Organizing and Managing the NW Ohio Strategic Alliance for Tobacco Control

Organizing and Managing the Organizing and Managing the NW Ohio Strategic Alliance for NW Ohio Strategic Alliance for

Tobacco ControlTobacco Control

Organizing and Managing the Organizing and Managing the NW Ohio Strategic Alliance for NW Ohio Strategic Alliance for

Tobacco ControlTobacco ControlJan L. Ruma, CFRE, MEdJan L. Ruma, CFRE, MEd

Kathy S. Silvestri, MPHKathy S. Silvestri, MPH

Stuart O. Kerr, BAStuart O. Kerr, BA

James Price, MPH PhDJames Price, MPH PhD

Timothy Jordan, MEd PhDTimothy Jordan, MEd PhD

Sadik Khuder, MPH PhDSadik Khuder, MPH PhD

Jan L. Ruma, CFRE, MEdJan L. Ruma, CFRE, MEd



James Price, MPH PhDJames Price, MPH PhD

Timothy Jordan, MEd PhDTimothy Jordan, MEd PhD

Sadik Khuder, MPH PhDSadik Khuder, MPH PhD

The Alliance programming is The Alliance programming is funded in large part by:funded in large part by:

The Alliance programming is The Alliance programming is funded in large part by:funded in large part by:

The Ohio Tobacco Use The Ohio Tobacco Use Prevention and Control Prevention and Control Foundation (OTUPCF)Foundation (OTUPCF)

The Ohio Tobacco Use The Ohio Tobacco Use Prevention and Control Prevention and Control Foundation (OTUPCF)Foundation (OTUPCF)

The ProblemThe ProblemThe ProblemThe Problem In the U.S., more than 2,000 youth under the In the U.S., more than 2,000 youth under the

age of 18 start smoking daily.age of 18 start smoking daily.Source: MMWR Surveillance Summary 2002;51(SS04)Source: MMWR Surveillance Summary 2002;51(SS04)

In Ohio, 11.5% of high school youth reported In Ohio, 11.5% of high school youth reported having smoked their first whole cigarette having smoked their first whole cigarette before the age of 11.before the age of 11.Source: Ohio Youth Tobacco Survey, 2002Source: Ohio Youth Tobacco Survey, 2002

In Ohio, 68.5% of middle school and 78.3% of In Ohio, 68.5% of middle school and 78.3% of high school students are exposed to second high school students are exposed to second hand smoke while indoors or riding in cars.hand smoke while indoors or riding in cars.

Source: Ohio Youth Tobacco SurveySource: Ohio Youth Tobacco Survey, 2002, 2002

The ProblemThe ProblemThe ProblemThe Problem In NW Ohio 32% of high school students In NW Ohio 32% of high school students

in grades 9-12 have used tobacco in the in grades 9-12 have used tobacco in the past 30 days.past 30 days.

46% of NW Ohio youth in grades 4-12 46% of NW Ohio youth in grades 4-12 live in a household with a smoker.live in a household with a smoker.

58% of students surveyed were in a room 58% of students surveyed were in a room with someone smoking in the past week.with someone smoking in the past week.

13% will definitely or probably smoke a 13% will definitely or probably smoke a cigarette in the next 3 months.cigarette in the next 3 months.Source: NW Alliance Tobacco Use Survey, 2003Source: NW Alliance Tobacco Use Survey, 2003

Alliance VisionAlliance VisionAlliance VisionAlliance Vision

Established in 2001Established in 2001 The NW Ohio Strategic Alliance for The NW Ohio Strategic Alliance for

Tobacco Control will significantly reduce Tobacco Control will significantly reduce tobacco use through community-based tobacco use through community-based partnership, and implementation of a partnership, and implementation of a comprehensive research-based tobacco comprehensive research-based tobacco control plan.control plan.

Alliance MissionAlliance MissionAlliance MissionAlliance Mission To develop a tobacco control plan for To develop a tobacco control plan for

Northwest Ohio, request funding for the Northwest Ohio, request funding for the plan from the Ohio Tobacco Use plan from the Ohio Tobacco Use Prevention and Control Foundation, and Prevention and Control Foundation, and to implement the plan to measurably to implement the plan to measurably reduce tobacco use in the targeted reduce tobacco use in the targeted populations.populations.

