measuring progress in tobacco control
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Measuring Progress in Tobacco Control. Patrick Remington Erich Mussak Ann Christiansen David Ahrens. Overview. Predicting expected rates of tobacco use using historical trends Setting goals based on predicted rates Evaluating progress using comparison states. - PowerPoint PPT PresentationTRANSCRIPT
Measuring Progress in Tobacco Control
Patrick RemingtonErich Mussak
Ann ChristiansenDavid 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
0
20
40
60
80
100
120
140
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Packs/y
ear
Trends in Per Capita Cigarette Sales, Wisconsin, 1950-2000
0
20
40
60
80
100
120
140
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Packs/y
ear
Trends in Per Capita Cigarette Sales, Wisconsin, 1950-2000
0
20
40
60
80
100
120
140
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Packs/y
ear
Predicting Trends in the Future
64
30
48
0
20
40
60
80
100
120
1990 1995 2000 2005
Year
Packs/y
ear
What is expected by 2005?
Predicted Trend Using Linear Regression
79
0
20
40
60
80
100
120
1990 1995 2000 2005
Year
Packs/y
ear
Predicted Trend Using 2nd Order Polynomial
59
0
20
40
60
80
100
120
1990 1995 2000 2005
Year
Packs/y
ear
Predicted Trend Using 3rd Order Polynomial
27
0
20
40
60
80
100
120
1990 1995 2000 2005
Year
Packs/y
ear
Predicted Trend Using “Visual Extrapolation”
59
0
20
40
60
80
100
120
1990 1995 2000 2005
Year
Packs/y
ear
Trends in Per Capita Cigarette Sales, Wisconsin, 1950-2000
70
75
80
85
90
95
100
1990 1995 2000 2005
Year
Packs/y
ear
Measure Percent Change from Year-to-Year
2%1%
-5%
1%
2%
-2%
0%
-4%
-5%-5%-6%-5%-4%-3%-2%-1%0%1%2%3%
1990 1995 2000 2005
Year
Ch
an
ge f
rom
pri
or
year
70
75
80
85
90
95
100
1990 1995 2000 2005
Year
Packs/y
ear
Year-to-Year Changes in Per Capita Sales
2%1%
-5%
1%
2%
-2%
0%
-4%
-5%-5%-6%-5%-4%-3%-2%-1%0%1%2%3%
1990 1995 2000 2005
Year
Ch
an
ge f
rom
pri
or
year
Year-to-Year Changes in Per Capita Sales
2%1%
-5%
1%
2%
-2%
0%
-4%
-5%-5%-5%-5%-5%-5%-5%-6%-5%-4%-3%-2%-1%0%1%2%3%
1990 1995 2000 2005
Year
Ch
an
ge f
rom
pri
or
year
Expected Rate with a 5% Annual Decline
62
50556065707580859095
100
1990 1995 2000 2005
Year
Packs/y
ear
Year-to-Year Changes in Per Capita Sales
2%1%
-5%
1%
2%
-2%
0%
-4%
-5%-5%
-3%-3%-3%-3%-3%
-6%-5%-4%-3%-2%-1%0%1%2%3%
1990 1995 2000 2005
Year
Ch
an
ge f
rom
pri
or
year
Expected Rate with a 3% Annual Decline
69
50556065707580859095
100
1990 1995 2000 2005
Year
Packs/y
ear
Expected Rate with a 3% Annual Decline
69
50556065707580859095
100
1990 1995 2000 2005
Year
Packs/y
ear
Summary
Assumption Expected RateLinear regression 79Polynomial regression 59 (or 27)“Visual regression” 595% per year decrease 623% per year decrease 69*
*Best estimate?
3. What Should the Goal be for 2005?
69
40
50
60
70
80
90
100
1990 1995 2000 2005
Year
Packs/y
ear
Expected by 2005
Program begins
3. What Should the Goal be for 2005?
69
55
40
50
60
70
80
90
100
1990 1995 2000 2005
Year
Packs/y
ear
Expected by 2005
20% reduction from expected
3. What Should the Goal be for 2005?
69
55
64
40
50
60
70
80
90
100
1990 1995 2000 2005
Year
Packs/y
ear
Expected by 2005
Actual Board Goal (20% less than 2000)
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
8077
74
7067
64
80
75
70
65
60
55
50
55
60
65
70
75
80
2000 2001 2002 2003 2004 2005
Year
Packs/y
ear
Board Goal
‘Aggressive’ Goal
Long-Term Trends in Per Capita Cigarette Sales, Wisconsin and US
5060708090
100110120130140
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Packs/y
ear
US
WI
Long-Term Trends in Per Capita Cigarette Sales, Wisconsin and US
0
20
40
60
80
100
120
140
160
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Packs/y
ear
US
WI
Long-Term Trends in Difference Between U.S. and Wisconsin in Per Capita Cigarette Sales
-30-20-10
0102030405060
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Packs/y
ear
Difference Between U.S. and Wisconsin Per Capita Cigarette Sales
0
2
4
6
8
10
12
1990 1995 2000 2005
Year
Packs/y
ear
Difference Between U.S. and Wisconsin Per Capita Cigarette Sales
0
2
4
6
8
10
12
1990 1995 2000 2005
Year
Packs/y
ear
Effective
NotEffective
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
30
50
70
90
110
130
150
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Packs/y
ear
AK
WI
Trends in Per Capita Cigarette Sales, Wisconsin and California, 1950-2000
30
50
70
90
110
130
150
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Packs/y
ear
CA
WI
Trends in Per Capita Cigarette Sales, Wisconsin, 1950-2000
-30
-20
-10
0
10
20
30
40
50
60
Year
Packs/y
ear
CA
WI
AR
US
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
• 41 slides * 1 set = 41 total slides
• Monitoring and Evaluation (WTCB)
• 265-9931 (Erich Mussak)
• 1 of 3 sets of slides