Community Coalitions Activity Survey (January June 2002)

Transcription

1 Community Coalitions Activity Survey (January June 2002) March 2003 By Barbara L. Hill, Center for Health Policy and Program Evaluation D. Paul Moberg, Center for Health Policy and Program Evaluation David Ahrens, UW Comprehensive Cancer Center Marion Ceraso, UW Comprehensive Cancer Center 610 N. Walnut Street Madison, WI / FAX 608/ Available at:

2 Community Coalition Activity Survey (January-June 2002) Executive Summary Introduction: Local tobacco control coalitions are an essential component of the Wisconsin Tobacco Control Board s comprehensive effort to reduce tobacco use in the state. Coalitions have been funded in all communities statewide to assess local need and design and implement evidence-based strategies to reduce tobacco use in their community. Coalition activities are expected to address the seven goals established by the Board to track progress in eliminating tobacco use. Methods: The Community Coalitions Activity Survey was developed to obtain information regarding the nature of coalition activities, determine how much of their time is being spent on the different categories of activities, and understand how coalition activities relate to the Board's goals. The coalitions will complete the Activity Survey twice each year, reflecting activities from the preceding six months. The results of these surveys will be shared with training and technical assistance staff so they may provide targeted assistance to ensure coalitions work on activities that have the highest probability of affecting local tobacco use. Results will also be shared with the Board to inform them about the coalitions progress in their work to decrease tobacco use at the local level. Results: This report provides results from the first Activity Survey, which covered the period January June At that time, the Board had funded most coalitions for approximately one year. Survey responses indicated that: Nearly all coalitions were working on one or more of the Board goals related to clean indoor air during this reporting period, Few coalitions reported activities related to conducting a campaign in support of smoke-free municipal government building policies and restaurant ordinances, Major accomplishments reported by coalitions included activities related to youth, clean indoor air, and cessation, and Many coalitions identified coalition development as a major challenge. Coalitions were asked to give their opinion regarding their progress toward each of the Tobacco Control Board s goals. Nearly all were working on the adult and youth prevalence and consumption goals, and 92% of coalitions indicated they were working directly on one or more of the four clean indoor air related goals during this reporting period. When asked to describe their accomplishments, all coalitions listed their youth-related activities such as work with FACT groups and involvement in educational programs; 54% mentioned clean indoor air activities, and 52% listed involvement in cessation activities. When describing their major challenges during the six months covered by this survey, two-thirds of coalition coordinators mentioned some aspect of coalition development. Some found it difficult to recruit or retain members while others were challenged by a lack of member participation.

3 Discussion: It was obvious when reviewing the results from this activity survey, conducted on activities and perceptions from the January June 2002 time period, that coalitions were engaged in many activities in a variety of areas related to tobacco control. During the time period covered by the survey, many coalitions had been in existence for a year or less and, for that reason, should be commended for their ability to work on multiple Board goals while actively developing and managing their coalition. The evidence base of tobacco control and community coalition literature highlights the importance of policy and environmental change strategies in achieving reductions in tobacco consumption and prevalence. Coalitions should be increasingly focusing their efforts on population impact activities related to smoke-free policies in restaurants, municipal government buildings and workplaces in order to produce the desired decreases in adult and youth prevalence and consumption called for by the Board s goals. Coalition activities reported during the first six months of 2002 were predominantly educational or informational activities rather than broader reach environmental or policy change activities. For example, 42% indicated they educated restaurant owners to accommodate non-smokers and 83% educated youth about tobacco use through direct educational services. Since coalition resources, especially coordinator time, are scarce, continuing to spend time on activities that are primarily informational and do not lead to environment or policy change will reduce the likelihood of reaching Board goals. When specific activities were examined related to conducting a campaign in support of smoke-free municipal government building policies or restaurant ordinances, it was evident that, during the time period covered by this survey, few coalitions were engaged directly in these activities. This may be due to several factors including a focus on activities preparatory to conducting a campaign, a focus on coalition development activities or a lack of clear understanding regarding how to organize a campaign. Clean indoor air is a major Board priority and most coalitions self-reported they are working on one or more of the clean indoor air goals. However, it is important that coalitions focus their efforts in this area on activities most likely to produce the desired outcomes. Overall, coalitions appear to be active in their attempts to develop and execute strategies designed to reduce tobacco use in their community. However, many are struggling with coalition development issues, which may slow their progress in organizing policy change initiatives. Coalitions need clear, consistent and specific guidance regarding objectives and related activities to pursue. With this, coalitions can move toward focusing their efforts on those interventions and activities most likely to lead to the desired outcomes. Recommendation for coalitions: Coalitions should concentrate their efforts on activities focused on environment or policy change. Recommendations for those providing support to coalitions: The Board and its partners should communicate clearly and consistently with coalitions regarding which strategies to pursue, Training and technical assistance to coalitions should focus on a) coalition development and b) activities with environment or policy change impact.