Williams

Wood

FultonLucas

HenryDefiance

PauldingPutnam

Ottawa

Sandusky

HancockSeneca

Erie

Huron

WyandotAllen

Auglaize

Alliance Service AreaAlliance Service Area

Alliance ProgramsAlliance ProgramsAlliance ProgramsAlliance Programs Youth Prevention ProgramsYouth Prevention Programs

– LifeSkillsLifeSkills– Word of MouthWord of Mouth– STAMPSTAMP– TATUTATU– Project AlertProject Alert

Youth Cessation ProgramsYouth Cessation Programs– TAPTAP– TEGTEG

Reduce Smoking During PregnancyReduce Smoking During Pregnancy– 5 A’s Counseling Intervention5 A’s Counseling Intervention

FoundationFoundationFoundationFoundation

The Alliance tobacco control plan is based on:The Alliance tobacco control plan is based on: Best Practices for Comprehensive Tobacco Best Practices for Comprehensive Tobacco

Control Programs, Control Programs, the the U.S. Centers for Disease U.S. Centers for Disease Control and Prevention (CDC, 1999)Control and Prevention (CDC, 1999)

Program and Funding Guidelines for Program and Funding Guidelines for Comprehensive Local Tobacco Control Comprehensive Local Tobacco Control ProgramsPrograms, The National Association of County , The National Association of County and City Health Officials (NACCHO)and City Health Officials (NACCHO)

The Strategic Plan of the Ohio Tobacco Use The Strategic Plan of the Ohio Tobacco Use Prevention and Control FoundationPrevention and Control Foundation

Session OutcomesSession OutcomesSession OutcomesSession Outcomes Discuss the nine elements of developing a Discuss the nine elements of developing a

collaborative approach to implementing a collaborative approach to implementing a comprehensive tobacco control plan.comprehensive tobacco control plan.

Identify management strategies for the Identify management strategies for the successful implementation and evaluation of a successful implementation and evaluation of a coordinated regional approach to tobacco coordinated regional approach to tobacco control. control.

Define the role of local coalitions in the Define the role of local coalitions in the implementation of a regional, comprehensive implementation of a regional, comprehensive tobacco control plan.tobacco control plan.

Why Collaborate to Reduce Why Collaborate to Reduce Tobacco Use? Tobacco Use?

Why Collaborate to Reduce Why Collaborate to Reduce Tobacco Use? Tobacco Use?


Project Director, Northwest Ohio Strategic Project Director, Northwest Ohio Strategic Alliance for Tobacco ControlAlliance for Tobacco Control

Vice President, Hospital Council of NW OhioVice President, Hospital Council of NW Ohio




Why Collaborate?Why Collaborate?Why Collaborate?Why Collaborate?

Commitment to mission of significantly reducing Commitment to mission of significantly reducing tobacco usetobacco use

To develop a comprehensive approachTo develop a comprehensive approach

To put the community’s needs first To put the community’s needs first

To bring the greatest possible resources to NW To bring the greatest possible resources to NW Ohio in a coordinated fashion & improve our Ohio in a coordinated fashion & improve our ability to work together as a regionability to work together as a region

Alliance Early WinsAlliance Early WinsAlliance Early WinsAlliance Early Wins

Regional, Voluntary Governance StructureRegional, Voluntary Governance Structure Representative Steering Committee with Representative Steering Committee with

diverse backgroundsdiverse backgrounds Member input and communication systemMember input and communication system Weighted funding allocation formulaWeighted funding allocation formula Development and implementation of a Development and implementation of a

comprehensive research-based tobacco control comprehensive research-based tobacco control planplan

Alliance Early WinsAlliance Early WinsAlliance Early WinsAlliance Early Wins

Secured Funding For:Secured Funding For: 30 subcontractors in 16 NW Ohio counties 30 subcontractors in 16 NW Ohio counties Tobacco use surveillance systemTobacco use surveillance system Key indicator program evaluation systemKey indicator program evaluation system Evidence-based youth prevention and cessation Evidence-based youth prevention and cessation

programs programs Best practice guidelines to reduce tobacco use Best practice guidelines to reduce tobacco use

by women during pregnancy in various by women during pregnancy in various hospital and clinic settings.hospital and clinic settings.

Enhancement of local coalitions Enhancement of local coalitions

Alliance Early Wins Alliance Early Wins Alliance Early Wins Alliance Early Wins

5,283 youth in grades 4-12 surveyed for 5,283 youth in grades 4-12 surveyed for tobacco use opinionstobacco use opinions

In the past 4-6 months:In the past 4-6 months:– 2,291 youth reached through prevention 2,291 youth reached through prevention

programs programs – 635 youth through cessation programs635 youth through cessation programs– 693 pregnant women and health providers 693 pregnant women and health providers

through 5As counseling interventionthrough 5As counseling intervention Changing Community Norms (clean indoor Changing Community Norms (clean indoor

air--Cities of Toledo and Bowling Green)air--Cities of Toledo and Bowling Green)

Nine Elements of a Nine Elements of a Collaborative Approach to Collaborative Approach to

Tobacco ControlTobacco Control

Nine Elements of a Nine Elements of a Collaborative Approach to Collaborative Approach to

Tobacco ControlTobacco ControlJan L. Ruma, CFRE, MEdJan L. Ruma, CFRE, MEd






1. External Catalyst1. External Catalyst1. External Catalyst1. External Catalyst

An external force is required for change.An external force is required for change.

