Evaluating the Impact of Statewide Anti-Tobacco Campaigns: The Massachusetts andCalifornia Tobacco Control Programs

Despite more than 30 years of public health programs to reduce tobacco use, smoking is still the leading preventable cause of death in the United States. In response to this continuing epidemic, voters in California (1988), Massachusetts (1992), Arizona (1994), and Oregon (1996) approved ballot initiatives that established statewide tobacco control programs funded by cigarette excise tax revenues. Evaluating these innovative public health interventions is important, both to improve existing programs and to guide other states in developing and implementing similar interventions. In this paper we describe the methods being used to evaluate the statewide anti-tobacco campaigns in California and Massachusetts, and review the findings of process and outcome evaluations of both programs.
Our review suggests that both programs have had a substantial impact on the public's health by reducing cigarette consumption and stimulating the development of policies to reduce environmental tobacco smoke exposure. However, it does not appear that either program has reduced smoking initiation among adolescents. Our evaluation suggests three problems in program implementation that future anti-tobacco campaigns must avoid in order to produce long-term, sustained effects: (1) the gradual erosion of program funding by the state legislatures and governors; (2) the lack of a consistent, supportive constituency within state government; and (3) inconsistency in campaign themes, messages, and programs. We conclude by offering recommendations to correct these problems so that statewide cigarette-tax-funded anti-tobacco campaigns can realize their potential to become one of the most effective public health interventions available.     

Facilitating visitation for infants with prenatal substance exposure

Permanency planning for infants with prenatal substance exposure is challenging due to characteristics of the infants and the ongoing substance use or relapse of the parents. Visitation is a primary mechanism through which child welfare workers determine and support permanency planning. Productive use of visitation for permanency planning for infants with prenatal substance exposure is described, along with strategies for skillfully focusing visits on issues and needs relevant to this population.     

Joint modeling of multivariate hearing thresholds measured longitudinally at multiple frequencies

Pure-tone thresholds are used to estimate hearing acuity and, when measured longitudinally, can characterize age-related changes in hearing. Measured at multiple-frequencies, multiple-irregular time points, for right and left ears, these longitudinal studies of age-related hearing loss produce data of inherent complexity due to: 1) multivariate outcomes at different frequencies; 2) longitudinal measurements taken at subject-specific time intervals; and 3) inter-ear correlations due to clustering and nesting. To address limitations in existing methods, we propose a multivariate generalized linear mixed model (mGLMM) and assess its performance. We demonstrate its application using a unique dataset from a cohort study of age-related hearing loss.     

Does Telephone Audio Computer-Assisted Self-Interviewing Improve the Accuracy of Prevalence Estimates of Youth Smoking? Evidence from the UMass Tobacco Study

Despite their advantage for obtaining representative samplesof adolescents, telephone surveys have been regarded as an inferiormethod for collecting data on youth tobacco use because theyyield lower estimates than school-based, self-administered surveys.Although no gold standard for smoking estimates exists, thelower estimates in telephone surveys have been attributed tounderreporting due to youths’ concern that parents orothers may overhear their responses. Telephone audio computer-assistedself-interviewing (T-ACASI) is a cost-effective method for obtaininga representative sample of youths and provides increased privacyfor the respondent. We hypothesize that using T-ACASI wouldencourage youths to report more fully smoking behavior comparedto traditional interviewer-administered telephone methods. Ouranalysis further assesses whether respondent age, gender, race/ethnicity,and parental attitude toward smoking moderated the relationshipbetween survey mode and smoking reports. Using data from a statewidetobacco use survey that randomly assigned youth respondentsto either T-ACASI or interviewer-administered modes, we findthat youths were more likely to report smoking behaviors inT-ACASI mode and that this was especially true for girls, particularlythose who believed their parents would disapprove strongly oftheir smoking. The findings suggest that traditional telephonesurveys may underestimate smoking prevalence in most girls bya factor of two, and that a technique for ensuring privacy forthese respondents is an important component of effective telephonesurvey methodology.