1. Evaluating Local Tobacco Control Organizations

2. David Ahrens, Research Program Manager http://www.medsch.wisc.edu/mep/ Research conducted by: Barbara Hill, MSSW, Coordinator, State Evaluation Paul Moberg, Ph.D, Director, Center for Health Policy and Program Evaluation Acknowledge assistance of: Wisconsin Tobacco Control Board Wisconsin Division of Public Health

3. Purposes of Evaluation Understand and describe the characteristics of local tobacco control organizations. Determine if these organizations are employing effective tobacco control strategies now and over time. Communicate findings and recommendations to local organizations, training and technical assistance and funding agency.

4. Barriers to Evaluation Lack of consistent measurements of process outcomes, especially as understood by local groups. Lack of outcome measures such as prevalence rates for small geographical areas where local organizations function. –High cost and impractical –Takes years for pre/post

5. Evaluation Methods (1) Created database of over 500 “deliverables” from county local tobacco control organizations to Division of Public Health. Each deliverable is a discrete outcome, e.g. “One Adams County restaurant will adopt a policy that restricts or prohibits smoking.”

6. Evaluation Methods (2) Surveyed all organizations on characteristics and governance. Surveyed all local tobacco control organizations on activities that may be related to those outcomes. Evaluated outcomes and related activities in light of American Journal Preventive Medicine Community Guide and CDC Best Practices.

7. Varieties of Local Tobacco Control Organizations Coalitions: An organization of organizations/ individuals with agreed- upon purposes and strategies. Collaborative: Group working together to achieve a “shared vision.” Network: Structure for sharing information.

8. What are Wisconsin’s Local Tobacco Control Organizations?(1) Known as local or county coalitions Based in all 72 counties: from population 5,000 to 1 million. Operated by “Coalition Coordinators” Most are new to tobacco control and public health Average:.5 FTE; 18% are Full-time

9. What are Wisconsin’s Local Tobacco Control Organizations? (2) Most are funded since 2001 by the state Tobacco Control Board. Average 20 adult members. Majority are professionals representing community agency and meet at lunch (31%) or during workday (52%). Members are likely to be from health dept., health organization, schools, law enforcement, AODA organization.

10. Youth Educate about tobacco use: -1-2 school based presentations - Listed in 1/3 of “contract objectives” and as an activity by 83% of coalitions. Youth access –Conduct compliance checks –Listed in 1/3 of “contract objectives” and as an activity by 40% of coalitions.

11. Youth Organize youth groups such as Teens Against Tobacco Use (TATU) and Fighting against Corporate Tobacco (FACT). These groups engage in school and community tobacco education and some advocacy. Listed in 20% of contracted objectives and 60% of activities.

12. Youth Work with school officials on tobacco curricula –Discuss changes in curricula with school officials. Unknown what changes are proposed. Listed in 10% of contracted deliverables and 70% of activities.

13. Youth Educate retailers, law enforcement about problem of youth access (such as cigarettes behind counter) and relevant laws. Listed in 10% of contracted deliverables and 40% of activities.

14. Youth Activities Youth Access: Insufficient evidence but can create ability for community mobilization. Does not require media activity or fines of retailers. Most goals are well over Synar requirement such as a 70% sell rate. Teens Against Tobacco Use (TATU): No evidence. FACT: Under study

15. Youth No evidence on benefits of direct provision of youth education: No evidence of positive impact of episodic presentations. No consistent tested curricula. Best Practice: Working with school officials on adoption of CDC approved curriculum on tobacco and health.

16. Clean Indoor Air: Activities Smoke free homes pledge campaign: Listed in one-third of contract deliverables and listed as an activity by half of coalitions. Community support for Smoke free ordinances. This includes gaining support by community organizations and individual petitions. Listed in one fourth of contract deliverables and as an activity by half of local organizations.

17. Clean Indoor Air Activities Convince restaurant owners to become smoke free or have non-smoking section. Listed in one-sixth of contract deliverables and as an activity by two thirds of the organizations. Convince business owners to become smoke free. Listed in one third of contract deliverables and as activity by two thirds of the organizations.

18. Clean Indoor Air Best Practice: organizational education on effects of secondhand smoke is necessary precondition to local ordinance or policy change campaign. No Evidence: Pledges for smoke free homes. No indication that persons making pledges are smokers. Best Practice if petitions for smoke free restaurants are linked to campaign and will provide a contact list.

19. Clean Indoor Air No evidence that convincing restaurant owners to become smoke free or accommodate non-smokers results in a community wide change. May mitigate against policy change. Insufficient evidence that convincing employers to make their workplaces smoke free due to insufficiency of resources.

20. Clean Indoor Air Best practice of organizing community for smoke free restaurant ordinance. Reduces exposure; develops new normative behavior. Spurs substantial debate in the community on the dangers of second hand smoke; builds a health focused action group.

21. Cessation Services Increase knowledge of state Quitline and increasing the number of unique calls. Listed in one fourth of contract objectives and as an activity by 90% of the organizations. Increase available cessation services by existing health care provider network. Listed in one fifth of contract objectives and as an activity by half of the organizations.

22. Cessation Services Evidence: Quitline is efficacious service. No evidence: Community based activities such as participation in health fairs substantially increases calls. Evidence: Support to increase community wide access to cessation services.

23. Conclusion Process: Local organizations were willing and in some cases eager to participate in data collection and evaluation process they are “held harmless”. State organizations are often reluctant to articulate or require best practices in tobacco control leaving nascent local organizations to “figure it out.”

24. Conclusions Organizations were rarely “coalitions” (power or resource sharing) or had significant grassroots base. Organizations had a broad range of contracted deliverables and activities. Only a small percentage were engaged in activities related to a best practice in tobacco control. Important to monitor in the long-term, how organizations develop, if activities become focused and goals are related to best practices.