Enhanced Implementation of CDC Guidelines for School Tobacco Programs: Results of a Statewide Evaluation

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Enhanced Implementation of CDC Guidelines for School Tobacco Programs: Results of a Statewide Evaluation. Shelly A. Greller, MS Wisconsin Department of Public Instruction D. Paul Moberg, Ph.D University of Wisconsin – Madison. Acknowledgements. Wisconsin Department of Public Instruction
Enhanced Implementation of CDC Guidelines for School Tobacco Programs:Results of a Statewide EvaluationShelly A. Greller, MSWisconsin Department of Public InstructionD. Paul Moberg, Ph.DUniversity of Wisconsin – MadisonAcknowledgements
  • Wisconsin Department of Public Instruction
  • John Hisgen
  • Douglas White
  • University of WI – Monitoring & Evaluation Program (www.medsch.wisc.edu/mep)
  • David Ahrens
  • Ann Christiansen
  • Amy Anderson
  • Patrick Remington, P.I.
  • Funded by the Wisconsin Tobacco Control Board
  • Participants should be able to:
  • Describe WI statewide school tobacco grant program
  • Describe CDC Guidelines for School Health Programs to Prevent Tobacco Use and Addiction
  • Identify effective program resources and strategies
  • Understand & apply results of WI school tobacco program to enhance implementation of CDC Guidelines
  • Apply assessment & evaluation tool to operationalize CDC Guidelines
  • Background
  • Master Settlement Agreement led to creation of WI Tobacco Control Board (WTCB)
  • WTCB developed comprehensive strategic plan for tobacco control
  • One focal area was youth tobacco prevalence
  • Youth goal: By 2005, tobacco use among middle & high school age youth will decline by 20%
  • School-based programs funded for $1,250,000 by competitive process through DPI
  • Background
  • DPI stated purpose for school-based tobacco control programs
  • “Create or expand upon strategies identified as most promising or effective in reducing or eliminating youth tobacco use”
  • Operationally, discussion focused on increased implementation of CDC Guidelines
  • Monitoring and Evaluation
  • Monitoring and Evaluation Program (MEP) contracted to perform monitoring/evaluation functions for WTCB
  • MEP comprised of
  • UW – Comprehensive Cancer Center
  • UW – Extension
  • Center for Health Policy and Program Evaluation
  • MEP collaborated with DPI on evaluation of school-based tobacco control programs
  • CDC Guidelines
  • Guidelines for School Health Programs to Prevent Tobacco Use and Addiction (MMWR, 1994)
  • Summarizes school based strategies “most likely to be effective in preventing tobacco use by youth”
  • Developed by CDC in collaboration with experts
  • In-depth review of research, theory & current practice
  • Impact of Guidelines
  • Rohde et al. (2001 in MMWR)
  • High or medium implementation of Guidelines in Oregon associated with significantly greater decline in 8th graders’ 30-day smoking prevalence
  • Impact of Guidelines
  • Rohrbach et al.(2002 Presentation at Society for Prevention Research-SPR)
  • 2 waves of student data from sample of schools
  • Indexed Guideline Implementation based on teacher surveys
  • Most schools did not fully implement comprehensive program of evidence-based strategies
  • Guideline implementation significantly related to smoking prevalence - quit attempts - negative expectations/attitudes regarding tobacco
  • Impact of Guidelines
  • Hallfors & Godette (2002, HER)
  • Dept. of Education has recent statement of “Principles of Effectiveness” for prevention programs
  • Surveyed 104 School Districts in 12 states
  • Only 19% of school districts are implementing research-based prevention curricula with “fidelity”
  • Goal of Our Evaluation
  • Focus on institutional change in implementation of the guidelines in schools with infusion of targeted funding
  • Not on impact of implementation of Guidelines on student outcomes
  • Methods of Our EvaluationDesign Sample: Applicant School Buildings/DistrictsMeasures – Self Assessment
  • Each building in applicant district completed checklist operationalizing CDC Guidelines
  • Operationalizes CDC Guidelines with 58 questions
  • Original purpose was self assessment and planning
  • Program evaluation secondary
  • Repeated at end of year 1 and year 2
  • Funded districts submitted as part of year end report
  • Unfunded districts mailed as survey at end of year 1
  • Scaling/Data Reduction
  • Exploratory Principal Components factor analysis indicated most items within areas of the guidelines were correlated
  • We created additive indices for each of the 7 areas
  • Scaling
  • 0 = No 1 = Somewhat 2 = YesScale Validation
  • 2001-2002 School Health Education Profile (SHEP) oversampled to include all funded schools
  • Reports from SHEP will be correlated with reports from schools
  • Compared baseline data of funded schools to full SHEP sample
  • How representative are they?
  • Scale ConstructionSample Size & Response RateMean Change During Year 1*P < .05 **P < .001Mean Change During Year 1*P < .05 **P < .001Mean Change During Year 1*P < .05 **P < .001Regression ResultsRegression analysis covarying baseline value found:
  • Baseline covariate always a sig. predictor of one year implementation measure
  • Significant effects of funding on
  • Training: B = .155 (.084)
  • Family / community involvement: B = .162 (.072)
  • Cessation: B = .25 (.09)
  • Percentage of Funded SchoolsReporting Positive ChangeFunded Schools Prohibit Tobacco Use…Funded School Policies…Funded Schools Tobacco Instruction…Rather Than Punitive – Funded Schools…Funded Schools Teach Developmentally AppropriateFunded Schools Teach Developmentally AppropriateDoes Funded School..Does Funded School..Variation by Level – Funded Schools
  • Elementary schools (57 schools)
  • High on baseline family & community involvement
  • Lowest on evaluation
  • Middle schools (52 schools)
  • Highest overall score at baseline, especially in training and curriculum
  • High schools (30 schools)
  • More change (than elementary & middle schools) on policy, training, parent & community involvement & cessation
  • Highest initially on cessation
  • Combinations (16 schools)
  • Highest level of change overall: high change on policy, curriculum, and instruction
  • Limitations and Issues
  • Tool originally intended as self assessment
  • Not a research tool
  • Validity/reliability to be established
  • SHEP link will help – in progress
  • Self Report from school staff (who want funding to continue) without validation
  • Low response rate from comparison group
  • No student outcomes
  • Conclusions
  • Baseline implementation of Guidelines highest in areas of
  • Policy
  • Curriculum
  • Implementation of Guidelines lowest in
  • Cessation
  • Evaluation
  • Training
  • Family / community involvement
  • Conclusions
  • Most gain with funding in
  • Cessation
  • Evaluation
  • Training
  • Family / community involvement
  • Unfunded schools also report gain in all areas--but significantly less in several areas
  • The tool is promising to assess school tobacco control programs both for planning & evaluation
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