4 Community Coalitions Activity Survey Results January June 2002 Community coalitions are a key component of Wisconsin s comprehensive tobacco control strategy. Coalitions are expected to assess community needs and develop evidence-based approaches to reduce local tobacco use. In order to better understand the role of the coalitions in the state s overall tobacco control program, it is useful to collect and analyze consistent information regarding how coalitions form, develop and operate within their community. The Coalition Reporting System (CRS) was designed by the University of Wisconsin Monitoring and Evaluation Program to gather information about coalition structure and operation. The CRS consists of information from the Characteristics of Tobacco Control Coalitions Survey and the Community Coalitions Activity Survey. Information from the CRS is being used by: The Wisconsin Tobacco Control Board to better understand how the coalitions are structured and organized to accomplish their goal of reducing tobacco use in the community; The local coalitions to compare their characteristics, activities and challenges with those of other coalitions; Technical assistance staff to identify future training and technical assistance needs. The Coalition Reporting System will hopefully address some of the challenges inherent in evaluating coalitions. Although community coalitions are a popular approach to dealing with community issues, their effectiveness has not been well documented. 1,2 Collecting uniform qualitative and quantitative data over time from key informants may contribute to the body of knowledge regarding coalitions and may serve as a useful tool for on-going program management and quality assessment and improvement. Methods In July 2002, the Community Coalitions Activity Survey was mailed to 77 coalition coordinators. Accompanying the survey was a cover letter from David Gundersen, Wisconsin Tobacco Control Board Executive Director, explaining the purpose and use of the survey and an attachment providing an overview of the Coalition Reporting System (CRS). (See Appendix A for cover letter, CRS overview, and entire instrument). The Activity Survey was designed to collect information twice annually from the coalitions in a number of areas. The first section contained a list of various activities undertaken by tobacco control coalitions. Coalitions were asked to check the activities they worked on during the preceding six months (January June 2002). The activities were organized into categories similar to those used in the Division of Public Health s Wisconsin Tobacco Control Board (WTCB) Community Coalition Grant Boundary Statement, The activities listed were a compendium of many coalition and tobacco control activities, both evidence-based and those without sufficient evidence. Coalitions were also asked to estimate the percent of time spent in each of the activity categories. 1

5 The next section requested an opinion of the progress the coalitions felt they had made during the previous six months on each of the Wisconsin Tobacco Control Board s major goals along a continuum from Not Working on the Goal to Major Progress. Finally, the coalition coordinator or other respondent was asked to describe the coalition s key accomplishments and major challenges during the six months covered by the survey. A respondent for each of the 77 coalitions completed and returned the survey. Surveys were entered into a master coalition database linked to characteristics data for each coalition. Results in this report are provided in a variety of formats. Initially, reported coalition progress on all seven Board goals was charted. Additionally, reported coalition progress on the four Board goals related to clean indoor air was examined. Next, all activities were analyzed by developing a frequency distribution within each of five activity categories. Results were further examined to explore the relationship of coalition activities to a number of other variables, including region of the state, whether the coalition was new or pre-existing, funding level, whether the coalition represented a metropolitan or non-metropolitan geographical area, and whether the coordinator was full or part time. The data regarding time spent on the five categories of activities were provided as a range of the percent of time spent by coalitions and as an average of time spent across all coalitions. Progress on individual Board goals is reported as a percentage of all coalitions reporting Not Working on the Goal, Making Minor Progress, Moderate Progress, Major Progress, or Already Having Completed the Goal. The final category (Already Completed) was developed based on notations made in the margins of the survey by some coalitions and will be included on the next version of this survey. Finally, narrative comments to the questions regarding key accomplishments and major challenges of the preceding six months were coded for ease of analysis and comparability with results from future surveys. Frequency distributions for these coded categories of comments were produced to provide a clearer picture of accomplishments and challenges across coalitions. Results Progress toward Wisconsin Tobacco Control Board goals The Wisconsin Tobacco Control Board established seven goals by which to measure the success of the state s comprehensive tobacco control efforts. The Monitoring and Evaluation Program has developed baseline measurements for all seven goals. Ultimately, the most important outcome of coalition activities should be progress on the Board s goals. Table 1 provides information regarding the coalitions current perception of their progress toward the seven Board goals. In addition to the four progress codes listed on the survey, a fifth, Already Completed, was added due to comments provided by coalitions on this section of the survey. 2

6 Table 1. Percent of Coalitions Indicating Progress Toward Wisconsin Tobacco Control Board Goals, January June BOARD GOAL LEVEL OF PROGRESS Not working Minor Progress Moderate Progress Major Progress Already Completed on goal Reduce tobacco use by middle 4% 54% 34% 8% and high school youth by 20% Reduce adult tobacco use by 4% 71% 24% 1% 20% Reduce tobacco consumption 5% 66% 28% 0% by 20% Establish smoke-free restaurant 43% 31% 17% 8% 1% ordinances in 100 or more municipalities Establish 100% smoke-free 47% 12% 23% 14% 4% municipal government-owned buildings Establish smoke-free 36% 44% 18% 1% 1% environments in 90% of all workplaces Encourage 70% of all homes to voluntarily establish smokefree environments 28% 38% 26% 8% As demonstrated by the data, coalitions were more likely to be working on broader, longer-term youth and adult prevalence and consumption goals than on clean indoor air related goals (range from 96% working on prevalence goals to 53% working on municipal government building goal.) However, the response to the municipal government-building goal also demonstrated the highest reported rate of major progress and completion of all Board goals (14% and 4% respectively). Another way to examine the clean indoor air related Board goals is to count the number of these goals each coalition was working on. The results, depicted in Figure 1, demonstrate that 92% of all coalitions were working on one or more of the four clean indoor air related Board goals during the reporting period. The highest percent of coalitions, 38%, reported working on three of the four clean indoor air related goals. Sixteen percent of coalitions reported working on all four clean indoor air related goals during the six months covered by the survey. Figure 1. Percent of Coalitions Working on Clean Indoor Air Related Board Goals 3

