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Introduction to Program Evaluation for Comprehensive Tobacco Control Programs



Executive Summary

This document is a "how to" guide for planning and implementing evaluation activities. The manual reflects the priorities of the Centers for Disease Control and Prevention (CDC), Office on Smoking and Health (OSH), for program monitoring and evaluation. The purpose of this manual is to assist state tobacco control program managers and staff in the planning, design, implementation, and use of practical and increasingly comprehensive evaluations of tobacco control efforts. The strategy presented in this manual will aid those responsible for evaluation activities to demonstrate accountability to diverse stakeholders. In this case, accountability includes assessing and documenting the effectiveness of programs, measuring program outcomes, documenting implementation and cost effectiveness, and increasing the impact of programs.

Why evaluate programs to prevent and control tobacco use?

Tobacco use is the leading preventable cause of death and disease in the United States, contributing to more than 430,000 deaths annually.1 Tobacco control programs are designed ultimately to help reduce disease, disability, and death related to tobacco use. To determine the effectiveness of these programs, one must document and measure both their implementation and their effect. Program evaluation is a tool used to assess the implementation and outcomes of a program, to increase a program's efficiency and impact over time, and to demonstrate accountability.

Program implementation

The task of evaluation encourages us to examine the operations of a program, including which activities take place, who conducts the activities, and who is reached as a result. In addition, evaluation will show how well the program adheres to implementation protocols. Through program evaluation we can determine whether activities are implemented as planned and identify program strengths, weaknesses, and areas for improvement. For example, a smoking cessation program may be very effective for those who complete it, but it may not be attended by many people. Evaluation activities may determine that the location of the program or prospective participants' lack of transportation is an attendance barrier. As a result, program managers can try to increase attendance by moving the class location or meeting times, or by providing free public transportation.

Program effectiveness

The CDC has identified four goals that tobacco control programs should work within to reduce tobacco-related morbidity and mortality:

  • Preventing the initiation of tobacco use among young people.
  • Promoting quitting among young people and adults.
  • Eliminating nonsmokers' exposure to environmental tobacco smoke (ETS).
  • Identifying and eliminating the disparities related to tobacco use and its effects among different population groups.

Comprehensive tobacco control programs use multiple strategies to address these goals. Typically, strategies are grouped into three program components: community mobilization, policy and regulatory action, and the strategic use of media. Program evaluation includes documenting the effectiveness of these strategies in meeting program goals.

Program accountability

Program evaluation is a tool with which to demonstrate accountability to program stakeholders (including state and local officials, policymakers, and community leaders) by showing them that a program really does contribute to reduced tobacco use and less exposure to ETS. Evaluation findings can thus be used to show that money is being spent appropriately and effectively and that further funding, increased support, and policy change might lead to even more improved health outcomes. Evaluation helps ensure that only effective approaches are maintained and that resources are not wasted on ineffective programs.

This manual is based on the CDC's Framework for Program Evaluation in Public Health Practice3 and is aligned with the Healthy People 2010 4 objectives for the nation, Best Practices for Comprehensive Tobacco Control Programs,2 and other relevant guidelines. This manual is an adaptation of the CDC evaluation framework and is specific to tobacco control and prevention. It is organized into the following six steps:

  • Engage stakeholders.
  • Describe the program.
  • Focus the evaluation and design.
  • Gather credible evidence.
  • Justify conclusions.
  • Ensure use of evaluation findings, and share lessons learned.

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This page last reviewed September 08, 2003

United States Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Office on Smoking and Health