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

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

Presentation OverviewGoal: 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

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)

Project Background:Conceptual Model

The Best Practices

TC Program Goals

Organizational Capacity &

Network

Resources

ActivitiesFacilitating Conditions Planning

Political Climate

Financial Climate

Disparate Populations

Project Background:Participating States

• 10 states evaluated (2002-2003)– Washington– Oklahoma– Indiana– Wyoming– New York– Michigan– Pennsylvania– Mississippi– Hawaii– Missouri

Best Practices (BP)

• How are the CDC Best Practices for Comprehensive Tobacco Control Programs guidelines being implemented by states?

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

Best Practices: BP Priority Categories

Best Practices: State Funding by BP Category

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

Tobacco-related Disparities

• Which groups are states identifying as having disparities related to tobacco use?

Disparities: Categories of Priority Populations

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

Disparities: Resources Used in Identifying DP

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

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

Financial and Political Climate

• What is the interrelationship of states’ financial and political climates?

Tobacco Settlement

Funds as a % of CDC Lower Recommendations

Indiana

Oklahoma

Michigan

WyomingNew York

WashingtonPennsylvania

Mississippi

200%0% 50% 100% 150%

Source: Campaign for Tobacco Free Kids

Hawaii

Financial Climate: Strengths and Challenges

• Dedication of MSA dollars to tobacco control

• Trust fund

• Cigarette excise tax increase

• Securitization

• State budget shortfalls

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

Financial & Political Climate: Rating Variables

 

Financial Climate Political Climate% of TC budget meeting

CDC lower recommendation

Climate regarding TC

Per capita spending Major TC champions

FY 03 Excise Tax Governor support level

Securitization Legislature support level

— Industry presence

Financial & Political Climate: State Comparison Summary

StatePolitical

Support Financial Support

Total

IN Very strong Strong +5

MS Very strong Strong +4

HI Strong Very Strong +4

PA Moderate Strong +2

WA Strong Moderate 0

NY Moderate Moderate -1

WY Challenging Strong -3

MI Challenging Moderate -3

OK Challenging Challenging -5

Inter-agency Relationships

• Do inter-agency relationships reflect states’ financial and political climates?

Contact Network: Strong FP Climate

Indiana

(Centrality Index 22.7%)

Mississippi

(Centrality Index 20.5%)

Contact Network: Challenging FP Climate

Michigan

(Centrality Index 10.4%)

Oklahoma

(Centrality Index 6.6%)

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

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

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.eduhttp://repositories.cdlib.org/tc/surveys