7 40% 38% 35% 30% 25% 25% 20% 15% 10% 8% 14% 16% 5% 0% 0 CIA goals 1 CIA goals 2 CIA goals 3 CIA goals 4 CIA goals Frequency Distribution of Activities by Category In order to determine what activities a coalition worked on, coalition coordinators were asked to check the activities undertaken by their coalition during the preceding six months. To better understand the activities of the coalitions relative to the categories listed on the survey Coalition Development and Management, Eliminate Exposure to Secondhand Smoke, Reduce Youth Tobacco Use, Promote Quitting Among Youth and Adults, and Other Activities frequency distributions were completed for each category. The results appear in Tables 2-6. The information on the current Activity Survey was the first systematic attempt to learn what the coalitions are doing to develop and manage their coalition in order to impact on the tobacco related behaviors in their community. Since this survey will be conducted twice yearly for the next few years, future analysis will concentrate on the change in activities over time as coalitions receive more training and technical assistance regarding evidence-based strategies to pursue. Table 2. Coalition Involvement in Activities Related to Development and Management of the Coalition Number and % Responding YES to the Question Ordered From High to Low. A. Coalition Development and Management N % Manage coalition activities, e.g., plan meetings and develop agendas % Write press releases on coalition activities and contact media % Recruit representatives of community organizations, agencies and 65 84% institutions to become members of the coalition. Publicize coalition activities using free/earned media % Recruit individuals in the community who support tobacco control but are 60 78% not affiliated with an agency or organization. Create and maintain a list of community supporters % Develop sub-committees or work groups % Develop a short-term community tobacco control strategy that includes a 44 57% logic model or similar method of planning. Assess community needs and assets regarding tobacco control % 4

8 Evaluate coalition development activities including coalition operations % Write and distribute newsletter on coalition activities % Orient new coalition members to tobacco-related issues and tobacco 24 31% control strategies through formal training sessions. Develop by-laws or other governing documents % Analysis of the Coalition Development and Management activities indicated that, for the most part, coalitions were working on the major tasks necessary to operate a coalition. Almost all respondents indicated they manage basic coalition activities and communicate with media. The majority of coalitions asserted they recruit members and maintain a list of supporters. Fewer coalitions engaged in planning (57%), community needs assessment (48%) and evaluation (39%). Table 3. Coalition Involvement in Activities to Eliminate Exposure to Secondhand Smoke Number and % Responding YES to the Question Ordered From High to Low. B. Eliminate Exposure to Secondhand Smoke N % Educate coalition members about the effects of secondhand smoke % Encourage individual restaurants to voluntarily become smoke-free % Educate employers about benefits of restrictions on smoking in the 47 61% workplace. Write, publish and distribute a smoke-free dining guide of local 44 57% restaurants. Conduct general community awareness campaign on secondhand smoke 43 56% and reducing exposure using non-media strategies such as public speaking, meetings with officials, etc. Educate public on the effects of secondhand smoke in restaurants through 42 55% media advocacy practices such as creating media events, issuing studies or reports and press releases. Conduct survey of restaurants and drinking establishments to determine 39 51% smoking policies. Provide awards and other community recognition to smoke-free 38 49% restaurants. Establish goal of eliminating smoking in specific number of homes % Collect pledges or petitions for smoke-free homes and vehicles % Conduct survey of workplaces to determine smoking policies % Educate and mobilize local agencies for community campaign to eliminate 35 46% exposure to secondhand smoke in homes and vehicles. Plan events to gain media attention to increase public awareness of effects 34 44% of secondhand smoke in homes. Educate restaurant owners to accommodate non-smokers % Assess county and municipal policies and ordinances on smoking in public 32 42% buildings. Educate city and county officials and policymakers about the effects of 27 35% secondhand smoke in public buildings. Evaluate coalition secondhand smoke activities % Organize support by agencies and organizations for smoke-free homes % Discuss approaches to reducing secondhand smoke exposure in restaurants 16 21% with municipal officials and policymakers. 5

