1. Key characteristics of state tobacco control programs: Final evaluation results Center for Tobacco Policy Research Saint Louis University School of Public Health Douglas Luke, PhD Lisa Hepp, BS

2. Project Team Saint Louis University Lisa Hepp, BS Douglas Luke, PhD Stephanie Herbers,BS Nancy Mueller, MPH Melissa Krauss, MPH Angela Recktenwald, BA Patricia Lindsey, MS Ross Brownson, PhD MO Department of Health & Senior Services Janet Wilson, PhD Funded by Legacy and the CDC Foundation

3. Presentation Overview Goal: Present the most interesting early results from a three year multi-state tobacco program evaluation Highlighted Results: Best Practices Disparate populations Financial & political climate Inter-agency relationships

4. Project Background: Best Practices Process Evaluation Project Aims Develop a comprehensive picture of a state’s tobacco control program for tobacco control partners and policymakers Examine the effects of financial, political, and organizational factors on tobacco control programs Understand how states are utilizing the Centers for Disease Control and Prevention’s (CDC) Best Practices for Comprehensive Tobacco Control Programs (BP)

5. Project Background: Conceptual Model The Best Practices TC Program Goals Organizational Capacity & Network Resources ActivitiesFacilitating Conditions Planning Political Climate Financial Climate Disparate Populations

6. Project Background: Participating States 10 states evaluated (2002-2003) –Washington –Oklahoma –Indiana –Wyoming –New York –Michigan –Pennsylvania –Mississippi –Hawaii –Missouri

7. Best Practices (BP) How are the CDC Best Practices for Comprehensive Tobacco Control Programs guidelines being implemented by states?

8. Best Practices: Reorganization of BP Oklahoma’s Four Cornerstones –Community –Counter-Marketing –Classroom –Cessation Indiana –Community programs include cessation, school, and statewide programs New York –Three main strategies for programmatic activities Community mobilization Media Cessation

9. Best Practices: BP Priority Categories

10. Best Practices: State Funding by BP Category

11. Best Practices: Summary States are tailoring the BP to meet their needs Community programs and counter- marketing are high priorities & receive more funding Chronic disease programs are difficult to incorporate States want more “how to” guidance

12. Tobacco-related Disparities Which groups are states identifying as having disparities related to tobacco use?

13. Disparities: Categories of Priority Populations

14. Disparities: States’ Priority Populations Minorities –African Americans –Native Americans –Latino/Hispanics –SE Asians –Native Hawaiians –Communities of Color Low SES –Blue-collar workers –Pregnant women –Rural –Medicaid beneficiaries Youth –White females –Private schools Pregnant Women Other –Persons w/ mental illness –Male smokeless tobacco users –Rural communities

15. Disparities: Resources Used in Identifying DP

16. Disparities: Approaches to Addressing DP Establishing partnerships with existing local organizations Supporting new local organizations and coalitions Obtaining specific grant initiatives (e.g. ethnic networks) Organizing population-specific events (e.g. youth summits) Targeting counter-marketing campaigns

17. Disparities: Summary States vary in terms of: –Defining “disparity” –Identifying which strategies will work best to address specific populations Frequently mentioned lack of resources and guidance

18. Financial and Political Climate What is the interrelationship of states’ financial and political climates?

19. Tobacco Settlement Funds as a % of CDC Lower Recommendations Indiana Oklahoma Michigan Wyoming New York Washington Pennsylvania Mississippi 200% 0% 50%100%150% Source: Campaign for Tobacco Free Kids Hawaii

20. Financial Climate: Strengths and Challenges Dedication of MSA dollars to tobacco control Trust fund Cigarette excise tax increase Securitization State budget shortfalls

21. Political Climate: Champions and Barriers Political Champions Legislators Attorney General Governor Health Department Director Voluntary Agencies Other Organizations Political Barriers Tobacco Industry presence Preemption Lack of political support Pro-tobacco norm

22. Financial & Political Climate: Rating Variables Financial ClimatePolitical Climate % of TC budget meeting CDC lower recommendation Climate regarding TC Per capita spendingMajor TC champions FY 03 Excise TaxGovernor support level SecuritizationLegislature support level —Industry presence

23. Financial & Political Climate: State Comparison Summary State Political Support Financial Support Total INVery strongStrong+5 MSVery strongStrong+4 HIStrongVery Strong+4 PAModerateStrong+2 WAStrongModerate0 NYModerate WYChallengingStrong-3 MIChallengingModerate-3 OKChallenging -5

24. Inter-agency Relationships Do inter-agency relationships reflect states’ financial and political climates?

25. Contact Network: Strong FP Climate Indiana (Centrality Index 22.7%) Mississippi (Centrality Index 20.5%)

26. Contact Network: Challenging FP Climate Michigan (Centrality Index 10.4%) Oklahoma (Centrality Index 6.6%)

27. Financial, Political & Inter-agency: Summary Political and Financial Climates are closely related Climates may affect how agencies are working with each other Importance of political champions Qualitative advocacy approach

28. Inter-agency Relationships Key Points Competent, knowledgeable, and supportive lead agencies are critical due to their strong influence on the network Geographic dispersion of a network influences communication among agencies Improving organizational structures and relationships could improve program efficiency Investigating networks can help shed light on the highly complex process of coordinating tobacco control programs

29. Conclusions State tobacco control programs are large, complex inter-organizational entities Evaluation is just starting to move beyond counting activities –Important to look at state strategies and polices –Important to examine inter-organizational characteristics Evaluation needs to be continued to examine the effects of state budget crises on tobacco control programs E-mail: dluke@slu.edu http://repositories.cdlib.org/tc/surveys