Master Tobacco Settlement Agreement Master Tobacco Settlement Agreement 11/199811/1998

Formation of Ohio Tobacco Use Formation of Ohio Tobacco Use Prevention & Control Foundation 2/2000Prevention & Control Foundation 2/2000

2. Neutral Leadership2. Neutral Leadership2. Neutral Leadership2. Neutral Leadership

Mission-minded, community leadership is needed.

“A great hunger for community and collaboration exists everywhere . . . despite profound mistrust, alienation, and skepticism. People want to come together. They simply do not know how.”

E. Schindler-Rainman & R. Lippitt

2. Neutral Leadership2. Neutral Leadership2. Neutral Leadership2. Neutral Leadership

Mission-minded, community leadership is needed.

NW Ohio Coalition (founded in 1994) met with NW Ohio Coalition (founded in 1994) met with local member of Foundation Board 3/2001local member of Foundation Board 3/2001

Healthy Communities Foundation (HCF) of the Healthy Communities Foundation (HCF) of the Hospital Council of NW Ohio (HCNO) was Hospital Council of NW Ohio (HCNO) was asked by the Coalition to lead a regional effort.asked by the Coalition to lead a regional effort.

2. Neutral Leadership2. Neutral Leadership2. Neutral Leadership2. Neutral Leadership HCF secured a planning grant 7/2001HCF secured a planning grant 7/2001 Hired strategic planning consultant (Catherine Hired strategic planning consultant (Catherine

Kinney, PhD)Kinney, PhD) Appointed project directorAppointed project director

– Experienced collaborative leaderExperienced collaborative leader

– Political savvyPolitical savvy

– Servant leadership philosophyServant leadership philosophy

– Unwavering enthusiasm and dedication to Unwavering enthusiasm and dedication to the missionthe mission

3. Regional Readiness 3. Regional Readiness 3. Regional Readiness 3. Regional Readiness Organizations must delegate authority Organizations must delegate authority

for successful collaboration.for successful collaboration.

Conducted Regional Readiness Survey Conducted Regional Readiness Survey 8/20018/2001

Analyzed and Disseminated ResultsAnalyzed and Disseminated Results Nominations and Appointment of Nominations and Appointment of

Steering Committee 9/2001Steering Committee 9/2001

Components of the RegionalComponents of the RegionalReadiness SurveyReadiness SurveyComponents of the RegionalComponents of the RegionalReadiness SurveyReadiness Survey

Sent to Organizational Leadership in the Sent to Organizational Leadership in the RegionRegion

– Hospital CEOs, Health Hospital CEOs, Health Commissioners, Non-Profit Executive Commissioners, Non-Profit Executive Directors, Government Agency HeadsDirectors, Government Agency Heads

44 Organizations Responded44 Organizations Responded

Regional ReadinessRegional ReadinessSurveySurvey Regional ReadinessRegional ReadinessSurveySurvey

Mission/Structure/PlanningMission/Structure/Planning

95.5% agree with the mission of the Alliance95.5% agree with the mission of the Alliance

72% agree with the proposed structure72% agree with the proposed structure

91% give the Alliance the authority to 91% give the Alliance the authority to develop a tobacco control plandevelop a tobacco control plan

Regional Readiness SurveyRegional Readiness SurveyRegional Readiness SurveyRegional Readiness Survey

ImplementationImplementation

93% are comfortable with the Alliance 93% are comfortable with the Alliance coordinating the implementation of the plancoordinating the implementation of the plan

86% are comfortable with the Alliance identifying 86% are comfortable with the Alliance identifying

service providers to implement the planservice providers to implement the plan

88% are comfortable with the Alliance evaluating 88% are comfortable with the Alliance evaluating the performance of the service providers the performance of the service providers


Fiscal ResponsibilityFiscal Responsibility

95.5% are comfortable giving the Alliance authority to 95.5% are comfortable giving the Alliance authority to apply for funds apply for funds

84% are comfortable giving the Alliance the authority 84% are comfortable giving the Alliance the authority to allocate fundsto allocate funds

AdministrationAdministration

95% are comfortable with the Healthy Communities 95% are comfortable with the Healthy Communities Foundation administering the AllianceFoundation administering the Alliance


Alliance AuthorityAlliance Authority Do you agree with the proposed:Do you agree with the proposed:

– Mission 95.5%Mission 95.5%

– Structure 72%Structure 72%

– Lead Agency (Healthy Communities Lead Agency (Healthy Communities Foundation of the Hospital Council of Foundation of the Hospital Council of NW Ohio) 95%NW Ohio) 95%

4. Process for Action 4. Process for Action 4. Process for Action 4. Process for Action You can’t lead people where they You can’t lead people where they

are not ready to go.are not ready to go.