9 Conduct survey and tally data of the public s opinion on smoking policies in restaurants and support for clean indoor air policy. Conduct campaign to implement policies prohibiting smoking in county and municipal buildings. Organize a broad community-wide committee in support of a municipal smoke-free restaurant ordinance. Develop a formal plan to conduct community-wide campaign in support of smoke-free restaurant ordinance. Participate in smoke free committee activity to conduct campaign to pass and implement an ordinance prohibiting smoking in restaurants. Work with college youth, administrative staff and faculty on establishing smoke free campuses or campus buildings % 14 18% 13 17% 10 13% 10 13% 9 12% The most frequently reported activity in this section was educating coalition members about the effects of secondhand smoke (81%). The majority of the activities in this section were reported by fewer than half of the coalitions. The activities reported least often were associated with planning and conducting a smoke-free restaurant campaign and establishing smoke-free campuses. Table 4. Coalition Involvement in Activities to Reduce Youth Tobacco Use Number and % Responding YES to the Question Ordered From High to Low. C. Reduce Youth Tobacco Use N % Educate youth about tobacco use through direct educational services such 64 83% as guest speakers, exhibits and presentations. Work with a youth group to develop a plan for youth activism, such as 53 69% FACT. Discuss tobacco education curricula with school administrators and health 50 65% educators. Work with youth group to assist in implementation of plan for youth 46 60% activism, such as FACT. Train teen volunteers as peer educators in tobacco for programs such as 44 57% TATU. Earn media coverage in coalition youth activities through press releases 42 55% and media contacts. Conduct compliance checks to determine level of sales to minors % Educate retailers and/ or clerks about policies regarding tobacco sales % Educate law enforcement on retailer compliance % Promote or teach Life Skills Training or other refusal-skills program % Evaluate coalition youth activities % Conduct educational campaign that promotes media literacy for youth % Survey youth in middle and/or high schools on tobacco use % Discuss implementation of CDC best practices guidelines with school 22 29% district administration. Work with law enforcement to fine youth that violate possession laws % Participate in tobacco court diversion project for youth % Conduct Operation Storefront, Community Ad Watch or similar 19 25% activity to increase community awareness of retail advertising. Conduct alternative smoke-free activities for youth such as recreational 18 23% programs. 6

10 Promote ordinances/policies to fine youth for possession of tobacco % Work with retailers and law enforcement to eliminate illegally placed 14 18% vending machines. Enlist support of community and businesses to ask retailers to place 14 18% tobacco behind the counter. Organize, conduct or sponsor youth sports activities % Fine tobacco retailers who sell tobacco to youth % Advocate with City Council to increase license fees to sell tobacco % Develop and implement a campaign to pressure retailers to reduce or eliminate indoor and/or outdoor tobacco advertising. 9 12% Activities from this section appeared similar to those in the secondhand smoke section. Eighty-three percent of coalitions indicated they educated youth about tobacco use through direct educational services such as guest speakers, exhibits and presentations. The activity in this section reported least often dealt with starting a campaign to pressure retailers to eliminate tobacco advertising (12%). Table 5. Coalition Involvement in Activities to Promote Quitting Among Youth and Adults Number and % Responding YES to the Question Ordered From High to Low. D. Promote Quitting Among Youth and Adults N % Place CTRI Quit Line materials in a variety of venues to reach the target 71 92% audience. Promote knowledge of Quit Line in service agencies and organizations % Participate in community health fairs % Promote Quit-line and other cessation activities through the media % Work with WIC and PNCC service agencies to promote cessation services 62 81% for pregnant women and new mothers. Implement public education campaign to increase awareness of Quit Line % Distribute materials promoting cessation in libraries and other public 47 61% places. Organize and/or administer other cessation programs for adults (e.g., 37 48% cessation courses for WIC clients, support group for smokers). Provide cessation services for adults % Encourage and assist health care providers in developing cessation 36 47% programs. Organize/administer N-O-T or other youth cessation programs through 28 36% local schools. Contact local employers to encourage tobacco cessation campaigns % Provide cessation services for youth % Evaluate coalition cessation activities % Work with youth groups such as FACT and B-Free to promote cessation % Develop anti-tobacco billboards and place in community % Conduct B-Free Dance(s) for Middle School students % Sponsor and promote Quit and Win contests. 2 3% Activities related to promoting the Quit Line were the activities reported most often in this section. Eighty-three percent of respondents also reported participating in health fairs. The least reported activity, sponsoring and promoting Quit and Win contests (3%), was also the least reported activity on the entire survey. 7

11 Table 6. Coalition Involvement in Other Activities Number and % Responding YES to the Question Ordered From High to Low. E. Other Activities N % Organize and conduct local activities in support of state legislative 23 30% program such as increasing tobacco control funding. Conduct special outreach campaigns for non-majority populations in the 18 23% community that are primarily focused on education. Conduct special outreach campaigns for non-majority populations in the 18 23% community that are primarily focused... on provision of cessation services. Organize and conduct Legislative Breakfasts or other periodic formal 16 21% meetings with elected state officials. Organize and conduct local activities in support of state legislative 13 17% program such as reducing youth access. Conduct local programs in support of state mass media counter-marketing 10 13% campaign. Conduct special outreach campaigns for non-majority populations in the community that are primarily focused... on policy change. 4 5% All activities in this section were undertaken by less than a third of the coalitions. Conducting special outreach campaigns for non-majority populations focused on policy change was the least frequently reported activity in this section at 5%. Activities by coalition variables In order to better understand what factors contribute to coalition activity, variables from the Coalition Characteristics Survey, conducted in January 2002, were cross tabulated with coalition activities. Variables and their categories are listed in Appendix B. Analysis revealed that only slight variation in results appeared related to these variables. Regional Difference: When examining the activity data by the five Division of Public Health regions, only a few areas were noteworthy. For questions related to establishing a goal regarding smoke-free homes or collecting pledges for smoke-free homes or vehicles, the Northern Region had a high amount of activity (86% and 79% respectively) while the Western Region had low activity in these areas (17% and 22% respectively). In another area, 36% of coalitions in the Northern Region worked on B-Free dances during the preceding six months while 0% of Northeastern Region coalitions and 6% of Southeastern Region coalitions worked on B-Free dances. Finally, none of the Southeastern Region coalitions reported as an activity conduct special outreach campaigns for non-majority populations in the community that are primarily focused on policy change. Since this region contains a high proportion of the state s non-majority population, this area requires attention. Metropolitan Non-Metropolitan Differences: When comparing the responses of coalitions that had a metropolitan population density to those that were non-metropolitan, no real differences were noted in any of the five categories of activity covered by the survey. Funding Differences: An analysis of the activity survey data by 2001 Board funding categories demonstrated that in none of the five activity categories did the highest 8

