Transcript Putting the Pieces Together to Create a Smoke

Putting the Pieces Together to
Create a Smoke-Free Vermont
Todd Hill, LiCSW, LADC and Jessie
Brosseau, MPH
Vermont Department of Health
Introduction

Program established in January 2001

Designed to be comprehensive, based on CDC Best
Practices

Creation of the VT Tobacco Evaluation and Review
Board


VT Statute: “There is created and established, within the office of
the secretary, a body to be known as the Vermont tobacco
evaluation and review board, an independent state board created
to work in partnership with the agency of human services and
the department of health in establishing the annual budget,
program criteria and policy development, and review and
evaluation of the tobacco prevention and treatment programs”.
Funding - In 2004 Vermont was ranked 11th in the
nation by the Campaign for Tobacco Free Kids for
percentage of funding according to CDC minimums.
Vermont’s funding was 59% of the recommended
CDC amount.
Introduction (2)

Goals (Healthy Vermonters 2010)
 Reduce the prevalence of adult smoking to 12%

Reduce the prevalence of youth smoking to 16%

Increase the percentage of adult smokers who
attempt to quit to 75%


Increase percentage of pregnant women who quit
smoking during the first trimester of pregnancy to
30% Reduce the percentage of young children
regularly exposed to tobacco smoke to 10%
Some success in achieving goals, not complete.
Program Components


Tobacco-Free Communities/Community
Coalitions
Media and Public Education/CounterMarketing

Help for Smokers to Quit/Cessation

Tobacco-Free Schools

Enforcement

Evaluation
Tobacco-Free Communities/Community
Coalitions


There are currently 20 coalitions
Coalitions participate in RFP process on an annual
basis – RFP includes work plan for the year, specifically
detailing how they will:
 Participate in the “Common Themes” campaigns


Work on the three stated goals of dealing with
second hand smoke, cessation, and youth projects
Goals for coalitions mirror those set at the state-level
 However, the strategies to achieve them are
developed and implemented at site, local level.
Tobacco-Free Communities/Community
Coalitions (2)


Required to collaborate with community organizations.
Examples include – hospitals, health care providers,
youth organizations, businesses and retailers.
Required to Participate in Common Themes Campaign
 3 messages per year determined at state-level

During time of state campaign, coalitions required to
perform activities and events related to the same topic
area

As above, overall topic is mandated, strategies are
localized

State and local messages reinforce each other
Tobacco-Free Communities/Community
Coalitions (3)

Required to Participate in Common Themes
Campaign (cont)
 In 2004, the 3 common campaigns were:
 Creating a smoke free zone around kids (910/04)


Quitting to save money (11/04-1/05)
Butts of Hollywood/Smoking in the movies (34/04)
2004 Tobacco
Community
Coalitions
Shaded areas represent
communities served by a
Community Coalition
Media and Public Education/CounterMarketing


Tobacco industry spends approximately $24 million per
year in Vermont
 Develop own messages and use those created by
other states where appropriate.
Use media and counter-marketing efforts to connect
smokers to services and to increase awareness of the
services available.
 Campaigns are correlated with increases in
enrollment
Media and Public Education/CounterMarketing (2)

Adult campaigns focus on multiple areas:
 Common themes


Young adults, Quit to save money, Take it outside
Youth campaigns focus on prevention
 “8 out of 10”

“Good Reasons” to say no to smoking

Butts of Hollywood
Media and Public Education/CounterMarketing (3)


Contract with a Media firm, Kelleher, Samets, Volk in
order to help develop media plans, produce
coordinated, themed materials.
 Gives a common look to a campaign, takes pressure
off the coalitions to have to produce their own
materials, and reduces cost by mass producing
materials for the whole state, instead of 20
coalitions paying to produce a limited product in
their area.
Various outlets used to reach population –
 Include: tv, radio, newspaper ads, bus signs,
holiday shopping bags, workplace tool kits,
sponsorships, direct mail, news stories, etc.
2002-2004 Unduplicated, Current Smoker Calls to Quit Line and Hospital-Based
Program by Month*
600
Quit Line
500
VAHHS
Statewide
Household
Mailing
5/2004
Direct Mail
VHAP
"Chuck" -> "Line"
April 8 - Jun 16
# of Callers
400
VHAP
Mailing
Dec 2003
Media Campaign
"Photos" Series
Nov 20 - Feb 23
300
200
100
Month
Feb
Dec
Oct
Aug
June
2004
Apr
Feb
Dec
Oct
Aug
June
2003
Apr
Feb
Dec
Oct
Aug
June
2002
April
Feb
0
2005
*Quit Line data does not include non-smokers calling for information only, those requesting only community referrals, or those with an unknown service
at time of intake. Hospital-based program data does not include those who are Quit Line users who must use hospital-based program to get their Quit
Bucks.
Laundromat :60 Television
PGSFX :60 Radio
Help for Smokers to Quit/Cessation