If you bring a diverse and appropriate group If you bring a diverse and appropriate group of people together, give them good of people together, give them good information and an effective process, they information and an effective process, they will create effective strategies and take will create effective strategies and take responsibility to implement them.responsibility to implement them.

4. Process for Action 4. Process for Action 4. Process for Action 4. Process for Action Start Where People AreStart Where People Are ListenListen EducateEducate AccommodateAccommodate Build Consensus to Accomplish the MissionBuild Consensus to Accomplish the Mission Movement from Silo to Collaborative Movement from Silo to Collaborative

PerspectivePerspective Focus on the target of reducing tobacco use . . . Focus on the target of reducing tobacco use . . .

allowing organizational roles to fall into place.allowing organizational roles to fall into place.

5.5. Decision-Making ModelDecision-Making Model5.5. Decision-Making ModelDecision-Making Model

Decisions must be based on research and Decisions must be based on research and

made through consensus to build trust.made through consensus to build trust.

Research-Based Tobacco Control PlanResearch-Based Tobacco Control Plan Planning Template To:Planning Template To:

– Prioritize strategies, indicators, Prioritize strategies, indicators, leverage points, and activitiesleverage points, and activities

NW Ohio Tobacco Control NW Ohio Tobacco Control Plan ComponentsPlan ComponentsNW Ohio Tobacco Control NW Ohio Tobacco Control Plan ComponentsPlan Components

VisionVision StrategiesStrategies IndicatorsIndicators

To measurably

reduce tobacco

use in NWOhio

Prevent youth tobacco use

initiation% youth 12-18 who have tried

tobacco

Implement prevention programs

Recruit youth advocates for tobacco control

ActivitiesActivities

Reduce youth tobacco

consumption

Reduce tobacco use

among pregnant

women and diverse,

underserved populations

% youth reporting use

in last 30 days

%of tobacco use within the

targeted population

Involuntary youth cessation programs

Voluntary youth cessation programs

Culturally specific programming

Implement 5As Counseling Intervention for Prenatal

Clients

All indicators stratified by ethnic group, age, gender, economic status, county

5.5. Decision-Making ModelDecision-Making Model5.5. Decision-Making ModelDecision-Making Model

Decisions must be based on research and Decisions must be based on research and made through consensus to build trust.made through consensus to build trust.

Weighted Funding FormulaWeighted Funding Formula– Increased allocation to rural and diverse Increased allocation to rural and diverse

countiescounties Implementation PlanImplementation Plan Alliance StructureAlliance Structure

– RoleRole– Operating ProceduresOperating Procedures

Strategies to monitor progress and qualityStrategies to monitor progress and quality

6. Secure Funding 6. Secure Funding 6. Secure Funding 6. Secure Funding

No money, no missionNo money, no mission..

Funding should flow through collaborative tableFunding should flow through collaborative table Request for Implementation Plans 4/2002Request for Implementation Plans 4/2002

– Plans required to address one or more goalsPlans required to address one or more goals– Evidenced-based programsEvidenced-based programs

Steering Committee Selected Plan Implementers Steering Committee Selected Plan Implementers 5/20025/2002

OTUPCF Released RFP 6/2002OTUPCF Released RFP 6/2002 Proposal Submitted 7/2002Proposal Submitted 7/2002 $835,000 Grant Awarded 10/2002$835,000 Grant Awarded 10/2002 Renewable for Three YearsRenewable for Three Years

6. Secure Funding 6. Secure Funding 6. Secure Funding 6. Secure Funding Alliance Funding Distributions in Year One

Local Level Interventions

79%

Evaluation7%

Surveillance6%

Coordination8%

7. Implement the Plan 7. Implement the Plan 7. Implement the Plan 7. Implement the Plan

Ongoing care, feeding, hand-holding and conflict resolution required.

Experienced professional to coordinate plan implementation– Content knowledge– Interpersonal skills– Ability to problem-solve– Provide technical assistance – Bridge the gap between practice and theory

Steering Committee guides decision-making

8. Engage Grassroots 8. Engage Grassroots Coalitions Coalitions

8. Engage Grassroots 8. Engage Grassroots Coalitions Coalitions

Harness the passion to reduce tobacco use.

