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


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


What Is the TUS-CPS?

Source: http://riskfactor.cancer.gov/studies/tus-cps/

http://riskfactor.cancer.gov/studies/tus-cps/


NCI State Cancer Legislative Database

Image source: U.S. National Cancer Institute. (2007).

http://www.scld-nci.net/scld_tobaccoratings.cfml


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


SoTC Conceptual Framework


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


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


Source: adapted by CTLT from U.S. National Cancer Institute. (2006). Monograph 17.

Initial Outcome Index (IOI)


IOI Averaged over ASSIST/Non-ASSIST States

Source: adapted by CTLT from U.S. National Cancer Institute. (2006). Monograph 17.


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).


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).


Trend in Newspaper Coverage by Policy

Source: adapted by CTLT from U.S. National Cancer Institute. (2006).


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


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


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


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).


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

2007 Johns Hopkins Bloomberg School of Public Health Section B ASSIST Evaluation.

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