12 funding level correlate with the highest level of activity as reported by coalitions. Some interesting differences appeared in the second-hand smoke category. Coalitions receiving in excess of $100,000 a year in Board funding were more likely to educate and mobilize local agencies for community campaigns to eliminate exposure to secondhand smoke in homes and vehicles than those from any other funding category. They were also much more likely to organize support by agencies and organizations for smoke-free homes. Regarding working with colleges to establish smoke-free campuses, the two lowest funding categories indicated no activity in this area while 29% of the $50,000 - $100,000 category and 33% of the $100,000+ category indicated activity in this area. In the Other Activities category the highest funded coalitions completed the most outreach for non-majority populations in education and cessation. Coordinator Time Differences: Interestingly, few noteworthy differences were found in the data when analyzing responses according to whether a coordinator(s) worked less than half time, 50%-99%, or 100%+ for the coalition. A minor difference was found in the category of Reducing Youth Tobacco Use. Coalitions with a full time coordinator, earn media coverage in coalition youth activities through press releases and media contacts at a higher rate than the other two groups. Duration of Coalition Differences: The final variable studied related to whether a coalition indicated it had been in existence prior to the current Wisconsin Tobacco Control Board funding or was newly developed as a result of the new tobacco funds. Of particular interest is the category of Coalition Development and Management. Results demonstrated no real differences between new and existing coalitions in this area. Both types of coalitions appeared to be focusing their activities on recruiting members, writing press releases, publicizing activities, and managing coalition activities. Both appeared to engage in few activities related to orienting members, developing by-laws or writing and distributing a newsletter. In the category of Eliminate Exposure to Secondhand Smoke, existing coalitions completed slightly more activities, with the greatest difference occurring in the area of writing, publishing and distributing a smoke-free dining guide 78% for existing and 26% for new coalitions. Activities in the Other Activities category were always completed more by existing than by new coalitions. Percent of coalition time spent in activities by category In addition to learning what activities coalitions are carrying out in their effort to impact the tobacco use and norms in their community, it is also important to understand the amount of coalition time spent on activities in each category. To obtain this information, coalition coordinators were asked to estimate the percent of time the coalition (including coordinator, volunteers, and members) spent on the activities they checked in each of the five survey categories. They were asked to make sure the total equaled 100% regardless of whether they were employed as full or part time staff. The results from this question appear in Table 7. Table 7. Percent of Coalition Time Spent on Activities by Category. ACTIVITIES % TIME SPENT ON ACTIVITIES RANGE AVERAGE Coalition Development and Management 0 80% 21% Eliminate Exposure to Secondhand Smoke 5% 70% 26% Reduce Youth Tobacco Use 0 60% 28% 9

13 Promote Quitting Among Youth and Adults 0 70% 21% Other Activities 0 25% 5% As demonstrated by the data, most coalitions reported spending a similar amount of time in each category of activity except for the Other Activities category. Of particular interest is the range of time spent by coalitions on activities in various categories. In all but the Eliminate Exposure to Secondhand Smoke Category, the range of time spent begins at zero. This indicates some coalitions currently are concentrating their efforts in some categories and not undertaking activities in others. Coalition Key Accomplishments and Major Challenges The final questions on the survey asked the coalition coordinator to briefly describe their key accomplishments and challenges during the past six months. Coalitions were not limited in the number of accomplishments or challenges they could list. This information provides insight into the areas in which coalitions are working and also provides topics for training and technical assistance. Tables 8 and 9 display the various categories developed from an analysis of the narrative comments, the count of coalitions mentioning an accomplishment or challenge in that category, category percent of all responses given and the percent of coalitions responding in each category. Table 8. Key Accomplishment of Coalitions - Categories and Distribution of Responses Across Categories. Category Count % of All Responses (273) % of Coalitions Responding (77) Youth/FACT activities Clean Indoor Air Cessation activities Community/coalition development Smoke-free restaurants Survey activities Media Promotional events Miscellaneous No response Coordination with other programs Totals % Table 8 demonstrates that all coalitions mentioned some aspect of their work with youth as a key accomplishment during the reporting period. The next most frequently mentioned accomplishments, clean indoor air activities and cessation activities, were referred to by slightly over half the coalitions. The information on challenges is especially helpful in understanding the areas in which coalitions require additional training or technical assistance. As can be seen in Table 9, coalition development issues were mentioned as a major challenge by 2/3 of the coalitions. The next most frequently mentioned challenge, money concerns, was mentioned by 1/3 of the coalitions. 10