Provide services and increase accessibility of NRT
 Quit Line
 24/7 provision of services



Provide counseling and referral to local
communities
Recently added direct shipping of NRT to
certain populations
Average number of calls per month
 2001-2004: 147.2

2001:91, 2002: 143.8, 2003: 139.3, 2004:
205.3
Help for Smokers to Quit/Cessation (2)

Provide services and increase accessibility of NRT
(cont)
 Community Counseling Services/VAHHS
 Group, Individual, Telephone Counseling

Coordinator located in each of our 14 hospitals

Collaborate with hospitals to enroll inpatients;
also outpatients and walk-ins

Provision of free NRT to those who participate
in counseling (Quit Bucks and Quit Bills
Programs – outline insurance requirements in
notes section)
Help for Smokers to Quit/Cessation (3)

Specific Programs and Initiatives to Address Targeted
Groups
 TAP/TEG, NOT (Not on Tobacco- the American
Lung Association) programs to help youth quit

Young adults

Pregnant women

Recently begun working with RU12 to target the
GLBT population
Tobacco-Free Schools

Department of Education School-based Tobacco Use
Prevention Program funds local school efforts.
 Receipt of funds requires:
 Strategic plan that meets CDC
recommendations




Employment of tobacco use prevention
coordinator
Development of comprehensive school tobacco
policy
Delivery of tobacco use prevention education
Involvement of parents and community
members
Tobacco-Free Schools (2)

Prevention education and cessation service programs
are based upon research-based curricula


Prevention models include Know Your Body (K-6)
and Life Skills (3-6)
Cessation programs provide punishment options
for kids caught smoking on grounds and help for
kids who want to quit. Programs include:
TAP/TEG and NOT
Number of Vermont Schools Teaching Research-Based Tobacco Prevention Curricula
Vermont Department of Education, 1997 - 2005
250
Number of Schools
200
150
100
50
0
1997
1999
2001
2003
2004
*Expected number of schools based upon implementation plans and midway reports submitted in December 2004.
2005*
Tobacco-Free Schools (3)

Actively engage kids in the anti-tobacco movement
via peer leadership and youth empowerment
programs
 VKAT (kids in 5 – 8 grade)
 Plan and conduct local activities to inform
peers and communities of hazards of smoking
and to support tobacco-free choices.
 Example: Annual Statehouse rally against
smoking

OVX (kids in 9 – 12 grade)
 Youth run and youth led

Locally design and implement activities.
Includes media.
 Key participants in implementing 2005 Butts
of Hollywood campaign
Enforcement


Training by DLC of tobacco licensees became
mandatory in 2002.
 Via seminars, some of which are co-sponsored by
the local community coalitions, on site trainings,
and training tapes
Tobacco Compliance Checks
Tobacco Compliance Checks
By Department of Liquor Control
Year
# Checks
% Passed
2000
1,320
77%
2001
1,279
82%
2002
1,086
86%
2003
1,111
85%
Evaluation

In general:
 Ties all the pieces of the program together

Key questions to evaluation:
 Program activities being implemented as
planned

Strengths, weaknesses and areas to improve

Limited resources being used efficiently

Program outcomes occurring as expected

Are outcomes the result of tobacco control
efforts or other factors (such as tobacco tax
increase)
Evaluation (2)

VT Approach to evaluation includes
 Independent Evaluation
 Working with RTI since 2002



Collaboration of RTI, VDH and VTERB
Evaluation Time Line (Include time line table in
work plan)
Surveillance Activities
 BRFSS

YTS

ATS
Evaluation (3)

VT Approach to Evaluation Includes: (cont)
 Program Activity
 VAHHS Process Measures Database (i.e. Local
Classes offered)

Community Coalition database and reports (i.e.
coalition activities and events)

Media ads run, direct mailings data, earned
media stories, etc.

