part of its policy efforts.⁶The alliance between the Institute and progressive organizations on cigarette excise taxes represents a departure from the more typical formation of policy coalitions by like-minded groups with shared political philosophies and a history of working together.⁷ Although there are other examples of tobacco industry support for social justice organizations, including the American Civil Liberties Union⁸ and leading civil rights groups,⁹ CTJ and Citizen Action were progressive groups whose populist political philosophies contrasted with the antiregulatory impulses and corporate mission of the tobacco industry, making their collaboration with the industry particularly surprising. The Institute was able to gain their support by employing a strategy that employed key ideas, institutions, and interests to induce policy behavior that would otherwise not have occurred.Details of the arrangement with CTJ and Citizen Action became available with the release of internal tobacco industry documents as a result of litigation.^10,11 These documents offer insight into the tobacco industry''s strategies in opposing tobacco control initiatives, as well as activities of groups and individuals collaborating with the industry. We drew on documents retrieved through the Legacy Tobacco Documents Library at the University of California at San Francisco (http://legacy.library.ucsf.edu) and Tobacco Documents Online (http://tobaccodocuments.org) to examine how the tobacco industry was able to attract support from progressive groups on excise tax debates.We searched both databases with key terms such as “coalition strategy,” “Citizens for Tax Justice,” “CTJ,” “Citizen Action,” “Strategy Group” (consulting group), “McIntyre” (Robert McIntyre from CTJ), and “Wilhelm” (David Wilhelm from CTJ and the Strategy Group), and pursued relevant threads contained in the documents. We also searched for Institute budgets between the years 1984 and 1999 to obtain funding information for coalition members. We reviewed more than 700 documents through these searches. We based our analysis on approximately 100 documents most relevant to the creation and maintenance of the tax coalition. We used Lexis–Nexis and newspaper and periodical searches to determine whether op-ed pieces referenced in Institute documents as part of the effort to influence public opinion actually ran in newspapers and magazines as claimed.     

Labor flexibilization and deregulation for nursing workers in Brazil: the PROFAE case

This study analyzed the flexibilization process of labor relations in the PROFAE Professionalization Project of Nursing Workers (Projeto de Profissionaliza??o dos Trabalhadores da Area de Enfermagem - PROFAE) in Brazil. This qualitative study used dialectical and historical materialism as the theoretical-methodological framework. Data were collected through directed interviews with open-ended questions, and answers were submitted to discourse analysis. The obtained results evidence the flexibilization and deregulation process of labor relations in the health area in Brazil, characterized by the following elements: payment by production; fragmented labor division; criteria for variable wage payment; qualified and versatile professionals; perceived professional freedom; reduced governability and power to make decisions; multiple jobs; activity planning as a substitute for planning models, and the massive systematic operationalization of actions.     

Building coalitions: lessons from the Alliance for a Healthy New England

Official pronouncements that the U.S. economy is in recession have confirmed the bad news that health care advocates began experiencing months ago. State budgets are deep in deficit. Medicaid programs are in jeopardy. And making the case for expanded health care access now seems harder than ever. There is good news, though: in the Alliance for a Healthy New England, health advocates may have found a new funding mechanism. Built on a broad-based coalition model, the Alliance is seeking to raise tobacco taxes in all six New England states, with the revenue generated to be used for tobacco control and expanded health care access. This States of Health looks at how the diverse organizations that make up the Alliance are learning to work together--and why working together is so valuable.     

Achieving organizational change: findings from case studies of 20 California healthy cities and communities coalitions

As part of an evaluation of the California Healthy Cities and Communities (CHCC) Program, we assessed the extent to which coalitions implementing the healthy cities and communities model demonstrated capacity to leverage financial resources, expand programs and influence organizational policies. The evaluation design was a multiple case study of 20 participating communities with cross-case analysis. Participating communities spanned the state's diverse geographic regions and ranged from remote areas within rural counties to neighborhoods within large cities. Data included: semi-structured interviews with coordinators and community leaders, focus groups with coalition members and document review. Many CHCC coalitions were able to leverage significant financial resources across a diverse array of funding sources, including federal, state, county and city governments. In addition, all CHCC coalitions developed at least one new program, most commonly focused on youth development, civic capacity-building or lifelong learning. Changes in policies, reported by 19 of the 20 coalitions, were consistent with healthy cities and communities principles and were implemented in community-based organizations, county and city governments, and school districts. Typical changes included an increased willingness to collaborate, increased emphasis on engaging diverse parts of the community, greater responsiveness to community needs and more opportunities for resident input into decision-making. Our findings suggest the healthy cities and communities model has the potential to strengthen the organizational infrastructure of communities to promote health.     

刍议公立医院编制外人员劳动合同管理

对于公立医院来讲,创建医院的和谐劳动关系构成了现阶段的医院管理要点。编制外人员属于特殊的劳动者群体,并且编制外人员在公立医院的范围内占据关键地位。为了切实保障编制外人员的合法权益,那么目前必须着眼于此类人员的劳动合同管理,确保劳动合同能真正成为保护公立医院编制外人员的重要凭据。在此前提下,公立医院管理者需要明确劳动合同管理对于保护编制外人员基本劳动权益的重要意义,并且结合公立医院管理编制外人员的现状来完善现有的劳动合同管理模式。     

A case study in dissemination: lessons learned from a pilot study involving the National Cancer Institute's Cancer Information Service

The Cancer Information Service Research Consortium (CISRC) was funded by the National Cancer Institute to disseminate as a pilot study a longitudinally tailored print intervention to promote the 5 A Day for Better Health program among callers to the National Cancer Institute's Cancer Information Service (CIS). Using a one-group (intervention-only) study design, 1,022 eligible CIS callers were enrolled to receive the intervention consisting of four mailings of tailored print materials over a 3-month period. Program evaluation focused on process and implementation evaluation, including adherence to the baseline interviews by CIS information specialists based on live-call monitoring (n = 55 eligible callers), and the timeliness of the intervention mailouts (4,088 scheduled mailouts). Adherence to the baseline interviews by CIS information specialists was extremely high, exceeding 90% for all indicators of quality control. Of the 4,088 intervention mailings, 75% occurred on or before the target date, while 95% occurred within 21 days of the target date. All delays in the scheduled mailouts occurred in the first mailing, due to changes made in the production process (batch printing of all tailored print materials at baseline). This change required additional system upgrades and more intensive and time-consuming quality control than originally anticipated, which was exacerbated by the faster-than-expected accrual of eligible participants. Based on this pilot study, the CIS is now positioned for widespread dissemination of the 5 A Day tailored print intervention. Several key lessons learned are also identified to facilitate the transition from research to dissemination.     

医疗质量管理委员会对医院管理持续改进的效能研究

目的：研究笔者所在医院质量管理委员会的效能与持续改进效果。方法：对2008-2011年医疗质量管理委员会的管理情况进行分析。结果：根据医院管理年评价体系标准,建立院、科两级管理体系,医疗质量管理委员会发挥持续改进优势作用,病历书写质量明显提高,诊疗行为进一步标准规范,医疗纠纷率下降,患者满意度提高。结论：完善医疗质量管理委员会的功能与职责,推进制度执行能力;改善院级质控方式,提升质控有效性。促进医疗质量持续改进。