14 Table 9. Major Challenges of Coalitions - Categories and Distribution of Responses Across Categories. Category Count % of All % of Coalitions Responding (71) Responses (173) Coalition development Money concerns Time issues, staffing Community issues Youth/FACT issues CIA/SHS related issues Paperwork issues Coordination with other programs School issues Media issues Changing priorities TA, regional support Special populations Totals % In addition to this listing of categories and distribution of coalition responses, Appendix C contains a summary of the categories for both accomplishments and challenges with specific examples provided by the coalitions. Discussion This report summarizes findings from the analysis of the first Community Coalitions Activity Survey (January-June, 2002). At this time, the Board had only funded coalitions for a year. This survey reflects early efforts to organize and develop coalitions and begin to execute local tobacco control strategies. This survey was conducted to obtain a better understanding of activities undertaken by coalitions. Since this survey will be administered twice annually, it is expected to serve as an indicator of where guidance to coalitions is needed in order to focus efforts on activities that will lead to desired tobacco control outcomes. Once guidance is given by the Wisconsin Tobacco Control Board (funder) and the Division of Public Health (contract manager and training and technical assistance provider), this survey will monitor resultant changes in coalition activity. This should result in measurable change in coalition activities in the desired direction over time. Much has been written nationally and in Wisconsin related to using best practice or evidence-based strategies for tobacco control. These strategies include cigarette tax increases and smoke-free ordinances for public places. Less is known regarding the effectiveness of specific activities. While it may be argued that almost any activity could be effective when it is part of an overall evidence-based strategy, coalitions should use experiences of other communities, both in Wisconsin and nationally, as well as the tobacco control literature, as a guide in determining what activities to undertake to reach Board goals. 11

15 Approaches to the prevention and control of tobacco use have evolved since the publication of the first Surgeon General s Report in A primarily educational and informational approach evolved to include interventions targeted at individuals and then interventions that focused on environmental and policy changes. At a statewide level, the Centers for Disease Control and Prevention recommend programs that are comprehensive and integrate informational, individual, environmental and policy strategies. 3 Many states, like Wisconsin, have included community coalitions as a key component of their comprehensive tobacco control programs. Coalitions, in turn, have had to assess the evidence base on what types of interventions are most suited to community coalitions, as well as what guidance exists as to effective community-level tobacco control strategies. On the first question, what kinds of interventions coalitions do best, while the literature is limited on this question, there is support for their strengths lying in environmental and policy change. 4 Regarding the second question, what community interventions have been most successful in preventing or controlling tobacco use, the Task Force on Community Preventive Services has provided a useful guide. 5 The Task Force recommendations clearly point communities in the direction of environmental and policy change approaches such as smoking bans. Even within more individually oriented interventions, such as strategies to increase cessation, they find stronger evidence for cessation approaches with broader reach such as health care system-level strategies as opposed to individual level cessation services. Thus, the evidence base provided by both the tobacco control and the coalition literature supports prioritization by local coalitions of strategies that aim to achieve environmental and policy change for the prevention and control of tobacco use. It is important to apply information from the evidence base to the local coalitions in order for them to most effectively focus their efforts. When discussing Board goals, the four clean indoor air related goals for restaurants, municipal government buildings, workplaces and homes can be considered intermediate term outcomes toward the long term outcomes of reduced youth and adult prevalence and reduced overall consumption. Other states, in their tobacco control programs, have engaged in a process to develop lists of key coalition practices. Participation in such an exercise provides coalitions and stakeholders with an opportunity to discuss the literature and arrive at a shared understanding of the importance of concentrating on the most effective strategies. The research group of the Monitoring and Evaluation Program began such a process in an attempt to prioritize the activities in this survey into a preliminary list of those considered most effective based on the literature and related experience. A paradigm of priority activities was developed by selecting activities that are targeted at broader environmental or policy change and that are most closely linked to Board goals. Table 10 contains a preliminary list of these suggested priority activities categorized by the section of the survey in which they appear. It is acknowledged this list is out of context and is not based on overall coalition plans or guidance to coalitions for the time period covered by the activity survey. Ideally, this process will continue with a broader set of participants and will include a well-developed multi-year action plan, evidence based objectives and relevant activities. 12

16 Table 10. Suggested Priority Activities Based on Environmental or Policy Change and Close Links to Board Goals*. A. Coalition Development and Management Activities Manage coalition activities, e.g., plan meetings and develop agendas. Write press releases on coalition activities and contact media. Recruit representatives of community organizations, agencies and institutions to become members of the coalition. Publicize coalition activities using free/earned media. Recruit individuals in the community who support tobacco control but are not affiliated with an agency or organization. Create and maintain a list of community supporters. Develop sub-committees or work groups. Develop a short-term community tobacco control strategy that includes a logic model or similar method of planning. Assess community needs and assets regarding tobacco control. Evaluate coalition development activities including coalition operations. Orient new coalition members to tobacco-related issues and tobacco control strategies through formal training sessions. B. Coalition Activities Related to Eliminating Exposure to Secondhand Smoke Educate employers about benefits of restrictions on smoking in the workplace. Conduct general community awareness campaign on secondhand smoke and reducing exposure using non-media strategies such as public speaking, meetings with officials. Educate public on the effects of secondhand smoke in restaurants through media advocacy practices such as creating media events, issuing studies or reports and press releases. Educate and mobilize local agencies for community campaign to eliminate exposure to secondhand smoke in homes and vehicles. Plan events to gain media attention to increase public awareness of effects of secondhand smoke in homes. Assess county and municipal policies and ordinances on smoking in public buildings. Educate city and county officials and policymakers about the effects of secondhand smoke in public buildings. Evaluate coalition secondhand smoke activities. Discuss approaches to reducing secondhand smoke exposure in restaurants with municipal officials and policymakers. Conduct campaign to implement policies prohibiting smoking in county and municipal buildings. Organize a broad community-wide committee in support of a municipal smoke-free restaurant ordinance. Develop a formal plan to conduct community-wide campaign in support of smoke-free restaurant ordinance. Participate in smoke free committee activity to conduct campaign to pass and implement an ordinance prohibiting smoking in restaurants. C. Coalition Activities Related to Reducing Youth Tobacco Use Conduct compliance checks to determine level of sales to minors. Educate retailers and/ or clerks about policies regarding tobacco sales. Educate law enforcement on retailer compliance. Evaluate coalition youth activities 13

