The CDC Best Practices: Implementation of the guidelines by 10 state tobacco control programs

1. The CDC Best Practices: Implementation of the guidelines by 10 state tobacco control programs Nancy B. Mueller, MPH Center for Tobacco Policy Research Saint Louis University School of Public Health

2. Acknowledgements • Douglas A. Luke, PhD • Stephanie Herbers, BA • Tanya Montgomery, MPH • Project funded by the American Legacy Foundation

3. Presentation Overview • Project background • Utilization of Best Practices guidelines • Specific state strategies • States’ evaluation of the guidelines • Conclusions

4. Cessation programs Chronic disease programs Community programs Counter-marketing Enforcement School programs Statewide programs Surveillance and evaluation Administration and management Background: The CDC Best Practices for Comprehensive Tobacco Control Programs

5. Background: Project Aims The Best Practices Evaluation Project • Develop a comprehensive picture of a state’s tobacco control program • 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)

6. Background: Participating States(2002-2003)

7. Background: Methods • Three phases of data collection • Archival data retrieval– inform interview team • Lead agency survey – provide background information on tobacco control program • Partner interviews – obtain information on program from key stakeholders in state • Quantitative and qualitative measures • Interview tailored to partner’s role in program • In-person or via telephone

8. Background: Tobacco Control Partners • Six agency types • Lead agency • Contractors/grantees • Coalitions • Other state agencies • Voluntary health & advocacy agencies • Advisory & consulting agencies • ~15 agencies/state interviewed (avg. 17 participants/state) • 162 interviews completed (50% in-person) • Average length of interview: 73 minutes

9. Background: Best Practices Measures • Level of familiarity with the guidelines • Estimated expenditures by BP category • Prioritization of categories • Utilization strategies • Evaluation of guidelines

10. Results: Utilization of Best Practices

11. Tobacco Control Program Characteristics(FY 02 & FY 03)

12. Utilization: Best Practices Familiarity F = 3.04; p = .012

13. Utilization: Estimated Funding Expenditures Millions $0 $2 $4 $6 $8 Community Counter-Marketing Cessation Statewide School S & E Enforcement Chronic Disease Admin. & Mgmt. States' Estimated Expenditures CDC Lower Recommendations

14. Utilization: Partners’ Category Prioritization

15. Utilization: Most common strategies • Model for tobacco control programs • lead agencies, contractors, grantees • Advocacy efforts, particularly funding • voluntary health and advocacy agencies • Program implementation • lead agencies, contractors, grantees, coalitions, and advisory/consulting agencies • General reference and grant writing • contractors, grantees, coalitions

16. Utilization: Least Common Strategies • Program evaluation • Program accountability • Training of new staff • Public education

17. Results: State Specific Strategies

18. State Specific Strategies: Models

19. State Specific Strategies: Disparities 0% 20% 40% 60% 80% 100% Epidemiologic data State/local needsassessment Tobacco use prevalence literature Disparate populationsliterature Anecdotal information Other CDC Best Practicesguidelines Other evidence-based guidelines Other state TC programs experience Other state TC programs data

20. Results: States’ Evaluation of Best Practices

21. States’ Evaluation: Strengths

22. States’ Evaluation: Weaknesses

23. States’ Evaluation: Suggested Improvements

24. States’ Evaluation: Addressing Disparities • More research should be conducted to identify effective culturally specific strategies • Case study examples should be provided • Guidelines should give the ‘nuts and bolts’ on how to address disparities so states can tailor it • A more culturally competent approach should be emphasized when working with populations

25. Summary & Future Directions

26. Summary of Findings • Prioritization of BP categories closely followed estimated funding expenditures • Lead agencies, advisory and consulting agencies were most familiar with guidelines • Community and counter-marketing programs were highest priorities

27. Summary of Findings • Chronic disease and enforcement were lowest priorities • States developed their own models based on the nine Best Practices categories • The guidelines did not adequately address tobacco-related disparities

28. Future Directions • Revision of the guidelines should address: • Suggested improvements and adapted models • Current financial challenges facing programs • Current evidence-based science • Wider dissemination of guidelines beyond lead agency, grantees, and contractors needs to happen.

29. Nancy B. Mueller, MPH Research Manager Center for Tobacco Policy Research Saint Louis University School of Public Health mueller@slu.edu http://ctpr.slu.edu 314/977-4027 Contact Information