Guiding Community Planning and Evaluation Efforts in Tobacco Control Using Data on Smoking During Pregnancy Vanessa Newburn Patrick Remington Paul Peppard University of Wisconsin Population Health Program, Madison, WI

Objectives Describe a method: –Model progress in using local data –Set objectives which account for local variation Illustrate the method: –Birth certificate data from Wisconsin Recommendation: –Set objectives be set as a percent less than predicted prevalence

Background Community-based programs are critical Few methods are available to guide local planning and evaluation efforts which: –Account for local variation –Can be systematically applied across communities US Birth Certificates are a useful source of local data

Methods Analysis Using Local Data: –Calculate prevalence of smoking by year –Model historical trends in prevalence –Predict prevalence in a future year –Set objective as a percent less than predicted Data (for illustration): –Wisconsin Standard Birth Certificates,

How to Model Local Trends Model: –Linear regression of log-prevalence on year Decreasing rates of change over time Avoids predicting negative future prevalence –Use slope to calculate Relative Annual Percent Change in Prevalence (100*(e m -1)) Constant percent change from year to year Describes progress over time

Model for the State--1 Percent smokers 3.3% per year relative decline

Model for the State--2 Percent smokers 3.3% per year relative decline

Model for the State--3 Percent smokers Current State Objective 20% less than predicted

Variation Across Counties

Model for a County Kenosha County Percent Smokers 5.3% per year relative decline

Model for a County Kenosha CountyWaukesha County Percent Smokers 5.3% per year relative decline 5.1% per year relative decline

County Objectives Kenosha CountyWaukesha County Percent Smokers 20% less than predicted 20% less than observed

Model for a County Percent Smokers Shawano CountyOutagamie County Percent Smokers 0.5% per year relative increase 0.6% per year relative decline

County Objectives Percent Smokers Shawano CountyOutagamie County Percent Smokers 20% less than predicted 20% less than observed 20% less than predicted

Variation in Observed Prevalence Across Counties (n=72) in WI WK KE SH ST OU County prevalence of smoking during pregnancy, 2000 (%) No. of Counties

Distribution of Relative Annual Percent Change in Prevalence ST KE WK OU SH No. of Counties Relative Annual Percent Change in Prevalence

Limitations of Birth Certificates Collects data on smoking in most but not all states Data on women whose pregnancies result in live birth Underestimates prevalence (self-report bias) Link with overall smoking prevalence still being made

Application to Evaluation Within Communities: –Reflect on past progress –Set challenging objectives –Evaluate the impact of new efforts Across Communities: –Comparisons can be made if data is consistent across jurisdictions

Summary of Results Substantial local variation exists: –Prevalence –Rates of change in prevalence –Local objectives should reflect variation Current methods for setting objectives are inadequate at the local level: –In WI, ¼ of counties & the State are expected to meet 20% less than observed rate (2000)

Recommendations Use local data to model local trends –Data: birth certificates –Analysis: linear regression models of trends in prevalence –Predict future prevalence Set objectives as a percent less than predicted

Acknowledgments Wisconsin Department of Health and Family Services –Kate Kvale, Randy Glysch Monitoring and Evaluation Program –Ann Christiansen, David Ahrens Wisconsin Tobacco Control Board Funding: Agency for Healthcare Research and Quality grant 5 T32 HS00083

Trends in Per Capita Cigarette Sales, Wisconsin and Arkansas, AR WI

Trends in Per Capita Cigarette Sales, Wisconsin, CA WI AR US

Trailer slide 24 slides x 1 set = 24 total slides Erich Mussak ( ) 1 set out of 1 in order Monitoring and Evaluation Program (WTCB)