17 Discuss implementation of CDC best practices guidelines with school district administration. Work with retailers and law enforcement to eliminate illegally placed vending machines. Enlist support of community and businesses to ask retailers to place tobacco behind the counter. Fine tobacco retailers who sell tobacco to youth. Advocate with City Council to increase license fees to sell tobacco. Develop and implement a campaign to pressure retailers to reduce or eliminate indoor and/or outdoor tobacco advertising. D. Coalition Activities to Promote Quitting Among Youth and Adults Promote knowledge of Quit Line in service agencies and organizations. Promote Quit Line and other cessation activities through the media. Implement public education campaign to increase awareness of Quit Line. E. Coalition Activities to Promote Other Activities Organize and conduct local activities in support of state legislative program such as increasing tobacco control funding. Organize and conduct Legislative Breakfasts or other periodic formal meetings with elected state officials. Organize and conduct local activities in support of state legislative program such as reducing youth access. Conduct local programs in support of state mass media counter-marketing campaign. *This is a preliminary list of suggested priorities based on a small group process within MEP. Further dialogue with a broader tobacco control constituency should be undertaken to refine this preliminary work. An examination of all activities in this survey resulted in the identification of significant coalition activity on (what was later determined to be) lower priority activities during the first half of For example, survey results indicated 64% of coalitions encouraged individual restaurants to voluntarily become smoke-free. Recent discussions on this strategy have taken place between staff from the Division of Public Health, the Monitoring and Evaluation Program and the Wisconsin Tobacco Control Board. The outcome was a decision to dissuade individual coalitions from working to encourage restaurants to voluntarily become smoke-free but rather to work with them to initiate smoke-free restaurant ordinances. Results from future activity surveys would therefore be expected to reflect this change in guidance to the coalitions. Another area where discussion may prove beneficial concerns local smoke-free dining guides. According to the survey, 57% of coalitions engaged in writing, publishing and distributing a smoke-free dining guide of local restaurants during the past six months. Since Wisconsin Initiative on Smoking and Health, Inc. (WISH) now publishes a statewide smoke-free dining guide, it may no longer be efficient for coalitions to duplicate this effort. If coalitions receive guidance to discontinue this activity at the local level, they would have more resources to spend on policy related activities. Cessation activities are another area where discussion would be helpful in providing role clarification to coalitions. The Quit Line has been funded by the Wisconsin Tobacco Control Board to provide cessation services to Wisconsin residents. Coalitions are involved in promoting the Quit Line in their communities. Survey results demonstrate 92% of coalitions place CTRI Quit Line materials in a variety of venues to reach the 14

18 target audience and 83% promote knowledge of the Quit Line in service agencies and organizations. Survey results also indicated 48% of coalitions provided cessation services for adults and 31% provided cessation services for youth during the first six months of These results may reflect coalition activities conducted using other funding sources. However, some coalitions have indicated they are unsure whether Tobacco Control Board funds may be used to conduct cessation activities, especially with youth. Clarifying this point may result in coalition resources, currently involved in direct provision of cessation services, becoming available for other activities. In the category of promoting quitting among youth and adults, 83% of coalitions indicate they participate in community health fairs. Participating in health fairs is a staff intensive activity that is best undertaken when clearly connected to a policy goal, such as building a list of community members supportive of a clean indoor air ordinance. Additionally, survey results demonstrated areas where low coalition activity might indicate the need for further examination. Items related to evaluation of coalition activities were included in four of the five categories on the survey. Coalition response to the evaluation items ranged from 27% for evaluation of cessation activities to 39% for evaluation of coalition development and management activities. Evaluation resources are available to all coalitions via their UW-Extension regional support staff person so it should be expected that coalitions would engage in appropriate evaluation activities to assess the effectiveness of their activities. Another area where low coalition activity, as demonstrated by responses on the activity survey, may be cause for concern is the area of clean indoor air policies. Several questions were included regarding priority activities related to the development of smoke-free restaurant and municipal government building ordinances. In most instances, very low levels of coalition activity were indicated. For example, 18% indicated they conduct surveys and tally data of the public s opinion on smoking policies in restaurants and support for clean indoor air policies, 18% conduct a campaign to implement policies prohibiting smoking in county and municipal buildings, 17% organize a broad community-wide committee in support of a municipal smoke-free restaurant ordinance, 13% develop a formal plan to conduct a community-wide campaign in support of smoke-free restaurant ordinance, and 13% participate in smoke-free committee activity to conduct a campaign to pass and implement an ordinance prohibiting smoking in restaurants. These activities relate to major Board goals regarding clean indoor air. In order to reach the 2005 outcomes set by the Board, these activities should be increasingly undertaken by more coalitions. Results from the activity survey demonstrated that 29% of coalitions work with law enforcement to fine youth that violate possession laws and 22% promote ordinances/policies to fine youth for possession of tobacco. While clear evidence does not exist that this approach is ineffective, several published articles review the issue and question the efficacy of criminalizing possession and levying fines against youth. 6,7 Since the activities related to youth tobacco possession fines are often time and resource intensive, it is important to discuss this issue and determine whether it is an activity that should be supported by Wisconsin Tobacco Control Board dollars. Additional discussion may prove beneficial regarding all items on this survey. While coalitions have been encouraged to develop local strategies and approaches to decrease 15