Re-energize existing or form new tobacco control coalitions

Encourage local coalitions to coordinate tobacco control efforts within their service area

Encourage local coalitions to lead policy initiatives

9. 9. Continuous Improvement CycleContinuous Improvement Cycle 9. 9. Continuous Improvement CycleContinuous Improvement Cycle Be prepared to expand what is working and

change what is not.

Experienced professionals to design an indicator-based evaluation strategy– Program evaluation content knowledge– Knowledge of latest research-based tobacco

control strategies– Flexibility

9. 9. Continuous Improvement CycleContinuous Improvement Cycle 9. 9. Continuous Improvement CycleContinuous Improvement Cycle

Be prepared to expand what is working and change what is not.

Experienced professionals must:– Maintain an interest in building evaluation

capacity of subcontractors– Communicate complex program evaluation

results in subcontractor language Regular Progress Reports to the Alliance and

OTUPCF

Nine Elements of a Nine Elements of a Collaborative Approach to Collaborative Approach to Tobacco ControlTobacco Control

Nine Elements of a Nine Elements of a Collaborative Approach to Collaborative Approach to Tobacco ControlTobacco Control1.1. External CatalystExternal Catalyst2.2. Neutral LeadershipNeutral Leadership3.3. Regional ReadinessRegional Readiness4.4. Process for ActionProcess for Action5.5. Decision-Making ModelDecision-Making Model6.6. Secure FundingSecure Funding7.7. Implement the PlanImplement the Plan8.8. Engage grassroots coalitionsEngage grassroots coalitions9.9. Continuous Improvement CycleContinuous Improvement Cycle

Alliance ChallengesAlliance ChallengesAlliance ChallengesAlliance Challenges

Relying on one grant to create a system to Relying on one grant to create a system to reduce tobacco usereduce tobacco use

Traveling Upstream: Silos Rule!Traveling Upstream: Silos Rule! Coordination with tobacco control efforts Coordination with tobacco control efforts

in NW Ohio funded independently of the in NW Ohio funded independently of the AllianceAlliance

Expand programs that are proven effectiveExpand programs that are proven effective Improve or eliminate ineffective programs Improve or eliminate ineffective programs Financial SustainabilityFinancial Sustainability

Alliance OpportunitiesAlliance OpportunitiesAlliance OpportunitiesAlliance Opportunities Demonstrate effectiveness of Alliance Model Demonstrate effectiveness of Alliance Model

compared to independent granteescompared to independent grantees Apply Alliance Model to other public health Apply Alliance Model to other public health

challengeschallenges Organizational shift to viewing their role in Organizational shift to viewing their role in

tobacco control in the context of the Alliance tobacco control in the context of the Alliance system as a wholesystem as a whole

Learn how to use our community resources Learn how to use our community resources effectivelyeffectively

Change NW Ohio community norms regardingChange NW Ohio community norms regarding tobacco usetobacco use

Managing Program Managing Program Implementation and EvaluationImplementation and Evaluation

Managing Program Managing Program Implementation and EvaluationImplementation and Evaluation


Project Coordinator, Northwest Ohio Strategic Project Coordinator, Northwest Ohio Strategic Alliance for Tobacco ControlAlliance for Tobacco Control

Director of Health Planning for Hospital Council Director of Health Planning for Hospital Council of Northwest Ohioof Northwest Ohio


Project Coordinator, Northwest Ohio Strategic Project Coordinator, Northwest Ohio Strategic Alliance for Tobacco ControlAlliance for Tobacco Control

Director of Health Planning for Hospital Council Director of Health Planning for Hospital Council of Northwest Ohioof Northwest Ohio

Key Program Components to Key Program Components to ManageManageKey Program Components to Key Program Components to ManageManage

Building Trust and RespectBuilding Trust and Respect Multi-Layered Communication SystemMulti-Layered Communication System Evaluation Strategy ComponentsEvaluation Strategy Components Youth Tobacco Use Surveillance SystemYouth Tobacco Use Surveillance System Program SubcontractorsProgram Subcontractors Alliance OutcomesAlliance Outcomes

Building Trust and RespectBuilding Trust and RespectBuilding Trust and RespectBuilding Trust and Respect

Listen to problem-solve, trouble-shoot, Listen to problem-solve, trouble-shoot, and supportand support

Pay attention to the needs and concerns Pay attention to the needs and concerns of individual subcontractorsof individual subcontractors

Be flexibleBe flexible Maintain sense of humorMaintain sense of humor

Multi-Layered Multi-Layered Communication SystemCommunication SystemMulti-Layered Multi-Layered Communication SystemCommunication System

TUPCFTUPCF Program DirectorProgram Director Program CoordinatorProgram Coordinator Steering CommitteeSteering Committee

