Utilizing Community Indicators To Link Process Measures To

Program Outcomes

T.M. Hinman, M.P.H., H.R. Juster, Ph.D., A.M. Beigel, M.F.A.

New York State Department of Health

Objectives

To track community coalition progress towards annual workplan goals and objectives.

To develop a reporting mechanism that links coalition activities to performance standards.

Background

Sustained tobacco control programs that utilize community resources have been shown to be effective in reducing tobacco use.

Successful comprehensive programs address tobacco control issues in multiple ways within a given community.

References

– American Cancer Society’s Communities of Excellence in Tobacco Control: A Community Planning Guide, 2000.

– Fawcett, S.B., Sterling, T.D., Paine-Andrews, A., Harris, K.J., Francisco, V.T., Richter, K.P., Lewis, R.K., and Schmid, T.L. (1995). Evaluating community efforts to prevent cardiovascular diseases. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.

Measures of Success

Community indicators (CIs) are community level objectives that measure what is occurring in a community in the areas of tobacco control.

Each objective is associated with recommended strategies and expected outcomes.

Coalition activities are linked to CIs to measure changes at the community level.

Community Indicators

38 community indicators are categorized into 4 major priority areas:

1. Eliminate Secondhand Smoke Exposure2. Prevent Youth Initiation

– School-based Prevention Indicators– Reduce Youth Access to Tobacco Products Indicators

3. Promote Tobacco Cessation Services4. Reduce Tobacco Industry Influence

– Tobacco Marketing and Deglamorization Indicators– Economic Indicators

Example Community Indicators: “Eliminate Secondhand Smoke

Exposure”

Proportion of local communities with clean indoor air policies for public buildings, private worksites, restaurants, and day care centers

Proportion of homes with a smoker in the household who report their home is smoke free

Example Community Indicators: “Prevent Youth Initiation”

Proportion of schools that provide intensive tobacco use prevention instruction

Enforcement/compliance with tobacco retail licensing requirements

Example Community Indicators:“Promote Tobacco Cessation Services”

Extent of the availability and use of culturally and linguistically appropriate behavior modification-based tobacco cessation services in the community

Proportion of public school districts that provide cessation support for students and all staff who use tobacco

Example Community Indicators:“Reduce Tobacco Industry Influence”

Extent of in-store tobacco advertising and promotions

Extent of tobacco advertising outside retail stores

Extent of tobacco advertisements in magazines, newspapers and other print media

Methods

1. Coalitions incorporate community indicators in workplan goals and objectives.Workplan Goal: to eliminate exposure to environmental tobacco

smoke.

Objective: to have 500 smokers sign a smoke-free home/car pledge via an ETS multi-media campaign.

Community Indicator(s):

Proportion of homes with a smoker in the household who report their homes/vehicles are smoke free.

Methods - continued

2. Coalitions document program activities into the Local Program Monitoring System (LPMS).The LPMS is a database management system for tracking major coalition activities and accomplishments (process evaluation).

Activities are coded into the following categories:Planning Products (PP), Media (M), Services Provided (SP), Community Actions (CA), Community Changes (CC), Impact Rating.

Methods - continued

3. Data is submitted for analysis, quarterly reports are produced.

- Activity tabulation reports by community indicator summarize process events for each coalition.

- Impact ratings are averaged by activity category.

- Cumulative activity charts highlight activity month to month.

LPMS Activity Codes

Planning Products (PP) – results of planning activities within the coalition.Example: development of a mission statement, action plans, surveys, hiring staff, grant preparation.

Media (M) – local media coverage of the coalition or its projects.Example: media campaigns developed by the coalition.

LPMS Codes - continued

Services Provided (SP) – events that inform or educate community members.Example: classes, program, workshops

Community Actions (CA) – actions taken to bring about change in the community.Example: meeting with directors of health clinic to discuss availability of cessation services to youth, other advocacy activities.

LPMS Codes-continued

Community Changes (CC) – changes in programs, policies or practices of governmental bodies, agencies, businesses and other sectors of the community.Example: health clinic offers new cessation services for youth, community restricts smoking in bars

Impact Rating – a measure of the effect of a coalition’s activities within the community. Includes breadth of the community affected and degree of movement towards workplan objectives.Examples: Low Impact - Healthfairs

Moderate Impact – write letters to local/state representatives High Impact – County ban on advertising

New York State Results: January-June, 2002

26 coalitions documented 1,708 activities that were coded to a specific community indicator

41% of activities statewide were linked to CI #24: “appropriate behavior modification-based tobacco cessation services in the community”.

26% of activities were linked to CI #9: “schools that provide intensive tobacco use prevention instruction”.

11% of activities were linked to CI #1: “clean indoor air policies”.

Cumulative Statewide Activity Chart, 2002

0

500

1000

1500

2000

2500

3000

3500

Jan Feb Mar Apr May Jun

PP

M

SP

CA

CC

Individual Coalition (#01) Report

Community

Indicator

#PP #M #SP #attendees #CA #CC

CI #1: Clean indoor air policies

9 11 2 150 11 0

CI #4: Smoke free homes

98 6 2 22 1 3

CI #9: Tobacco prevention instruction

4 44 44 2,048 1 7

CI #24: Cessation services

25 21 18 216 6 4

Impact ratings (average)

N/A 2.3 1.9 N/A 2.4 1.9

Cumulative Coalition (#01) Activity Chart – Clean Indoor Air Policies

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Jan Feb Mar Apr May Jun

PP

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CA

CC

Cumulative Coalition (#01) Activity Chart – Smoke Free Homes

0123456789

Jan Feb Mar Apr May Jun

PP

M

SP

CA

CC

Cumulative Coalition (#01) Activity Chart – Tobacco Prevention Instruction

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Jan Feb Mar Apr May Jun

PP

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CA

CC

Cumulative Coalition (#01) Activity Chart – Cessation Services

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Jan Feb Mar Apr May Jun

PP

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SP

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CC

Results The area of “Cessation Services” require direct

services be provided to the public and have resulted in increased opportunities for smokers who want to quit.

Significant planning products, media and community actions are necessary to result in expanded services to the community.

Community changes have resulted in programs, policies and practices being offered at new sites, businesses and governmental agencies within the community.

Conclusions

Quarterly reports summarize process events related to a given community indicator.

Coalitions can identify if they are meeting given targets of a specific objective documented in their workplan.

Reports provide the ability to identify areas of greatest activity and highest impact to the community.