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Why Indicators MatterUsing Outcome Indicators to Plan and Evaluate Comprehensive Tobacco Control Programs
Todd Rogers, PhD
California Tobacco Control Program, CX Webinar
July 9, 2009
Plan for this Presentation
• Demonstrate the importance of indicators for:– Planning and evaluating tobacco control programs– Monitoring the national tobacco control effort– Advocating for policy support and additional
resources
Specific, observable, and measurable characteristics that shows progress a program is making toward achieving a specified outcome
What is an indicator?
Measuring Program Outcomes: A Practical Approach. Alexandria, VA: United Way of America; 1996
Characteristics of a “Good” Indicator
• Relevant – important/useful information• Affordable – requires reasonable resources• Valid
– Appropriate – meaningful for intended use– Understandable – makes sense
• Reliable – minimal measurement error
Inputs
Activities
Outputs
Outcomes
Context
Simplified Program Logic Model
Focus on Program Outcomes
Outcomes
Completed effortsto disseminate
anti-tobacco/pro-healthmessages
Completed efforts to reduce and counteractpro-tobacco messages
Inputs
Activities
Completed efforts to increase tobacco
curricula and tobacco free policies
Outputs
Reduced initiationamong youth
Reduced youth smoking prevalence
School-based
prevention
Policy and Regulatory
Action
2
1
13
14
Targeted toDisparate
Populations
3
Decreased tobacco-related disparity
Reduced tobacco-related morbidity
and mortality
16
15
Completed efforts to increase restriction and
enforcement of tobacco sales to
minors
Completed efforts to increase cigarette
excise tax
5
4
Communitymobilization
Countermarketing
Long-term
State Health Department
and Partners
Reducedsusceptibility to experimentation
Decreased access
Increased price on cigarettes through tax
Increased anti-tobacco policies and programs
in schools
8
9
10
12
11
Increased in anti-tobacco attitudes,
support for policies to reduce youth initiation
7
6
IntermediateShort-term
Reduced tobacco industry influences
Increased restriction, enforcement on
restrictions on tobacco sales to minors
Outcome Component 9
Reduced tobacco industry influences
Indicator 1.9.3
Extent of tobacco advertising outside stores
Indicators Drive Program Planning
• Develop program outcome objectives in the context of logical model “pathways” and associated outcome indicators
• Integrate program and evaluation planning
Indicators Shape Program Objectives
From: Local Program Evaluation Planning Guide (December 2004)California Department of Health Services, Tobacco Control Section
Local Evaluation of a “Pathway”
• Does passage of SHS policies lead to:– Increased enforcement of policies?– Increased compliance with policies?– Reductions in reported exposure to SHS?
Weber MD, Bagwell DAS, Fielding JE, Glantz SA. Long term compliance with California’s Smoke-Free Workplace Law among bars and restaurants in Los Angeles County. Tobacco Control 2003;12:269-273.
Although CX was an Early Innovation in State Tobacco Control Planning and Evaluation …
… There are Other National Efforts to Track Key Outcome Indicators for Tobacco Control …
… and Indicators are Being Developed for Many Other Public Health Issues
Indicators Are Widely Used to Track State and National Progress in Tobacco Control
CDC OSH Indicator Utilization by Funded State Tobacco Control Programs
(2007-08)
Initiation SHS Cessation Total
Avail Used Avail Used Avail Used Avail Used
Short 38 25 19 18 24 23 81 66
Inter 12 11 5 5 4 4 21 20
Long 4 4 8 8 6 6 18 18
Total 54 40 32 31 34 33 120 104
TM
CDC OSH Indicators Not Being Utilized by Funded State Programs (2007-08)
Indicator Type
1.6.6 Level of awareness among parents about the importance of discussing tobacco use with their children
Init ST
1.8.3 Proportion of jurisdictions with policies that control the location, number and density of retail outlets
Init ST
1.9.4 Proportion of jurisdictions with policies that regulate the extent of tobacco advertising outside of stores
Init ST
1.9.8 Extent of tobacco advertising in print media Init ST
1.9.10 Number and type of MSA violations by tobacco companies Init ST
1.9.12 Amount of tobacco industry campaign contributions to local and state politicians
Init ST
1.11.5 Proportion of young people reporting that they purchased cigarettes from a vending machine
Init IT
TM
• Of 120 KOIs named by CDC, CTCP lacks data on only 22 indicators (18%):– Youth initiation – 6/54 missing (11%)– Secondhand smoke – 4/32 missing (13%)– Cessation – 12/34 missing (35%), especially on health
care provider and insurance-related indicators
CTCP Evaluation Indicators Overlap Substantially with CDC OSH Indicators
State Indicator Tracking Motivates Policy and Media Advocacy Actions
Indicator Data Presented by CTFK in State-Specific Press Releases
Summary
• Indicators help your planning and evaluation efforts
• Indicators are used to monitor state-specific and national progress
• Indicator data are used to advocate for poicy change and program support
• Indicators matter
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