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

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

5
Background Project Aims
  • The Best Practices Evaluation Project
  • Develop a comprehensive picture of a states
    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 Preventions (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 partners 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)
State Per capita TC spending () meeting CDC minimum recommendations
MS 7.29 108
IN 5.54 97
HI 7.39 83
PA 4.37 82
WA 3.53 62
WY 8.47 57
NY 2.90 55
OK 1.10 17
MI 0.53 10
MO 0.32 5
12
Utilization Best Practices Familiarity
Agency Type Mean SD
Lead agency 2.33 .637
Advisory consulting 2.33 .492
Contractors/grantees 2.02 .766
Coalitions 1.97 .770
Voluntary health advocacy 1.97 .861
Other state agencies 1.43 .776
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 needs assessment
Tobacco use prevalence literature
Disparate populations literature
Anecdotal information
Other
CDC Best Practices guidelines
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
Strength of states of participants
Provides basic framework 10 32
Emphasizes comprehensive approach 9 30
Provides useful funding recommendations 9 28
Is evidence-based 9 21
Published from reputable source 8 22
22
States Evaluation Weaknesses
Weakness of states of participants
Lacks implementation guidance 9 18
Not updated with new evidence 6 8
Does not address disparate populations 6 8
23
States Evaluation Suggested Improvements
Improvements of states of participants
Provide more successful programs from diverse populations 8 15
Recognize guidelines are dynamic and need to be updated regularly 8 11
Provide implementation strategies 6 12
Provide cost effectiveness data (limited budget guidelines and potential impact) 5 11
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
Contact Information
  • Nancy B. Mueller, MPH
  • Research Manager
  • Center for Tobacco Policy Research
  • Saint Louis University School of Public Health
  • mueller_at_slu.edu
  • http//ctpr.slu.edu
  • 314/977-4027
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