2007 Johns Hopkins Bloomberg School of Public Health Section B ASSIST Evaluation.
-
Upload
kelley-morgan -
Category
Documents
-
view
218 -
download
0
Transcript of 2007 Johns Hopkins Bloomberg School of Public Health Section B ASSIST Evaluation.
2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Section BSection B
ASSIST Evaluation
2 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Measures
Strength of tobacco control index Index to measure state capacity and
infrastructure
Initial outcomes index Measure of policy change
Media advocacy Assessed change in newspaper coverage of
tobacco policy issue
3 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Measures
Final outcomes Smoking prevalence (number of people who
smoke) Adults 18+ Tobacco Use Supplement to the Current
Population Survey (TUS-CPS), an NCI-sponsored survey that was part of the U.S. Census Bureau’s Current Population Survey in 1992, 1993, 1998, and 1999
Per capita cigarette consumption Calculated every two months for each state Sales data for the total number of
cigarette packs moved from wholesale warehouses, divided by the state’s adult population
4 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
What Is the TUS-CPS?
Source: http://riskfactor.cancer.gov/studies/tus-cps/
http://riskfactor.cancer.gov/studies/tus-cps/
5 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
NCI State Cancer Legislative Database
Image source: U.S. National Cancer Institute. (2007).
http://www.scld-nci.net/scld_tobaccoratings.cfml
6 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Strength of Tobacco Control Index (SoTC)
SoTC summarizes the multiple components of tobacco control efforts
Provides information on which components of ASSIST or ASSIST-like programs might be related to lower smoking prevalence or cigarette consumption
SoTC is a multi-element measurement Assesses the effects of three variables in each
state:
1. Tobacco control resources (funding)
2. Capacity and infrastructure
3. Program efforts focused on policy and environmental change
7 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
SoTC Conceptual Framework
8 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Initial Outcome Index (IOI)
Cigarette price NCI Cancer Legislative Database
Smoke-free work environment TUS-CPS
Clean indoor air (CIA) legislative rating NCI Cancer Legislative Database
9 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Components of the Legislative Ratings
Clean indoor air Government work
sites Private work sites Schools Childcare facilities Restaurants Retail stores Recreation/cultural
facilities Penalties Enforcement
Youth access Minimum age Packaging Clerk intervention Photo
identification Vending machines Free distribution Graduated
penalties Random inspections Enforcement
10 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Source: adapted by CTLT from U.S. National Cancer Institute. (2006). Monograph 17.
Initial Outcome Index (IOI)
11 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
IOI Averaged over ASSIST/Non-ASSIST States
Source: adapted by CTLT from U.S. National Cancer Institute. (2006). Monograph 17.
12 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Newspaper Tracking System
Content analysis of all daily newspapers in all states (n = 1,767)
Continuous tracking from October 1993 to December 2000
Selective extraction of tobacco control policy coverage Clean indoor air Access to minors Economic disincentives Advertising and promotion Miscellaneous
Image source: Daily Freeman. (May 11, 2002).
13 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Variables Collected by the Newspaper Tracking System
Coverage of tobacco issues Volume Placement Type of articles Slant
Image sources: The Palm Beach Post. (May 9, 2002); New York Post. (May 12, 2002).
14 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Trend in Newspaper Coverage by Policy
Source: adapted by CTLT from U.S. National Cancer Institute. (2006).
15 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Overall Challenges for the ASSIST Evaluation
Evaluate NCI non-randomized study and understand tobacco control as conducted within states across the United States
Address the complex, independent, and non-linear forces occurring Many state-level factors
Test a process for reducing tobacco use on a population-wide level Multiple experiments are occurring with
slightly different approaches in each state
16 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Overall Challenges for the ASSIST Evaluation
Lack of consistent measurement data
Gaps in linking exposures to outcomes
Lack methods to measure quality, fidelity, and rate of implementation
Need better methods to model dynamic hierarchical and time series data
17 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Data Challenges
Limited baseline data
No measure of intervention dose or exposure
Diffusion of intervention strategies to non-ASSIST states; variation between ASSIST states in implementation of interventions
Lack of data to assess tobacco industry’s strength of counter efforts
18 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Framing the Results
“The small but significant differences in the reduction of adult smoking prevalence in ASSIST, when applied on a population basis, could be expected to have a large impact on the public’s health”
“If all 50 states and the District of Columbia had implemented ASSIST, there would have been approximately 1,213,000 fewer smokers nationally”
Source: Stillman, F., et al. (2003).
19 2007 Johns Hopkins Bloomberg School of Public Health 2007 Johns Hopkins Bloomberg School of Public Health
Summary
ASSIST evaluation established the effectiveness of the ASSIST interventions Lower adult smoking prevalence in ASSIST
states Lower consumption rates in states with higher
levels of SoTC, especially related to capacity Lower prevalence and consumption in states
with stronger policies
Results from ASSIST provided evidence that the investment in state tobacco control programs that focused on policy interventions was an effective strategy to reduce tobacco use