– e-mail list serve “Tobacco Control”e-mail list serve “Tobacco Control”– Monthly meetingsMonthly meetings

Alliance SubcontractorsAlliance Subcontractors– e-mail list serve “Tobacco Talk”e-mail list serve “Tobacco Talk”– personal phone and conference callspersonal phone and conference calls– visitsvisits

General Alliance MembershipGeneral Alliance Membership– WinFax messagesWinFax messages– General Alliance meetings and trainingsGeneral Alliance meetings and trainings

Youth Tobacco Use Youth Tobacco Use Surveillance SystemSurveillance SystemYouth Tobacco Use Youth Tobacco Use Surveillance SystemSurveillance System Contracted with outside vendor (Great Lakes Contracted with outside vendor (Great Lakes

Marketing) for:Marketing) for:– Survey developmentSurvey development– Data collection and analysis planData collection and analysis plan– Coordination with local school districts through Coordination with local school districts through

coalitions and subcontractorscoalitions and subcontractors– Development of individual county report formatDevelopment of individual county report format– Executive summary of NW Ohio youth tobacco Executive summary of NW Ohio youth tobacco

use opinionsuse opinions– Comparison with national and state figuresComparison with national and state figures– Report distributionReport distribution

Alliance Surveillance Alliance Surveillance ProceduresProceduresAlliance Surveillance Alliance Surveillance ProceduresProcedures

GLM pilot tested the survey instrument with 5 GLM pilot tested the survey instrument with 5 classrooms. Conducted “logic check” for classrooms. Conducted “logic check” for readability, acceptability, and reliability. readability, acceptability, and reliability.

Great Lakes Marketing (GLM) and Alliance Great Lakes Marketing (GLM) and Alliance subcontractors contacted school administrators subcontractors contacted school administrators for permission so conduct survey.for permission so conduct survey.

Employees of GLM administered surveys to Employees of GLM administered surveys to students. Data analysis completed by GLM.students. Data analysis completed by GLM.

Alliance Surveillance Alliance Surveillance Survey InstrumentSurvey InstrumentAlliance Surveillance Alliance Surveillance Survey InstrumentSurvey Instrument

Based on National Youth Tobacco Survey Based on National Youth Tobacco Survey (NYTS) 2001-2002 Core Questionnaire (NYTS) 2001-2002 Core Questionnaire – Modified for Alliance useModified for Alliance use

– Affords comparison of NW Ohio data to state and Affords comparison of NW Ohio data to state and national data (CDC) national data (CDC)

Used CDC guidelines for school-based tobacco Used CDC guidelines for school-based tobacco programs as basis for items regarding the role programs as basis for items regarding the role of schools of schools

Total of 77 items: Likert-type response formats Total of 77 items: Likert-type response formats or multiple choice formatsor multiple choice formats

Alliance Surveillance Alliance Surveillance Survey SubjectsSurvey SubjectsAlliance Surveillance Alliance Surveillance Survey SubjectsSurvey Subjects

Cluster sampling methods of grades 4-12Cluster sampling methods of grades 4-12 Grade levels & number of students were Grade levels & number of students were

proportional to school district populationsproportional to school district populations Random selection of grades and classrooms Random selection of grades and classrooms

from all 16 NW Ohio counties in the Alliancefrom all 16 NW Ohio counties in the Alliance 124 schools were included in the sample124 schools were included in the sample Final sample size = 5,283Final sample size = 5,283 5,000 students completed the survey5,000 students completed the survey Completion rate = 95%Completion rate = 95%

Characteristics of Characteristics of RespondentsRespondentsCharacteristics of Characteristics of RespondentsRespondents

1266

543 556 549 561 560 599

367

0

200

400

600

800

1000

1200

1400

TO

TA

L N

UM

BE

R

11 12 13 14 15 16 17 18

AGES

Total Number by Ages

Components of the Alliance Components of the Alliance Evaluation StrategyEvaluation StrategyComponents of the Alliance Components of the Alliance Evaluation StrategyEvaluation Strategy

Evaluation Team Contract for:Evaluation Team Contract for: Youth Tobacco Use SurveysYouth Tobacco Use Surveys

– Grades 7-12Grades 7-12– Excel and ScanTron formatsExcel and ScanTron formats

Elementary School Youth Tobacco Use SurveyElementary School Youth Tobacco Use Survey– Grades 4-6Grades 4-6

Tobacco Use During Pregnancy SurveyTobacco Use During Pregnancy Survey Translation of surveys to SpanishTranslation of surveys to Spanish Program implementation logsProgram implementation logs Ongoing data analysisOngoing data analysis Continuous feedback and trainingContinuous feedback and training

