1. Program Highlights, Highlights,Evaluation & Surveillance 2002-2004

2. Highlights from 2002-2004 Awarded grants to 25 agencies across Cuyahoga County Awarded grants to 25 agencies across Cuyahoga County Target areas included Cleveland (East and West), Lakewood, Warrensville Heights, Garfield Heights, Euclid, Cleveland Heights/University Heights Target areas included Cleveland (East and West), Lakewood, Warrensville Heights, Garfield Heights, Euclid, Cleveland Heights/University Heights

3. Highlights 2002-2004 Reached 2,414 fourth grade students with Word of Mouth Program (27 schools) Reached 2,414 fourth grade students with Word of Mouth Program (27 schools) Reached 1,666 sixth grade students with the Life Skills Program (14 schools) Reached 1,666 sixth grade students with the Life Skills Program (14 schools) Enrolled 356 adults in the Freedom from Smoking Program in 12 sites across Cuyahoga County Enrolled 356 adults in the Freedom from Smoking Program in 12 sites across Cuyahoga County

4. Highlights 2002-2004 Conducted two vendor compliance check programs reaching 474 sites Conducted two vendor compliance check programs reaching 474 sites Established 16 SHOUT teams Established 16 SHOUT teams Launched a second media campaign Launched a second media campaign

5. School-Based Prevention 4 th & 5 th graders: Word of Mouth 6 th graders: Life Skills Training School-Based Prevention 4 th & 5 th graders: Word of Mouth 6 th graders: Life Skills Training

6. Program Evaluation Methodology Pre- and post-test design. Post-test is within one month following the program (short-term). Pre- and post-test design. Post-test is within one month following the program (short-term). Pencil/paper questionnaire Pencil/paper questionnaire Standardized questions Standardized questions Changes over time examined. Changes over time examined. No control group in Year 2 evaluation (added in Year 3). No control group in Year 2 evaluation (added in Year 3).

7. Word of Mouth (4 th /5 th grade) 20% have been offered a cigarette in the past. 8% have tried at least a puff or two of a cigarette. 21% think that more than half of kids their age smoke. 53% live with someone who smokes. 8% do not think that smoking is harmful to their health. Students who live with a smoker are more than 3 times more likely to have tried smoking than those who do not live with a smoker (12% vs. 3%). Students who live with a smoker are also 3 times more likely to say they’ll probably smoke in the future (9% vs. 3%).

8. Program Impact: Word of Mouth Most of students begin the program with anti-tobacco beliefs. However, among the small number of students who don’t the program does impact their beliefs. Before the program started only 8% of students felt cigarettes were not harmful. However, 73% of these students changed their opinion after the program (compared to only 4% changing from harmful to not harmful). Before the program started, only 6% of students said they would be smoking five years from now. However, over half (51%) of these students changed their mind after the program, as compared to only 3% who developed new intentions to smoke.

9. Life Skills Training (6 th graders) 34% have been offered a cigarette or little cigar (41% males; 27% females). 18% have tried one or both of them. 12% of 11 yr olds; 21% of 12 yr olds and 37% of 13+ yr olds have tried smoking. Among those who have tried, 11% report that they now smoke everyday. 81% say that at least one parent has told them not to smoke in the past 12 months. 30% report that at least one of their 4 closest friends have tried smoking.

10. Program Impact: Life Skills Most of these students also begin the program with anti- tobacco beliefs. Program does appear to have a short-term impact. For example, only 10% of students felt it was safe to smoke for a few years as long as you quit after that. However, 74% of these students changed their opinion after the program (compared to only 7% changing from unsafe to safe). Before the program started, only 6% of students said they intended smoke in the next year. However, 34% of these students changed their mind after the program, as compared to only 5% who developed new intentions to smoke.

11. Smoking Cessation Freedom From Smoking Smoking Cessation Freedom From Smoking

12. Nearly half (49%) of adults in Cuyahoga County who currently smoke have tried to quit at least once in the past year. - Source: 2003 Cuyahoga County BRFSS. 47% of Cuyahoga County high school smokers say that they have tried to quit in the past 12 months. -Source: 2003 Partnership Youth Tobacco Survey

13. Adult Smoking Cessation Age when FSS participants started smoking regularly Use of Cessation Aids Among the 356 participants, % who had previously tried the following cessation aids: Nicotine patch48% Nicotine gum31% Pills (Zyban,Wellbutrin)26% Inhaler/nasal (Nicotrol) 7% Lozenge (Commit) 9% Counseling (face-to-face) 5% Tobacco Quitline 6%

14. Freedom from Smoking Of the 356 enrolled in the FES program, over half completed at least 5 sessions and 43% completed a final survey on the 8 th session. Of the 356 enrolled in the FES program, over half completed at least 5 sessions and 43% completed a final survey on the 8 th session. Of these participants, 84% reported quitting during the program and 74% were still abstinent on the last session (8 weeks). Of these participants, 84% reported quitting during the program and 74% were still abstinent on the last session (8 weeks). Current evaluation includes 30, 60, and 90 day follow ups. Current evaluation includes 30, 60, and 90 day follow ups.

