Transcript Measuring Progress in Tobacco Control Patrick Remington Erich Mussak Ann Christiansen

Measuring Progress in Tobacco Control
Patrick Remington
Erich Mussak
Ann Christiansen
David Ahrens
Overview
1. Predicting expected rates of tobacco use
using historical trends
2. Setting goals based on predicted rates
3. Evaluating progress using comparison
states
Background:
Wisconsin Tobacco Control Board
• Established in 2001 with funds from the
Master Settlement Agreement
• $24 million per year in first year/$15 million
per year since then
• Comprehensive program following the CDC
guidelines
Monitoring and Evaluation Program
• Goal: Evaluate the effectiveness of
Wisconsin’s $15 million/year tobacco control
program
• 3 components:
– Monitor trends in tobacco use in Wisconsin
– Evaluate statewide programs
– Provide training and technical assistance for local
program evaluation
1. Predicting Future Trends in Tobacco
Use
• First step: calculate the expected rates of
tobacco use in 2005
• Use Wisconsin historical trends to predict
future trends
• Will use per capita sales estimates as an
example
– Can be applied to other measures of tobacco use
Trends in Per Capita Cigarette Sales,
Wisconsin, 1950-2000
140
Packs/year
120
100
80
60
40
20
0
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Trends in Per Capita Cigarette Sales,
Wisconsin, 1950-2000
140
Packs/year
120
100
80
60
40
20
0
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Trends in Per Capita Cigarette Sales,
Wisconsin, 1950-2000
140
Packs/year
120
100
80
60
40
20
0
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Predicting Trends in the Future
What is
expected
by 2005?
120
Packs/year
100
80
64
60
48
40
30
20
0
1990
1995
2000
Year
2005
Predicted Trend Using Linear Regression
120
Packs/year
100
80
79
60
40
20
0
1990
1995
2000
Year
2005
Predicted Trend Using 2nd Order Polynomial
120
Packs/year
100
80
60
59
40
20
0
1990
1995
2000
Year
2005
Predicted Trend Using 3rd Order Polynomial
120
Packs/year
100
80
60
40
27
20
0
1990
1995
2000
Year
2005
Predicted Trend Using “Visual Extrapolation”
120
Packs/year
100
80
60
59
40
20
0
1990
1995
2000
Year
2005
Trends in Per Capita Cigarette Sales,
Wisconsin, 1950-2000
100
Measure Percent Change
from Year-to-Year
Packs/year
95
90
85
80
75
70
1990
1995
2000
Year
2005
100
Packs/year
95
90
85
80
75
70
1990
1995
2000
2005
Change from prior year
Year
3%
2%
1%
0%
-1%
-2%
-3%
-4%
-5%
-6%
2%
2%
1%
1%
0%
-2%
-4%
-5% -5%
-5%
1990
1995
2000
Year
2005
Change from prior year
Year-to-Year Changes in Per Capita Sales
3%
2%
1%
0%
-1%
-2%
-3%
-4%
-5%
-6%
2%
2%
1%
1%
0%
-2%
-4%
-5% -5%
-5%
1990
1995
2000
Year
2005
Change from prior year
Year-to-Year Changes in Per Capita Sales
3%
2%
1%
0%
-1%
-2%
-3%
-4%
-5%
-6%
2%
2%
1%
1%
0%
-2%
-4%
-5% -5% -5%-5%-5% -5% -5%
-5%
1990
1995
2000
Year
2005
Packs/year
Expected Rate with a 5% Annual Decline
100
95
90
85
80
75
70
65
60
55
50
62
1990
1995
2000
Year
2005
Change from prior year
Year-to-Year Changes in Per Capita Sales
3%
2%
1%
0%
-1%
-2%
-3%
-4%
-5%
-6%
2%
2%
1%
1%
0%
-2%
-3%-3%-3% -3% -3%
-4%
-5% -5%
-5%
1990
1995
2000
Year
2005
Packs/year
Expected Rate with a 3% Annual Decline
100
95
90
85
80
75
70
65
60
55
50
69
1990
1995
2000
Year
2005
Packs/year
Expected Rate with a 3% Annual Decline
100
95
90
85
80
75
70
65
60
55
50
69
1990
1995
2000
Year
2005
Summary
Assumption
Linear regression
Polynomial regression
“Visual regression”
5% per year decrease
3% per year decrease
*Best estimate?