Alliance Evaluation Alliance Evaluation Strategy MeasuresStrategy MeasuresAlliance Evaluation Alliance Evaluation Strategy MeasuresStrategy Measures

Examples of Common Indicators include:Examples of Common Indicators include: Decrease likelihood that a student will initiate Decrease likelihood that a student will initiate

smoking “intension to use.”smoking “intension to use.” Increase the skill to say “no” when offered tobacco, Increase the skill to say “no” when offered tobacco,

referred to as “refusal skills.”referred to as “refusal skills.” Increasing the number of quit attempts.Increasing the number of quit attempts. Increasing the proportion of tobacco users who Increasing the proportion of tobacco users who

successfully quit.successfully quit. Increase the number of women who attempt to quit Increase the number of women who attempt to quit

smoking during pregnancy.smoking during pregnancy. Increase the number of health care providers who use Increase the number of health care providers who use

the 5As counseling intervention.the 5As counseling intervention.

Program SubcontractorsProgram SubcontractorsProgram SubcontractorsProgram Subcontractors Making the CommitmentMaking the Commitment

– Subcontractor program narratives and Subcontractor program narratives and budgets budgets

– Yearly contractsYearly contracts Easy Quarterly Reporting ProcessEasy Quarterly Reporting Process

– Subcontractor report templateSubcontractor report template– Used to prepare summary report to TUPCFUsed to prepare summary report to TUPCF– Electronic reportingElectronic reporting

Making Quarterly PaymentsMaking Quarterly Payments– Setting up the accounting systemSetting up the accounting system

Key Alliance Outcomes to be Key Alliance Outcomes to be Reported – Year OneReported – Year OneKey Alliance Outcomes to be Key Alliance Outcomes to be Reported – Year OneReported – Year One

Reducing Tobacco Use During PregnancyReducing Tobacco Use During Pregnancy– CO monitor verified quit rates and CO monitor verified quit rates and

reductionsreductions Health Practitioners Role in Tobacco Health Practitioners Role in Tobacco

ControlControl– Use of Stages of Change to measure the Use of Stages of Change to measure the

increase of appropriate behaviors in increase of appropriate behaviors in regards to the 5 A’s Counseling regards to the 5 A’s Counseling Intervention Intervention


Youth Prevention and Cessation Youth Prevention and Cessation ProgrammingProgramming– Behavioral intention to use tobaccoBehavioral intention to use tobacco– Social approval of tobacco useSocial approval of tobacco use– Perceived role of schoolsPerceived role of schools– Additional tobacco educationAdditional tobacco education– Perceived health risks of tobaccoPerceived health risks of tobacco– Student attitudesStudent attitudes– Cessation outcomesCessation outcomes

CO Monitor verified quit rates and reductionsCO Monitor verified quit rates and reductions


Youth Prevention and Cessation Youth Prevention and Cessation ProgrammingProgramming– Smokeless tobacco useSmokeless tobacco use– Peer influencesPeer influences– Stages of ChangeStages of Change– Cigarette smoking behaviorCigarette smoking behavior– Fagerstrom scale of addictionFagerstrom scale of addiction– Cigar useCigar use– Outside influencesOutside influences

Early Alliance OutcomesEarly Alliance OutcomesStages of Change: Adolescent SmokersStages of Change: Adolescent Smokers

Stage Hollis Pallonen NW Ohio

PrecontemplationPrecontemplation 23.523.5 48.548.5 43.043.0

ContemplationContemplation 37.437.4 30.230.2 25.725.7

PreparationPreparation 26.226.2 21.121.1 10.710.7

ActionAction 0.60.6 0.30.3 0.00.0

MaintenanceMaintenance 0.00.0 0.00.0 0.00.0

RelapseRelapse NRNR NRNR 20.620.6

N= 346 394 498

Hollis, et. al. (2003). Am J Health Prom. 17: 231-239.Hollis, et. al. (2003). Am J Health Prom. 17: 231-239.

Pallonen (1998). Prev Med. 27: A29-A38.Pallonen (1998). Prev Med. 27: A29-A38.

