1. A Travel Adventure April Roeseler California Tobacco Control Program July 9, 2009

2. Historical Context for CX in 2000 California had completed over a decade of tobacco control work MSA was to generate $25 billion for California Prop 10 to generate $700 million annually Several local projects had promising interventions aimed at building community involvement and assessing the community in relation to standardized criteria

3. CX Goals Broaden participation of the community in local planning Implement a systematic framework to assess a community’s needs and assets Develop meaningful plans that emphasize community norm change strategies Strengthen the evaluation of local program efforts by examining similar interventions across and analyzing factors that contribute to success

4. CX is Born Circa 2000 California: efforts to increase community involvement & to use uniform criteria to assess a community were underway+ Nationally: ACS was developing a community planning model to jump-start effective use of MSA funds California and ACS partner = California & ACS partner on CX

5. CX Dissemination 2004 TTAC released CX Plus manual 2005 CDC issued Key Outcome Indicators 2005 California Prevention & Nutrition Center developed CX 3 indicators and began pilot testing it 2006 CTCP uses CX with Pilot Priority Population projects and Several states use CX including OK, NE, WI, MI 2006 MA adapts California CX indicators

6. CX an Adventure in Travel The CX needs assessment is your pre-trip research about possible destinations

7. Where do you want to go? Indicators and assets reflect possible travel destinations to investigate –Smoke-free outdoor dining –Smoke-free multi-unit housing –Tobacco retail licensing –Cessation services –Increased coalition diversity –Increased level of community activism

8. How will you decide where you want to go? Rating several indicators and assets gives you an idea of community needs based on data collected Priority setting allows you to select the most valuable destinations while factoring in your budget, people resources, time available, community readiness, coalition interest

9. The Travel Itinerary Your tobacco control plan is your travel itinerary which details where you will stay, sites you will visit, and the timeline for various portions of your trip

10. Trip Destination Plan objectives specify exactly where you intend to go –Where you are starting from –Where you will end up –When you plan to arrive –How you know that you have arrived

11. Trip Details Intervention activities describe how you are going to get to your destination and sight seeing along the way to the final destination

12. Timelines The plan timelines reflect arrival and departure dates for major activities. They describe how long you will spend at various sites.

13. Responsible Parties These are your traveling companions, tour guides that you hire, and others (both budgeted and non-budgeted, such as volunteers or coalition members) who are assigned various tasks on the trip.

14. Tracking Measures These are the souvenirs that you will collect and save from the trip. They may include press releases, training materials, survey instruments, and sign-in sheets. Some of these things you will share with your friends at CTCP in progress reports, others you will keep in your office and only share if your CTCP friends come visit your office to hear about your travels.

15. Document Your Trip Your evaluation documents your trip so you can share your experiences with others and have an even better trip next time because of all you learned on this trip

16. Basic Travel Assumptions Theory of Change This is the rationale that explains why the proposed interventions should work –Theory gives planners tools for moving beyond intuition to design and evaluate interventions –Theory provides a road map for studying problems and developing and evaluating interventions http://www.nci.nih.gov/PDF/481f5d53-63df-41bc-bfaf- 5aa48ee1da4d/TAAG3.pdf

17. Money Matters The Budget Your budget guides whether you will be staying in youth hostels or 4-star hotels, whether you will be eating at nice restaurants or from street vendors and how much you have to spend on souvenirs

18. Advice on Traveling Companions Have a Great Trip Get buy-in for travel destinations Set expectations about the trip Picking people who know the language spoken or have familiarity with the destination can make for a smoother trip

19. Benefits to Pre-Trip Research Avoid getting lost Pack the right clothes for the weather and activities Avoid fights with traveling companions over the quality of the hotels or food Avoid ruining relationships over unmet expectations Avoid wasting time and money

20. Benefits to Pre-Trip Research There’s a vast number of tobacco control destinations and you have limited money, people resources, and time Focusing on several destinations (indicators and assets) vs. the universe makes the pre-trip research more manageable Helps to identify possible types of activities that you need to include in the plan, (e.g., increase public support, improve cultural diversity of the coalition, expand educational activities, etc.)

21. Have Friends, Will Travel Benefits to Involving Traveling Companions in the Pre-Trip Research Ties the program to the community Brings together a variety of expertise and influence Bridges language and cultural gaps Increases the likelihood that members of your target audience will come into contact with your messages Mobilizes and empowers the community

22. “I wish my bags had been lighter” Benefits to Using Data in Your Pre- trip Research Arrive at a destination that is worth going to Helps you defend to others that this is an important destination (especially when it is a controversial destination) Keeps you focused on spending your limited resources on changing tangible community norms, (e.g., How will my community be different as a result of this trip?) Helps you figure out what items you need to pack for the trip (e.g., paid advertising, spokesperson training for coalition members, cameras to document the trip)

23. Indicators are Possible Destinations Tobacco control related environmental or community level measure Addresses an intermediate tobacco-related goal Items are stated neutrally

24. Indicator 1.1.11 Number and type of tobacco use, tobacco advertising, and secondhand smoke depiction by the entertainment industry (e.g., movies, music videos, TV, music, etc.) -or- The extent that elected officials, parent organizations, health groups, and others adopt resolutions and voluntary policies that promote a socially responsible depiction of tobacco use, tobacco advertising, and secondhand smoke by the entertainment industry (e.g., movies, music videos, TV, music, etc.)

25. What’s in a Rating? The overall CX rating factors in several characteristics

26. Destination: China or Smoke-free MUH? Attributes Hotels Restaurants Tourist Sites Transportation Climate Money Exchange Health Considerations Passport/Visa Issues Public Awareness Public Support Media Attention Educational Awareness Campaign Media Campaign Voluntary Policy Legislated Policy Enforcement Compliance

27. What does the CX Rating Mean?

28. What does the rating mean? The numerical rating is associated a descriptive meaning

29. Comments give music to the rating

30. Rating the Destination Indicator Rating Based on the nine (or so) attribute scores and the comments, the group comes to a consensus on an overall rating –The overall rating is not derived by averaging the attribute scores –It reflects a group consensus based on the ratings and comments

31. Meaning of the Rating Describes how well the community is doing in relationship to a specific indicator Reflects the community’s perception of the data while boiling it all down to the overall rating

32. BUT…that’s not scientific!

33. It’s a Needs Assessment Not Rocket Science Based on quantitative and qualitative data Based on community input Rating guide provides assistance to differentiate between descriptive terms of “None” to “Excellent”

34. Even if it’s not Rocket Science It helps in deciding where to go Comments are Helpful!

35. Rating Rubric Guide to the meaning of “None” to “Excellent”

36. Value of the CX Rating Makes it easier to make comparisons Provides a marker for community readiness Suggests what activities you need to “beef-up” Progress can be tracked over time Easy to communicate

37. Statewide CX Rating Core Indicators California Local Health Departments

38. California Local Health Department Budget Allocations by CX Indicators 2001-2007

39. CX Evaluation Positives and Negatives http://www.dhs.ca.gov/tobacco/documents/eval/CXRptFinal.pdf

40. Evaluation of the Community Intervention Tobacco Control Supplement There was strong evidence that higher local efforts and a well implemented work plan was predictive of TRL policies and SHS policies passed locally.

41. Dr. Who’s Coalition Rates Smoke-free Beaches as a Must See Destination