Expected Rate
79
59 (or 27)
59
62
69*
3. What Should the Goal be for 2005?
100
Expected
by 2005
Packs/year
90
80
70
69
60
Program begins
50
40
1990
1995
2000
Year
2005
3. What Should the Goal be for 2005?
100
Expected
by 2005
Packs/year
90
80
70
69
60
20% reduction from expected
50
55
40
1990
1995
2000
Year
2005
3. What Should the Goal be for 2005?
100
Expected
by 2005
Packs/year
90
80
70
Actual Board Goal
(20% less than 2000)
60
69
64
55
50
40
1990
1995
2000
Year
2005
Summary
• It is difficult to estimate the “expected” rates
of tobacco use, using historical trends
• Regardless, should calculate these expected
rates PRIOR to setting goals!
• Goals should be set based on a reduction for
the expected rate, not from the current rate.
4. Evaluating Program Effects
• The Board wants to know if the program
is effective (the sooner, the better)
• Strongest design is to use ‘comparison’
groups
• Control for ‘inputs’ (e.g., annual tobacco
control spending)
Recent Example
• Data from 2001 become available on
per capita sales (77 packs per capita?)
• These data showed a 3% decline from
the value in 2000
• Is there any “early” evidence that the
program is working?
Annual Rates of Per Capita Cigarette Sales, if
the State is to Meet its 2005 Goal
80
80
77
75
Packs/year
75
70
74
70
Board
Goal
70
65
65
67
64
60
60
‘Aggressive’ Goal
55
55
50
2000
2001
2002
2003
Year
2004
2005
Packs/year
Long-Term Trends in Per Capita Cigarette
Sales, Wisconsin and US
140
130
120
110
100
90
80
70
60
50
US
WI
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Long-Term Trends in Per Capita Cigarette
Sales, Wisconsin and US
Packs/year
160
140
120
100
80
60
US
WI
40
20
0
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Packs/year
Long-Term Trends in Difference Between U.S.
and Wisconsin in Per Capita Cigarette Sales
60
50
40
30
20
10
0
-10
-20
-30
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Difference Between U.S. and Wisconsin Per
Capita Cigarette Sales
12
Packs/year
10
8
6
4
2
0
1990
1995
2000
Year
2005
Difference Between U.S. and Wisconsin Per
Capita Cigarette Sales
12
Packs/year
10
Effective
8
6
4
2
Not
Effective
0
1990
1995
2000
Year
2005
Adjustments
• Stratify states prospectively, on the amount
spend per capita for tobacco control
• Compare Wisconsin to the low- medium- and
high-spending states
• Hypothesis: Wisconsin’s program will be
effective if it achieves rates similar to states
spending $3 per capita (and greater than
states spending less)
Trends in Per Capita Cigarette Sales,
Wisconsin and Arkansas, 1950-2000
150
Packs/year
130
110
AK
90
70
WI
50
30
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Trends in Per Capita Cigarette Sales,
Wisconsin and California, 1950-2000
150
Packs/year
130
110
90
70
WI
50
CA
30
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Packs/year
Trends in Per Capita Cigarette Sales,
Wisconsin, 1950-2000
60
50
40
30
20
10
0
-10
-20
-30
CA
WI
US
AR
Year
Summary
• States need to use historical data to predict
future trends in tobacco use
– Per capita sales
– Current smoking (BRFSS)
– Smoking in pregnancy (vital records)
– Middle and high school (YTS/YRBS)
Summary, cont.
• Program effects can be assessed by
comparing progress with other states,
stratified by per capita program investments
• Future research should consider long-term
trends in tobacco use in states
Acknowledgments
• Monitoring and Evaluation Program
– Ellen Taylor-Powell, Paul Moberg
– David Ahrens, Ann Christiansen, Erich Mussak, Ann Olen,
Barbara Hill, Matthew Renfro-Sargent, Amanda Riemer,
Eden Schafer
• Wisconsin Tobacco Control Board
– David Gunderson, Earnestine Willis
• Wisconsin Division of Public Health
– Meg Taylor, Tom Conway, Nancy Chudy, Cathryn Brue,
Jenny Commons
Trailer slide
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41 slides * 1 set = 41 total slides
Monitoring and Evaluation (WTCB)
265-9931 (Erich Mussak)
1 of 3 sets of slides