Long-Term Alliance Long-Term Alliance OutcomesOutcomesLong-Term Alliance Long-Term Alliance OutcomesOutcomes

Because we know where we started, at the Because we know where we started, at the end of three years, we will not see a end of three years, we will not see a dramatic decrease in the number of smokersdramatic decrease in the number of smokers

But we should be able to detect changes in But we should be able to detect changes in the attitudes and beliefs towards tobacco use the attitudes and beliefs towards tobacco use in youth and pregnant womenin youth and pregnant women

And we will know what worksAnd we will know what works

The Role of Grassroots The Role of Grassroots Coalitions in a Regional Coalitions in a Regional

Comprehensive Tobacco Control Comprehensive Tobacco Control PlanPlan

The Role of Grassroots The Role of Grassroots Coalitions in a Regional Coalitions in a Regional

Comprehensive Tobacco Control Comprehensive Tobacco Control PlanPlan


Alliance Steering CommitteeAlliance Steering Committee

Regional Policy Coordinator, NW OhioRegional Policy Coordinator, NW Ohio

Tobacco Free OhioTobacco Free Ohio


Alliance Steering CommitteeAlliance Steering Committee

Regional Policy Coordinator, NW OhioRegional Policy Coordinator, NW Ohio

Tobacco Free OhioTobacco Free Ohio

Changing Community Changing Community NormsNormsChanging Community Changing Community NormsNorms

PolicyPolicy

–InterestInterest

–EducationEducation

–OrganizationOrganization

–FundingFunding

–Action Action

Resources for Local Resources for Local Coalitions in NW OhioCoalitions in NW OhioResources for Local Resources for Local Coalitions in NW OhioCoalitions in NW Ohio

Tobacco Free Ohio (TFO)Tobacco Free Ohio (TFO) American Cancer Society (ACS)American Cancer Society (ACS) American Lung Association (ALA)American Lung Association (ALA) American Hospital Association (AHA)American Hospital Association (AHA) Ohio Department of Health (ODH)Ohio Department of Health (ODH) Ohio Tobacco Use Prevention and Control Ohio Tobacco Use Prevention and Control

Foundation (OTUPCF)Foundation (OTUPCF) Hospital Council of Northwest Ohio (HCNO)Hospital Council of Northwest Ohio (HCNO) NW Ohio Strategic Alliance for Tobacco

Control

Impact of the Alliance on Impact of the Alliance on GrassrootsGrassrootsImpact of the Alliance on Impact of the Alliance on GrassrootsGrassroots

Think regional and act locallyThink regional and act locally–Regional PlanRegional Plan–Local implementationLocal implementation

Through the Alliance counties Through the Alliance counties are not competing for fundingare not competing for funding

Coalitions Pre-AllianceCoalitions Pre-Alliance

Usual suspects Scared of money Emphasis on education Limited outcomes

Forming New CoalitionsForming New Coalitions

Alliance served as catalyst to Alliance served as catalyst to create coalitionscreate coalitions

Reenergized existing coalitionsReenergized existing coalitions Becoming more focused Becoming more focused ““New kids on the block” in New kids on the block” in

tobacco controltobacco control

Clean Indoor Air Clean Indoor Air Ordinances in NW OhioOrdinances in NW OhioClean Indoor Air Clean Indoor Air Ordinances in NW OhioOrdinances in NW Ohio

Ballot Ballot InitiativesInitiatives

RegulationsRegulations OrdinanceOrdinance

City of City of Bowling Bowling GreenGreen

City of City of FindlayFindlay

City of ToledoCity of Toledo

City of City of DefianceDefiance

City of ToledoCity of Toledo

City of City of WauseonWauseon

Example of Coordination Example of Coordination through Coalitionsthrough CoalitionsExample of Coordination Example of Coordination through Coalitionsthrough Coalitions

Tobacco Education, Prevention, and Tobacco Education, Prevention, and Cessation Committee (TEPAC Cessation Committee (TEPAC Committee) of the Lucas County Committee) of the Lucas County Tobacco Prevention CoalitionTobacco Prevention Coalition

Purpose: To coordinate Lucas County Purpose: To coordinate Lucas County tobacco control effortstobacco control efforts

Example of Coordination Example of Coordination through Coalitionsthrough CoalitionsExample of Coordination Example of Coordination through Coalitionsthrough Coalitions

Accomplishments to date:Accomplishments to date: Tobacco cessation & prevention Tobacco cessation & prevention

program guide for physiciansprogram guide for physicians Preparing marketing toolkit for Preparing marketing toolkit for

local bar ownerslocal bar owners Developing collaborative decision Developing collaborative decision

making policiesmaking policies

Alliance Clean Indoor Air Alliance Clean Indoor Air (CIA) (CIA)

Policy GoalPolicy Goal

Alliance Clean Indoor Air Alliance Clean Indoor Air (CIA) (CIA)

Policy GoalPolicy Goal

Ohio is a home rule stateOhio is a home rule state–Most townships and counties can Most townships and counties can

not pass CIA ordinancesnot pass CIA ordinances Cities can pass CIA ordinancesCities can pass CIA ordinances The ultimate goal is a State CIA The ultimate goal is a State CIA

policypolicy

Questions?Questions?Questions?Questions?

Documents

Organizing and Managing the NW Ohio Strategic Alliance for Tobacco Control