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, – 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 Exposure 2. Prevent Youth Initiation – School-based Prevention Indicators – Reduce Youth Access to Tobacco Products Indicators 3. Promote Tobacco Cessation Services 4. 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, 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

Individual Coalition (#01) Report Community Indicator #PP#M#SP #attendees #CA#CC CI #1: Clean indoor air policies CI #4: Smoke free homes CI #9: Tobacco prevention instruction 444 2,04817 CI #24: Cessation services Impact ratings (average) N/A2.31.9N/A2.41.9

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

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

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

Cumulative Coalition (#01) Activity Chart – Cessation Services

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.