Schools implementing research-based curricula
and students exposed

Number of clerks trained (DLC)
Example Report: Process Measures
Database
Quic kTime™ and a
Sorens on V ideo 3 dec ompr ess or
are needed to s ee this pic tur e.
Number of Vermont Schools Teaching Research-Based Tobacco Prevention Curricula
Vermont Department of Education, 1997 - 2005
250
Number of Schools
200
150
100
50
0
1997
1999
2001
2003
2004
*Expected number of schools based upon implementation plans and midway reports submitted in December 2004.
2005*
Evaluation (4)

VT Approach to Evaluation Includes: (cont)
 Awareness of Program
 Number of callers to quit line

Number of hospital-based, local program
clients

% Smokers aware of cessation programs or
events

% Advised to quit by MD

OVX website hits

% youth aware of prevention messages
targeted to them
New Clients Counseled* by Cessation Program
Vermont Tobacco Program
2001 - 2004
2500
Quit Line
VAHHS
Number of New Clients
2000
1500
1000
500
0
2001
2002
2003
2004
Year
*VAHHS data excludes those clients that received only NRT coupon from the VAHHS program; those receiving services from both Quit Line and
VAHHS are included in the VAHHS data if their last type of service was from VAHHS. The Quit Line data excludes non-smokers requesting only
information, those with no service information, and those requesting only a community referral.
Awareness of Programs and Events in the Area to Help People Quit Smoking
Current Smokers and Recent Quitters (Quit in Last 12 Months)
Adult Tobacco Survey 2001- 2004
90
Programs
Events
80
70
Percent
60
50
40
30
20
10
0
2001
2002
2003
Year
2004
Perception of Youth Smoking Among Middle and High School Students
by Current Smoking Status
Youth Tobacco Survey, 2004
80
Middle School
High School
70
60
Percent
50
40
30
20
10
0
6 or
Fewer
8
Overall
10
6 or
Fewer
8
10
Not Current Smokers
Of 10 Vermont Teens Number Choose NOT to Smoke
6 or
Fewer
8
Current Smokers
10
Evaluation (5)

VT Approach to Evaluation Includes: (cont)
 Attitudes and Behaviors
 % Youth reporting negative attitudes about
smoking



% smokers who do not smoke in homes or cars
with kids present

% smokers making >= 1 quit attempt in last 12
months

Average number of quit attempts per year
Tobacco Consumption
 Sales and Tax data
Prevalence
 Goal is to reduce prevalence, both youth and adults
by 50% by 2010
Attitudes about Smoking Among Young People by Smoking Status
Youth Tobacco Survey - 2000, 2002, 2004
90
Not Current Smoker
Current Smoker
80
70
Percent
60
50
40
30
20
10
0
2000
2002
2004
Definitely NOT Smoke in
Next Year
2000
2002
2004
Definitely NOT Smoking in
5 Years
2000
2002
2004
Definitely Think Young People
Can Harm Themselves By
Smoking 1-5 Cigarettes per Day
Prohibition of Smoking in the Home (at all times) and the Car when Children are Present
Current Smokers and Recent Quitters with Children
Adult Tobacco Survey - 2001- 2004
80
Home
Car
70
60
Percent
50
40
30
20
10
0
2001
2002
2003
Year
2004
Proportion Making Serious Quit Attempt and Average Duration of Longest
Quit Attempt Made in Last 12 Months
Current Smokers
Adult Tobacco Survey - 2001 - 2004
60
50
40
30
20
10
0
2001
2003
2004
Percent of Current Smokers Making
Serious Quit Attempt in Last 12
Months*
*The question used to assess quit attempts was not comparable in 2002.
2001
Year
2002
2003
2004
Average Duration (Days) of Quit Attempt When Made
Quit Attempt in the Last 12 Months
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Sales per VT adult
Cigarette Tax Stamp Sales per Capita*
13.0
12.0
11.0
1
10.0
2
9.0
8.0
7.0
6.0
* 5 month moving average
1. VT tax raised from $0.44 to $0.93, 7/1/02
2. VT tax raised from $0.93 to $1.19, 7/1/03
Conclusion



Comprehensive program
Collaborative efforts
 VTERB – Making recommendations to VDH about
program practices. Many are researchers in the
field of tobacco

Community Coalitions

Coalition for a Tobacco Free VT – Indoor air
Some successes, but still working towards goals
 Independent evaluation contractor has found that
accelerated decreases in consumption are 50% to
the program and 50% to increased taxes.
Conclusion (2)

Lessons learned:
 Using the “Common Themes” to harness the
power of our community coalitions to have an
overall statewide message


We have expanded our relationship with the
Department of Education in order to increase our
reach
The importance of thinking about evaluation and
the best measures to capture what you want to
evaluation before implementing the program
cannot be overstated