19 tobacco use in their community, some approaches may not be supported by research or field experience. Discussing these issues among staff from the Division of Public Health, including training and technical assistance staff, the Monitoring and Evaluation Program and the Wisconsin Tobacco Control Board, will inevitably lead to better and clearer guidance to the coalitions. Improved guidance should, in turn, lead to better tobacco control outcomes. Since funding is limited, coalitions should put their scarce resources only where they can be most effective. The Board recently (Fall 2002) emphasized clean indoor air efforts as a primary area for coalition activities. We anticipate increased activity in these areas based on this recent clarification of Board priorities. A final area for discussion and recommendation is the prioritization of the four clean indoor air related Board goals. Activity Survey results demonstrated that more coalitions were working on the voluntary smoke-free homes goal than on the restaurant, municipal government buildings or workplace goals. According to the 1999 Behavioral Risk Factor Surveillance System, 72% of Wisconsin residents reported that no one had smoked anywhere in their home in the past month. 8 While this statistic does not directly measure the Board goal, it provides a good approximation. Coalitions should prioritize making significant progress in their community on the other clean indoor air goals over putting significant energy into smoke-free homes. Limitations: Several limitations of this study should be mentioned. This survey was conducted after the first year of Board coalition funding. At that time, early 2002, coalitions were at various stages of development. Some had been in existence previously with other funding sources. Others had difficulty establishing their coalition and may have been focusing many of their efforts on development activities at the time of this survey. Since this was the first time this multi-year survey was conducted, some respondents may have been unclear regarding various questions. For example, a coalition may not think of an activity they performed in exactly the same terms as described on the survey and would therefore guess as to whether they should or should not check the activity. Also, some respondents may have been liberal in the activities they checked while another respondent may have been very conservative. That is why it is especially important not to focus on the results of one survey but rather to track results over time to assess change toward more priority activities related to clean indoor air Board goals. It should also be noted that the responses on the survey were one person s perspective and would not necessarily match the responses of another person knowledgeable about the coalition. Another limitation is that the question regarding progress toward Board goals may have been misinterpreted by some coalitions. Three coalitions indicated they completed the goal related to smoke-free municipal government buildings but only two of the three actually have all smoke-free municipal government buildings in their community according to the 2001 Tobacco Policies in Wisconsin Municipal Buildings report. In this area, and possibly other areas related to the progress question, coordinators may have responded relative to their Division of Public Health contracted objectives rather than the Board goals. To address this issue, wording was added to the July-December 2002 Activity Survey highlighting that the question does not relate to negotiated objectives. 16

20 It should also be mentioned that just because an activity is not checked, it does not mean that a coalition has not undertaken the activity. The directions for the survey asked respondents to check activities their coalition worked on during the previous six months. Coalitions may have completed a number of the listed activities prior to the time period covered by the survey. Therefore, it is sometimes more useful to examine groupings of activities, such as those related to restaurant ordinance work, to understand coalition efforts. Finally, the directions for the survey asked coordinators to check all activities the coalition worked on during the specified time period, including all activities, not just those paid for with Wisconsin Tobacco Control Board funding. Other funding sources may support activities other than those referred to in this report as priority activities. Conclusion: This analysis highlights areas of accomplishment as well as opportunities for improvement within the current system. Nearly all coalitions are working on clean indoor air. However, as can be seen from the frequency distribution of activities, many of these activities may not be considered priority activities based on the analysis provided in Table 10. Rather than focusing their efforts on environmental and policy change strategies, coalitions were working more on educational and informational interventions during this early time period. In order to ensure the tobacco control coalitions have the highest possibility of success, they must have clear direction regarding effective strategies to pursue. The strongest recommendation from this survey is that staff working with coalitions from the Division of Public Health, the Tobacco Control Board and the Monitoring and Evaluation Program discuss the issues raised and produce clear guidance to the coalitions regarding priority activities on which to work. With clear, consistent and specific guidance, coalitions can move toward focusing their activity on those interventions and activities most likely to lead to the desired Board outcomes. The Wisconsin Tobacco Control Board provided support for this report. Earnestine Willis, M.D., M.P.H., Chair, David Gundersen, M.P.H., Executive Director Suggested citation: Hill B, Moberg DP, Ahrens D, Ceraso M. Community Coalitions Activity Survey (January-June 2002), Monitoring and Evaluation Program Technical Report, Madison WI: UW Medical School, March,