15. Adult Tobacco Surveillance 2003 Cuyahoga County Risk Behavior Survey Random Digit, Telephone-Based Survey 1,516 Cuyahoga County residents Aged 18 and Older, Aug-Oct, 2003 Data collected by ORC Macro and managed by the CASE Center for Health Promotion Research Dept. of Epidemiology and Biostatistics CASE School of Medicine

16. Adult Tobacco Use in Cuyahoga County: 2003 Cuyahoga County BRFSS Current Tobacco Users

17. Adult Cigarette Use: County, State & National Comparisons Adult Cigarette Use: County, State and National Comparisons Cigarette Smoking History a Cuyahoga County, 2003 Ohio, 2003 b National, 2003 b Never Smokers 48.550.753.0 Past Smoker 24.923.924.6 Current Cigarette User 26.725.422.1 a Current cigarette smoking is defined in the BRFSS as persons aged 18-98 years who report having smoked >100 cigarettes during their lifetime and who currently smoke every day or some days. Past smokers report smoking >100 cigarettes but not currently. Never smokers report smoking <100 cigarettes in their lifetime. b State and national comparison data are derived from the 2003 Behavioral Risk Factor Surveillance Survey. The BRFSS is a state-based system and therefore does not provide a national estimate. Thus, thus as suggested by the CDC, the median prevalence rate across the 50 states is used for the national estimate (CDC, 2004).

18. Other Tobacco Products: County, State & National Comparisons Other Tobacco Product Use Among Adults: County, State and National Comparisons Other Tobacco Products Cuyahoga County, 2003 Ohio, 2002 a National, 2002 a Pipe Use0.8 Cigar Use b 5.27.25.7 Cigar & Little Cigar (e.g. Black & Milds) Use 7.1n/a Smokeless Tobacco Use1.62.83.6 a Data on other tobacco products, such as cigars, pipes and smokeless tobacco, are only collected in the even years (i.e., 2000, 2002) in the Ohio BRFSS. Thus, 2003 county-level estimates can only be compared to estimates from the 2002 Ohio BRFSS. b The BRFSS does not ask specifically about the use of little cigars (e.g., Black and Milds). Due to the suspected high use in Cuyahoga County, these products were specifically assessed in the Cuyahoga County BRFSS. Thus, cigar use prevalence is provided both with and without little cigar use for comparative purposes.

19. Key for Prevalence Rates Prevalence of Total Tobacco Use Among Adults, Cuyahoga County, 2003 Highest: 41% Lowest: 22%

20. Key for Prevalence Rates Prevalence of Cigarette Use Among Adults, Cuyahoga County, 2003 Highest: 42% Comparison: Ohio: 25.4% National: 22.1% Lowest: 16%

21. Key for Prevalence Rates Prevalence of Cigars and Little Cigar Use Among Adults, Cuyahoga County, 2003 Highest: 18% Lowest: 5% Comparison (cigars only): Ohio: 7.2% National: 5.7%

22. Adolescent Surveillance Partnership Youth Tobacco Survey (PYTS) Grade 9-12

23. Demographics of Adolescent Sample Grade Level Grade Level 30% 9 th grade 30% 9 th grade 28% 10 th grade 28% 10 th grade 22% 11 th grade 22% 11 th grade 19% 12 th grade 19% 12 th grade SES SES 25% Low 25% Low (neither parent attended college) (neither parent attended college) 54% Med 54% Med (at least 1 parent attended some college) (at least 1 parent attended some college) 21% High 21% High (at least 1 parent has graduate education) (at least 1 parent has graduate education) Gender Gender 48% Female 52% Male Race Race 56% White 26% African-American 7% Hispanic 3% Asian 2% Multiracial 1% American Indian 1% Pacific Islander Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

24. Prevalence of Students Who Are Currently Using Tobacco Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

25. Current Tobacco Use, by Product WhiteAfrican-AmericanHispani c % Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

26. Although only 16% of adolescents currently smoke cigarettes, an additional 47% appear to be susceptible to smoking in the future. Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

27. Parental Attitudes May Impact Student Tobacco Use % who have tried tobacco % who currently use tobacco Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

28. State and National Comparisons No tobacco related behaviors were reported at significantly higher rates in Cuyahoga County than in the state or nation. Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

29. State and National Comparisons Current Bidi Use Current Bidi Use Lifetime Cigarette Use Lifetime Cigarette Use Early Onset of Cigarette Use Early Onset of Cigarette Use Regular Cigarette Use Regular Cigarette Use Current Bidi Use Current Bidi Use Better than Ohio Better than US Data provided by the Center for Adolescent Health, CASE www.adolhealth.org

30. Year Three Expand the delivery of youth prevention and adult smoking cessation programs. Expand the delivery of youth prevention and adult smoking cessation programs. Launch a pilot youth smoking cessation program. Launch a pilot youth smoking cessation program. Enhance program evaluation design with the addition of control groups. Enhance program evaluation design with the addition of control groups. Continue adult and youth surveillance. Continue adult and youth surveillance.